Measuring and Reporting Performance Data Through Health IT

1

• Measuring and Reporting Performance Data Through
  Health IT
• AHRQ Annual Meeting
• Wednesday September 26, 2007
• A. John Blair, III, MD
• President, Taconic IPA

2
Evolution

• Process incentives/Claims data
• Structure incentives
• IT adoption and usage
• NCQA/POL
• Outcomes incentives/Clinical data

3
Process Incentives/Claims Data
Physician Feedback and Communication Efforts
Transparency
Multi-Payer P-4-P Project
Report Development
Single Payer P-4-P Project
2000
2004
2008
2006
2010
2002
4
Physician Reports
5
Single Payer P-4-P
6
Transparency
7
Multi-Payer Reports
8
Multi-Payer Reports
9
Physician Feedback Communication

• Medical Council
• PCP
• Specialty
• Clinical leadership
• Strong quality focus
• Initial report feedback
• Individual
• Group
• Monthly Newsletter
• Physician comment period prior to incentive
  payments

10
Structure Incentives
Physician Feedback and Communication
THINC RHIO, Quality Committee
EHR
NCQA/PPC
eRx
Community Viewer
Clinical Messaging
2000
2004
2008
2006
2010
2002
11
NCQA Physician Practice Connections

• Access / Communication
• Patient tracking / Registries
• Care management
• Self management support
• Electronic prescribing
• Test tracking
• Referral tracking
• Performance reporting improvement
• Interoperability

12
THINC RHIO, Quality Committee

• Activities
• Determine performance measures
• Promote standards
• HIE
• Measure metrics
• Coordinate payment incentives
• Committee composition
• Physicians
• Hospitals
• Health plans
• Quality measures experts

13
Claims vs. Clinical Reporting

• Uninsured not captured
• Services delivered, not health outcomes
• Non-reimbursable services not captured
• Inaccuracy due to income maximization
• Difficult to risk adjust (severity, stage)
• Lack of continuity with one health plan
• Fragmented health care market (and claims)
• Provider resistance

14
Advantages of EHR-Based Measurement

• Better data than claims-based
• More detailed clinical data (e.g. BP)
• More scalable than chart-reviews
• Faster, cheaper
• Greater sample size allows better provider
  comparisons
• Greater precision for encounter-level analyses
• Paradigm shift
• CDSS ? Registry ? Measure

15
Challenges of EHR-Based Measurement

• Structured data elements may not exist in EHR
• Data elements not standardized (e.g. lab codes)
• Outside data not available (e.g.
  hospitalizations)

16
Decision Support Tools

• Focus on THINC RHIO measures
• Passive active alerts and reminders
• Wary of alert fatigue
• Minimal set
• Actionable
• Consonant with workflows, not disruptive
• Not just alerts
• Order sets
• Templates
• Clinical knowledge
• Data presentation
• Process reengineering

17
Not Just Alerts

• Practice workflow reorganization
• Structured data collection
• Registries and panel management
• Alternative visit types
• Team-based care
• Case management
• Patient education and self-management

18
Questions?
19
Thanks for your time!

• A. John Blair, III, MD
• President, Taconic IPA