The Purchaser and Consumer Push for Transparency

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The Purchaser and Consumer Push for Transparency

• Presented at the Harvard Quality Colloquium
• August 22, 2005
• Melinda Karp
• Director of Programs, MHQP
• and
• Independent Consultant

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Objectives for Todays Session

• Provide an overview of the national landscape
  from purchaser and consumer perspectives
• Describe the consumer and purchaser push for
  transparency through the Consumer Purchaser
  Disclosure Project
• Introduce the Measures to Market Project

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Waste BeyondComprehension

• 30 of resources wasted due to overuse, under use
  and misuse
• 500 - 600 billion per year in 2001 dollars
• 1,700 to 2,000 per employee per year in 2001
  dollars
• Source Midwest Business Group on Health

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Injury to Insult

• 44,000-98,000 plus deaths from errors during
  hospitalizations
• 7,000 deaths from medication errors alone
• 17-29 billion in added costs
• Ambulatory care unknown
• Source Institute of Medicine

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Cadillac Prices,Yugo Quality

• Condition Receiving
  Recommended
• Care
• Breast cancer 76
• Heart attack coronary artery disease 68
• Immunizations 66
• High blood pressure 65
• Osteoarthritis 57
• Asthma 53
• Diabetes 45
• Urinary tract infection 41
• Sexually transmitted diseases 37
• McGlynn, et. al, New England Journal of
  Medicine, 2003

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Quality Measurement and Reporting 1995

• Limited public demand
• Few standardized quality measures
• Few organizations
• Few providers aware
• Public disclosure rare
• Few patients aware

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• Purchasers and regulators should create precise
  streams of accountability and measurement,
  reflecting safety, effectiveness,
  patient-centeredness, timeliness, efficiency, and
  equity.
• Crossing the Quality Chasm, IOM 2001

8
Leading Edge Effortsto Promote Transparency

• Leapfrog
• CMS
• Bridges to Excellence
• NCQA
• JCAHO
• Web-based proprietary vendors
• Benefit consultants
• NQF

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Not Just Leapfrog Anymore Everyones Getting
into the Act

• Is it the cavalry
• Or a stampede?

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The UnintendedTower of Babel
Defining Measures Data Gathering Reporting Results
Consultants X X X
Plans X X X
Collaboratives X X X
NQF X
NCQA X X X
JCAHO X X X
Spec. Groups X
AHRQ X
CMS/QIOs X X X
States X X X
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Persistent Problems

• Limited scope/applicability of standardized
  measures
• Trade-offs in measure importance and accuracy vs.
  burden and cost of measurement
• Limited coordination of measurement and reporting
  efforts by payers--dueling report cards
• Continued use of non-standardized and proprietary
  measures
• Sustainability of business models for performance
  measurement and reporting

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Consequences

• Public skepticism about performance results
• Limited impact of consumerism
• Sub-optimal motivation for QI
• Limited competition on quality
• Provider uncertainty about actions to improve
  quality
• Hesitancy to make financial investments in QI

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A Fine Mess Weve Got Ourselves Into

• Purchasers Not Buying Right
• Plans Not Letting Provider Value Show
  Through
• Providers Not Seeing Business Case for
  Reengineering
• Patients Not In the Quality Game
• Improved Transparency and Pay for Performance
• The Foundation for Reform

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Failure to Cross the Quality Chasm
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The Road Forward in 2005
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Benefit Design Trends Demand Vastly Improved
Transparency

• 8 in 10 employers somewhat or extremely
  comfortable having employees take more
  responsibility in selecting
• Plans 81
• Coverage levels 81
• Providers 81
• Services/treatments 83
• Source Hewitt Associates Health Care
  Highlights, Feb. 2003

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Paradigm for Chasm Crossing
Provider Performance Measures
Dramatic Improvement
Engaged Consumers Pay for Performance
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National Standards Essential

• Comparability across markets
• Credibility
• Reporting burden
• Economies of scale and leverage

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• RWJF and The Leapfrog Group Project Sponsors
• Participating Organizations
• 3M March of Dimes
• AARP Midwest Business Group on Health
• AFL-CIO Motorola
• American Benefits Council National Association
  of Manufacturers
• Buyers Health Care Action Group National Black
  Womens Health Project
• Carlson Companies National Business Coalition on
  Health
• California Healthcare Foundation National
  Citizens Coalition for Nursing Home Reform
  National Partnership for Women and Families
• Consumer Coalition for Quality Health National
  Business Group on Health
• Employee Benefits Research Institute National
  Breast Cancer Coalition
• Employer Health Care Alliance Coop. Niagara
  Health Care Quality Coalition
• ERISA Industry Committee Pacific Business Group
  on Health
• Ford Motor Company The Robert Wood Johnson
  Foundation
• General Motors State Medicaid Directors
  Association
• The Leapfrog Group Union Pacific Railroad
• National Coalition for Cancer Survivorship U.S.
  Chamber of Commerce

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• By January 1, 2007, Americans will be able to
  select hospitals, physicians, physician
  groups/delivery systems and treatments based on
  public reporting of nationally standardized
  measures for clinical quality, consumer
  experience, equity and efficiency.

