Market Scan and Sustainability Recommendations

November 19, 2008

Community quality collaboratives are community-based organizations of multiple stakeholders, including health care providers, purchasers (employers, employer coalitions, Medicaid and others), health plans, and consumer advocacy organizations, that are working together to transform health care at the local level. The Agency for Healthcare Research and Quality offers these organizations many tools to assist in their efforts.

This is the text version of the Market Scan and Sustainability Recommendations, November 19, 2008, slide presentation.

Slides

Slide 1: Market Scan and Sustainability Recommendations

Slide 1: Market Scan and Sustainability Recommendations

For Board Discussion

November 19, 2008

Note: This and all following slides have the logo of the Learning Network for Chartered Value Exchanges, a puzzle with three pieces in place and a fourth falling into place.

Slide 2: Today's Objectives

Slide 2: Today's Objectives

  • Clarify questions from last meeting.
  • Affirm priorities for immediate action and future direction.
  • Commit to strategies to achieve priorities.
  • Review next steps.

Slide 3: Current Expenditures by Programs (000s)

Slide 3: Current Expenditures by Program.

Pie chart showing current expenditures for the CVE program. The data is as follows: Measurement, $610,000; Assist clinics in using information, $110,000; Other, $100,000; Consumer engagement, $90,000; Web site and data, $80,000; Sustainability and administration, $7,000; Health policy, $1,000; Hospital partnership on National QI, $1,000; Partnership on disparities, $1,000.

Slide 4: Current Employee Time by Program (Staff FTE)

Slide 4: Current Employee Time by Program (Staff FTE).

Pie chart showing the number of staff employed by program. The data is as follows: Measurement, 1.4; Assist clinics in using information, 0.6; Other, 0; Consumer engagement, 1; Web site and data, 1.1; Sustainability and administration, 0.6; Health policy, 0.1; Hospital partnership on National Q1, 0.1; Partnership on disparities, 0.1.

Slide 5: Current Priorities: Distribution of Work Effort (through December 2008)

Slide 5: Current Priorities: Distribution of Work Effort (through December 2008).

Bar chart showing the distribution of work effort by program track. The tracks are shown as follows:

Track 1: Measurement and public reporting
Aggregate data―Priority rank; C1, executive director; 0.1 FTE, staff; 1.3 FTE, contractor; 2 FTE, total: 3.4 FTE.
Publish quality information―Priority rank; C3, executive director; 0.1 FTE, staff; 1.0 FTE, contractor; 1.0 FTE, total; 2.1 FTE.
New report on specialty care—Priority rank; F4, total; 0.0 FTE.
New report on efficiency and value: Priority rank—F2, total; 0.0 FTE.

Track 2: Foundation commitments (includes publishing quality information)
Partnership to engage consumers—Priority rank; C2, executive director; 0.1 FTE, staff; 0.9 FTE, contractor; 1.0 FTE, total; 2 FTE.
Partnership to report on disparities—Priority rank; C5, executive director; 0.0 FTE, staff; 0.1 FTE, contractor; 0.0 FTE, total; 0.1 FTE.
Facilitate hospital partnership in National Q1―Priority rank; C6, executive director; 0.0 FTE, staff; 0.1 FTE, contractor; 0.0 FTE, total; 0.1 FTE.
Assist clinics in using quality information—Priority rank; C7, executive director; 0.0 FTE, staff; 0.6 FTE, contractor; 0.5 FTE, total; 1.1 FTE.
Dissemination and use of Dartmouth Atlas Data—Priority rank; XX, total; 0.0 FTE.

Track 3: Organizational development
Shaping of health policy—Priority rank; C4, executive director; 0.1 FTE, staff; 0.0 FTE, contractor; 0.0 FTE, total; 0.1 FTE.
Development and Sustainability—Priority rank; XX— executive director; 0.6 FTE, staff; 0.0 FTE, contractor; 0.0 FTE, total; 0.6 FTE.

