Measuring and Improving the Quality of Workers Compensation Medical Care Lessons from the Workers Co

1
Measuring and Improving the Quality of Workers
Compensation Medical Care Lessons from the
Workers Compensation Health Initiative

• Jay S. Himmelstein, M.D. - Director
• Allard E. Dembe, Sc.D. and Sharon E. Fox, Ph.D. -
  Co-Deputy Directors
• Anne Pratt Research Coordinator
• Ann Clayton Program Consultant
• University of Massachusetts Medical School
• Center for Health Policy and Research
• http//www.umassmed.edu/workerscomp

2
Todays Outline

• RWJF WCHI Overview
• Accomplishments
• Selected Examples
• The WCHI Legacy

3
Overview of the WCHI

• National program of the Robert Wood Johnson
  Foundation launched in 1995
• Six-year, 6 million initiative
• 21 grants awarded in 9 states and D.C.
• Demonstration and evaluation projects
• Innovations in the delivery and financing of care
• Helped build interest in enhancing access,
  containing costs and improving quality

4
Background and Context

• 80s -90s cost crisis ? catalyst for reform
• Introduction of managed care and rapid adoption
  of cost containment tools by states
• Interest in understanding impact on cost savings
• Increasing concern about accessibility and
  quality of care
• Proposed integration of WC and Auto related
  health care by Clinton Health Security Act

5
Increase in the Implementation of Medical Cost
Containment
6
Broad Focus of Projects

• Establishment of standards for measurement of the
  quality of WC medical care
• Dissemination and evaluation of guidelines for
  treatment of injuries frequently suffered by
  workers
• Tools to measure satisfaction and outcomes of
  care
• Implementation and evaluation of integrated case
  and disability management programs
• Tools to speed communication and enhance return
  to work more quickly and safely
• Improving access to data and information to
  assist in research and policy arenas

7
WCHI Accomplishments

• Created a National Focus on Quality of WC Medical
  Care
• Defined Quality and Established Standards for
  Measurement
• Disseminated and Evaluated Treatment Guidelines
• Developed Tools to Measure Satisfaction and
  Outcomes of Care
• Developed Tools and Methods to Speed
  Communication
• Encouraged and Evaluated the Implementation of
  Integrated/Coordinated Benefit Programs
• Supported Efforts to Collect and Disseminate
  Needed Information

8
Highlights from Specific Projects

• URACs Performance Measures for Managed Care
  Organizations
• Evaluating the Minnesota Treatment Parameters
• Mid-America Coalition for Healths Uniform
  Workability Form and Employer Benchmarks
• Minnesota Health Partnerships Integrated Health
  Care Model

9
URAC Development of a Performance Measurement
Set for MCOs

• GOAL
• Develop standardized set of performance measures
  for MCOs
• Monitor and compare clinical quality and increase
  accountability for quality of care
• METHODS
• Broad set of consensus measures and data
  collection strategies
• Appropriateness of care, access to care,
  satisfaction, utilization, costs, coordination,
  return to work, communication, and prevention
• Surveys of injured workers, medical record
  review, administrative data analysis

10
URAC Development of a Performance Measurement
Set for MCOs

• KEY FINDINGS AND IMPLICATIONS
• First publically available standardized protocol
  for the collection and reporting of quality
  performance measures
• Tools sufficiently tested for internal quality
  improvement more testing needed for comparisons
• Challenges Limitations of WC and MCO data
  systems and current lack of MCO incentives to
  report information

11
Mid-America Coalition on Health Care

• Development of Uniform Workability Form
• Communication from health care provider to
  employee and employer on physical status
• Gathering of information for Employer Benchmarking

12
Evaluation of the Minnesota Treatment Guidelines

• 70.8 of workers studied were provided complient
  treatment
• Less time away from work
• Similar outcomes on
• Pain relief
• Physical functioning
• Satisfaction with care
• Source Stratis Health Care

13
Minnesota Health Partnership

• GOAL
• Improve health care delivery and outcomes for
  patients by integrating treatment of occupational
  and non-occupational injuries
• METHODS
• Emphasis on coordinated health and disability
  prevention
• Proactive activity advice for health condition
• Written communication tool (activity plan)
• Similar management by employer of occupational
  and non-occupational conditions
• Evaluate impact on clinical outcomes, cost,
  patient, provider, and employer perceptions, and
  organizational analysis

14
Minnesota Health Partnership

• KEY FINDINGS AND IMPLICATIONS
• Joint effects of disability prevention and a
  strong patient-provider relationship associated
  with decreased restricted activity days enhanced
  satisfaction with primary care doctor
• Primary care providers with strong
  patient-provider relationships can add disability
  prevention to their practices

15
WCHI Important Lessons Learned

• Disability outcomes can be improved by
  integrating disability management approaches with
  high quality medical care
• Quality measurement of medical care and
  disability management is in its infancy
• The quality of medical care can be defined,
  measured and improved if stakeholders recognize
  value and make necessary investments
• Future progress will depend on access to detailed
  medical and other data, including information
  from injured workers

16
Vision for the future Workers Compensation and
Integrated Disability Management

• Applying lessons learned from WC to
  non-occupational disabilities
• Focusing on quality and measuring patient
  outcomes
• Providing tools and training on how to use them
• Building a business case for future investment in
  quality medical care

17
How Will It Happen

• Targeting Change Strategies
• Working with state WC agencies to help them
  measure quality health care
• Developing tool boxes and training for programs
  currently involved in WC training
• Fostering the development of an enduring research
  infrastructure for the study of WC medical care

18
For More Information on the Robert Wood Johnson
Workers Compensation Health Initiative (WCHI)

• http//www.umassmed.edu/workerscomp