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• C-PDP Priorities
• Support measure development
• Encourage endorsement of national standards
• Encourage implementation of national standards
• Build support for the Disclosure Goal

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• Primary drivers of improvements to
• the health care system
• Consumers using valid performance information to
  choose providers and treatment
• Purchasers building performance expectations into
  their contracts and benefit designs
• Providers acting on their desire to improve,
  supported by better information

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Architecture of Full Dashboard
Hospitals Physicians Integrated Delivery Systems Treatment Options
Clinical Quality (Safe, Timely, Effective)
Efficiency
Patient Experience
Equity
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For More Information

• Web www.healthcaredisclosure.org
• Katherine Browne
• Managing Director
• Email kbrowne_at_nationalpartnership.org
• [phone]
• Steve Wetzell
• Strategic Director
• Email swetzell_at_msn.com
• [phone]

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Measures to Market Project Funded by the Robert
Wood Johnson Foundation
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What is Measures to Market?

• A deliberative response to an environment where
• there are numerous, competing and duplicative
  efforts to measure and report on the performance
  of ambulatory health care providers
• there are few, if any, existing business models
  for sustaining the necessary activities to do so
  and
• the interests of the consumer/patient are often
  secondary to those of other stakeholders
• A collaborative effort to identify desirable and
  sustainable business models for supporting the
  activities involved in bringing ambulatory care
  performance measures to market and keeping them
  up-to-date

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Who is conducting the M2M Project?

• Sponsoring Organization Consumer-Purchaser
  Disclosure Project
• Why The Disclosure Project impartially
  represents critical end-users
• and
• does not specifically represent either those
  being measured or those operating measurement
  systems
• (They have no horse in the race)

• Funding provided by Robert Wood Johnson
  Foundation
• Research Team for Development Evaluation of
  Business Models
• Kathryn Coltin, MPH, Lead
• Melinda Karp, MBA
• Eric Schneider, MD, M.Sc.
• Christy Bethell, PhD, MPH, MBA
• Stan Hochberg, MD

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M2M Goals and Objectives

• Goal
• Identify viable business model(s) for sustaining
  credible performance measurement and reporting
• Objective 1
• By the end of May 2005, define key
  characteristics of an ideal business model for
  bringing ambulatory care measures to market
• Objective 2
• By the end of December 2005, identify potentially
  viable business model(s) that fit most evaluative
  criteria
• Objective 3
• By the end of March 2006, make recommendations
  regarding one or two viable business models that
  best fit evaluative criteria and have broad
  stakeholder support

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Overview of the M2M Process
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M2M Process Implementing Objectives Phase 1
October 2004 May 2005

• Define key characteristics of an ideal business
  model for bringing ambulatory care measures to
  market
• Based on broad stakeholder input and key
  informant interviews
• Identify and validate the continuum of activities
  required to publicly report ambulatory care
  performance measures
• Develop consensus around the characteristics of a
  sustainable public good business model for
  bringing measures to market and desired impacts
  of such a model
• Develop, validate and weight criteria for
  evaluating alternative business models for
  accomplishing each activity--either on its own or
  in combination with other related activities
• Identify leading industry practices and
  alternative methods or approaches for
  accomplishing each activity

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M2M Process Implementing Objectives Phase 2
June 2005 December 2005

• Identify business model(s) that best fit
  evaluative criteria
• Identify and/or develop business models to
  support each of the activities necessary to bring
  measures to market
• Assess existing potential models against
  evaluative criteria
• Identify potential positive and negative impacts
  of various implementation models
• Recommend options for implementing viable and
  sustainable business models based on evaluative
  criteria, practical considerations and desired
  impacts

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M2M Process Implementing Objectives Phase 3
January 2006 March 2006

• Solicit broad stakeholder views on potentially
  viable, sustainable and acceptable business
  models for bringing measures to market
• Distribute draft report to stakeholders for
  review
• Conduct follow-up Webcast with stakeholders
• Present results of evaluations
• Review draft recommendations
• Solicit stakeholder feedback
• Summarize stakeholder views and make
  recommendations to Consumer-Purchaser
  Disclosure
• Consumer-Purchaser Disclosure issues final
  recommendations