Indiana SRD Community-wide Quality Reporting (Text Version)

On September 16, 2009, Marc Overhage made this presentation at the 2009 Annual Conference. Select to access the PowerPoint® presentation (24 MB) (Plugin Software Help).

Slide 1

Indiana SRD Community-wide Quality Reporting

September 16, 2009

Slide 2

Operational Challenges*

• Data Credibility - inherent weaknesses in claims/admin data
• Inadequate sample size
• Competing Plans use different measures - or operationalize differently
• Proprietary measures are used - physician distrust
• Performance payments among carriers are not aligned
• Actionable - most Plans fail to provide information in a clear and actionable manner

* Physician Performance Measurement, Debra Draper, June 2009 Commentary, Center for Studying Health System Change.

Slide 3

Legal and Legislative Activity*

• Measures with national standing - NQF, AQA...
• Transparent program design - to providers and consumers
• Meaningful provider input into measures and methods
• Provider ability to correct or appeal erroneous information
• Independent verification of results

see: Tiered Physician Network: A New Twist on an Old Issue, American Health Lawyers Association briefing, May 2008, Christine C. Rinn, Esquire

Slide 4

Quality health First®

Slide 5

Overview

A disease management, preventive care and reporting service. Provides disease management reports, clinical alerts and reminders, along with population-based reports to providers and participating health plans.

• It enables better clinical decisions by combining clinical data, medical and drug claims and point-of-care data to monitor patients' health and wellness.
• Employers Forum of Indiana instrumental in program design.
• $10,000 - $20,000 physician incentive.
• Involves spectrum of healthcare industry.

Slide 6

The Plan

Leverage the strength of a partnership of payers, providers and health information technology to:

• Merge community wide data on provided care and outcomes
  • Health claims
  • Physician Office point of care data
  • Hospital data
  • Outpatient data (e.g. labs, xrays, drugs)
• Identify BEST care outcomes
• Give providers the opportunity to reconcile report data
• Reward providers who demonstrate either best care or improved trends towards best care

Slide 7

Background

• Indianapolis MSA
  • 1.7M population
  • 3,000 active physicians
  • 1,500 primary care physicians

Slide 8

The data architecture for the Quality Health First program builds on the Indiana Network for Patient Care or INPC.

Slide 9

Medical Group Summary Reports

Slide 10

Patient Reconciliation Report

Slide 11

Total Unique Patients

• Total Unique Patients: 1,071,442
• Total Unique Patients with Exclusions: 73,354
• Total Unique Patients by Denominator:

Slide 12

QHF Overall early results

Image: A radar graph of measure results early in the program demonstrates the variability between provider groups, that the results are generally comparable to the California based IHA program and the results for McGlynn's nationwide study.

Slide 13

Map of Indiana showing INPC database

In order to estimate how well the INPC and Quality Health First "cover" different regions of the state of Indiana we computed the ratio of patients in the INPC database whose last address was within a given census tract with the census results for population in that tract to form a ratio. We found, as expected that coverage across the central half of the state was much higher with essentially all patients represented. In the northwest, northeast and southwest portions of the state pentration was generally in the range of 50-75% and only in a few census tracts is pentration less than 50%. Since these data were analyzed the southwest and northwest portions of the state have or are about to go live so pentration will increase dramatically;