Using Measurement Data to Improve Quality: Transcript of Web Conference (continued)

Cindy DiBiasi: Michael?

Dr. Michael Belman: We think that the feedback, closing the loop, is important. In other words, the survey is out there. There are questions on courtesy and items such as that. Publishing the data but also linking it then to financial incentives, which go to the group and as we said, we had in Blue Cross of California, we had an additional component to our incentive where those results are fed back to the individual physicians so that the individual physician by his actions can see that by beating the expectations of his or her patient, they can in fact improve their own financial rewards or their own satisfaction with the practice. So we think it is important to have that loop closed and that way we think that there is a way of bringing this down to the real (unclear).

Male: (Unclear) relates to the way we present the data back to the plans. Right now we don't give it back with much identifying information at all. We give it to them at an aggregate level. They can compare their performance to their regional peers and to the statewide averages, but they don't know, for example, if I am a plan serving New York City and I fall below the average for the city and a certain measure, they don't know if that is a problem that is being driven by one borough, four boroughs, five boroughs and so I think we are going to reexamine how we present the data back to the plans this year and try to get them a little more detail so they can do what you are talking about.

Dr. Michael Belman: As I mentioned, when we had the, we have noticed several medical groups introduce the Open Access Programs within medical groups and we think that is largely a result of these incentives and the fact that it appeared to improve patient access and reduce waiting times that improve satisfaction.

Cindy DiBiasi: How did Blue Cross of California get interested in payment for performance?

Dr. Michael Belman: I think the it was originally was the medical groups where we started this probably in the mid-90's when capitation was pretty much the rampant method of payment for medical groups. It was felt that in addition to paying for medical services, that adding payment for qualities such as performance on the HEDIS® measures and member satisfaction as well as administrative measures was an additional way to ensure that these areas would not be neglected and so that was I think the early beginning.

Cindy DiBiasi: Bruce, a different type of incentive. You talked about hospital CEO compensation levels tied to measures in western New York. How did that spark?

Bruce Boissonnault: The truth is, in western New York, our hospital CEOs had the same trepidation that I think all hospital CEOs would have, but we began publicly reporting back in '98, '99. So when they actually started to see the measures come up, not only because of measurement but because of collaborative quality improvement projects, they started wanting to get credit for it. So I don't think it was a hard push. I did mention earlier thought that it makes for a more interesting hospital board meeting when the local newspaper publishes specific information that the board members then bring to the board meetings for discussion. I think that also is helpful.

Cindy DiBiasi: Is there any sharing of information? You said it is just starting among hospitals, but is there any avenue that is set up to do that?

Bruce Boissonnault: Actually in our region, again I think our hospital leaders I think are, I think everybody loves their hospitals. I love my hospitals maybe more. Our hospitals have been meeting monthly. The senior quality people, chief medical officer, head of nursing, senior quality officials from all of our participating western New York hospitals have been meeting monthly around this same uniform measures. That is why in our region we have seen some statistically significant improvement.

Cindy DiBiasi: Joe, do you provide plans any assistance in their efforts to improve? Do you give them opportunities to share best practices?

Joseph Anarella: Yes we do. It is an area where sometimes we go begging, but occasionally we have plans who are performing at high levels and they are willing to step up and talk to their colleagues who are working very closely with the plans this year promoting collaboratives, regional collaboratives where they can address areas of mutual concern. We hope to do something related to asthma and partner with the Center for Healthcare Strategies later on this summer using that approach.

Cindy DiBiasi: So if you had to pick one key element to get providers and plans to pay attention to change the practices in response to your reports, you mentioned publishing the data. Is that it? What is the...

Joseph Anarella: The message for people on this call is the time is now. Don't wait to give consumers the information that they need. But to the provider community, I think they are going to know what I am about to say. It is not a big deal when you publish these measures, as long as you don't get defensive about them and you say you have got a plan in place. The sky doesn't fall.

Cindy DiBiasi: Vi, let's talk about how you get committee members and hospitals involved in all this.

Vi Naylor: Well, I guess I am a little prejudiced with the Georgia hospitals, but they have been...

Cindy DiBiasi: That is good that you are all in love with your own hospitals. (Laughs.)

Vi Naylor: They really are early adopters and have served as a laboratory, if you will, for a number of new activities with a lot of different national areas. So when we started the partnership for health and accountability, I mean they were right there with us and as we go out and meet with hospital members we pick up what their interests are and just ask them to serve and they do. We recognize though that their time is very limited. We use audio conferencing for meetings as much as we possibly can and again the staff has to do the staff work.

Cindy DiBiasi: Who do you approach at the hospitals? Is there a key level that you are able to..?

Vi Naylor: We have identified contacts in each one of our hospitals for the partnership and if we need someone as a health outreach contact, we contact our primary contact and say, "Please get this information to the right individual." That really does help. We generally "cc" the CEO on anything so that he is kept apprised of what is going on, but we have one person that the CEO has identified as the contact for the partnership.

Cindy DiBiasi: Before we close, I would like to go around and get some final thoughts from all of you because it seems like you have had very successful outcomes. A lot of hard work, but very successful outcomes. Just to wrap up today, let's start Michael with you.

Dr. Michael Belman: I think one of the messages that has been delivered is the fact that member satisfaction, which some years ago might have been thought of as a very subjective measure, not really measurable, has been turned into something quite the opposite. The fact that it is objective and can be measured, is somewhat reproducible, and it can accurately reflect the member perception of the physician, the medical group or the health plan so that I think we are going to see increasing use of these kinds of tools and increasing acceptability in the provider community.

Cindy DiBiasi: Bruce?

Bruce Boissonnault: I guess I have two things I wanted to say. The first is I think people think of AHRQ as this huge group of thousands of people; it is a very lean, mean organization and yet folks from the hospital association, from the Department of Health, from business, from health plans are all using measures because they are uniform and I for one and my employers are grateful to AHRQ for stepping up and making the measures public and uniform.

The second thing that I guess I want to say is there is a whole lot of states that are sitting on administrative databases and letting them lie fallow. There is a big difference between data and information. I really think there is value in having states turn their administrative databases into information rather than letting them lay fallow and this tool allows them to do that. The important thing is many states who haven't figured out how to use the data as information are in fact stopping the collection of these data or turning them over to third parties where they may not have as much control over their access to the data. That is a real I think, you are sort of giving away the cards at precisely the wrong moment. So there is a real opportunity here for states.

Cindy DiBiasi: Joe?

Joseph Anarella: I think a number of points have been made, but I will reiterate the one that hasn't been made is multifaceted. Don't rely on a single tool or a single method but rather as a number of us talked about here, there are a number of things out there to use. You may be inclined to invent some measurement tools on your own.

Cindy DiBiasi: If they do they should call you and share them, right?

Joseph Anarella: Yes, sharing is another key point. There is so much going on in the area of quality measurement and publishing of performance information now that I think you can go to any other state or public health agency and learn a lot so it is important to poke around and explore before you embark on anything where you think you have to start from scratch. You may not have to.

Cindy DiBiasi: Great. Vi?

Vi Naylor: Well, the first thing I want to say is I can't wait to get Mike to Georgia so he can convince Georgia health plans to pay for performance. But I think really recognition, whether it is monetary or public recognition, is a good incentive and the approach we have used in Georgia is public recognition of good things that hospitals have done. Whether the data are reported publicly or whether they are used internally for improvement processes, the fact that the data are used will improve the data. I think that is the important thing to remember is that we don't just need data as Bruce alluded to. We need to make use of that data.

Cindy DiBiasi: Thank you for joining us this afternoon. Very interesting information you are giving to us and obviously from the audience reaction you can tell there is a lot of interest out there.

If you have any unanswered questions, you can send an E-mail to info@ahrq.gov and depending on the number of questions, we will try and answer you directly. We also encourage you to send us any researchable questions that you are facing for AHRQ's consideration as the agency plans its future research priorities. In a minute, we are going to ask you to provide some input on today's event by filling out a short evaluation.

As we wind down, let me mention that a number of products from this audio conference will be available at a later data. An audio-streamed archive of today's call, a written transcript and all of the presenter's slides, including those used in the question and answer session will be posted to the following website at www.hsrnet.net/ulp/ahrqtools. The presentation slides as well as text versions of the slides will also be available for downloading at the same web address.

An audiotape of this event will be available for purchase in several week's time. The cost for the tape of this audio conference will be $10. To order a copy, call the AHRQ Publications Clearinghouse at 1-800-358-9295 and ask for AHRQ04-0014-AU. It is entitled Making Quality Count: Tools, Strategies and Resources.

Our next audio conference will take place on Tuesday, March 2nd from 2-3:30 Eastern Standard Time. This event will be the first in a series that addresses education and training for healthcare workers in times of crisis. To receive more information on this series, please go to the following website at www.hsrnet.net/ahrq/surgecapacity.

Finally, before you log off don't forget to take a few minutes to fill out the brief evaluation form that will appear on your screen at the end of the broadcast. Easy to follow instructions are included. For those of you who have been listening by phone only and not using your computer, please stay on the line. The operator will ask you to respond to the same evaluation questions by using the keypad on your telephone. You may also E-mail your comments to us at https://info.ahrq.gov.

Thank you for joining us for this series of calls. We hope you found the information presented useful in your efforts to measure and improve quality. Have a nice day.

Return to Web Conference

Current as of June 2004

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Internet Citation:

Using Measurement Data to Improve Quality. Transcript of second event of a Web Conference, broadcast February 18, 2004. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/ulp/qcount/evnt2trans.htm

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