Track 4: New program development
New: Explore ICSI Model—Priority rank; F1, total; 0.0 FTE.
New: Explore provider incentives—Priority rank; F3, total; 0.0 FTE.
Total: 9.5 FTE

Notes: C1-7: Stakeholder priority ranking of current opportunities, F1-9: Stakeholder priority ranking of future opportunities, XX: Was not included in ranking surveys.

Slide 6: Track 1: Measurement & Reporting

Slide 6: Track 1: Measurement & Reporting

Funded through 2010, predominantly by Health Plans.*

Today's Tasks

  • Affirm commitment to this work as a core priority.
  • Affirm evolution toward reporting on specialty care and efficiency/value.

Strategies

  • Confirm what we need to do to ensure funding by Health Plans will continue.
  • Identify opportunities to expand and diversify funding beyond 2010.

* Health Plans = 85%; Foundation Grants = 11%; Purchasers = 4%

Slide 7: Track 2: Foundation Commitments

Slide 7: Track 2: Foundation Commitments

Funded through 2011, with flexibility to design programs that achieve specified goals.

Today's Tasks:

  • Affirm distribution of efforts.

Strategies:

  • Actively maintain relationship with RWJF.
  • Identify opportunities to expand and diversify funding:
    • Scan other foundations for interest in funding specific work.
    • Track health fund recommendations.
    • Further explore health plan and/or purchaser interest.

Slide 8: Track 3: Organizational Development

Slide 8: Track 3: Organizational Development

Funded primarily by Plans through 2010. Strategies for 2010+ will require additional core and program funding.

Today's Tasks:

  • Affirm allocation of effort.
  • Assign ongoing oversight responsibility and active role in supporting Nancy to Executive Committee.

Strategies:

  • Identify opportunities to expand and diversify funding:
    • Evaluate overlap in data aggregation activities with HFB recommendations.
    • Compare to benchmarks of funding by plans and purchasers in other communities-explore opportunities to expand in Oregon.
    • Explore opportunities for provider funding, such as potentially selling provider-clinic crosswalk lists.

Slide 9: Track 4: New Program Development (ICSI Model; Provider Incentives)

Slide 9: Track 4: New Program Development (ICSI Model; Provider Incentives)

Identified as high priorities. Board involvement needed to secure funding and shape direction.

Today's Tasks:

  • Obtain commitment for working group to further explore ICSI model, define options, and make recommendation to the Board.
  • Confirm next steps for Provider Incentives:
    1. Consider moving to Watch List or
    2. Obtain commitment for working group to explore further, define options, and make recommendations.

Strategies:

  • Scan other CVEs for strategies that are working.
  • Scan foundations for funding opportunities.
  • Explore partnership opportunities.

Slide 10: Track 4: Watch List

Slide 10: Watch List

Agreed to watch for future developments. Not in scope at this time.

Today's Tasks:

  • Affirm programs to remain on this list*:
    • Interoperability of Electronic Health Records (F5).
    • Consumer Incentives (F6).
    • Provider Use of Electronic Medical Records (F7).
    • Reporting on Patient Experience (F8).
    • Monitor Quality of Care to Publicly Advocate (F9).

* Funding currently does not exist for these programs, except for Reporting on Patient Experience which is partially funded by RWJF.

Strategies:

  • Revisit at least 2x per year to evaluate changes in the market and within the Quality Corporation.

Slide 11: Evolution of Priorities — 2009

Slide 11: Evolution of Priorities &8212; 2009

Short Term Shifts to Expand on Current Activities

Bar chart showing the distribution of work effort by program track. The tracks are shown as follows:

Track 1: Measurement and public reporting
Aggregate data—Priority rank; C1, executive director; 0.1 FTE, staff; 1.1 FTE, contractor; 1.7 FTE, total: 2.9 FTE.
Publish quality information—Priority rank; C3, executive director; 0.1 FTE, staff; 0.8 FTE, contractor; 0.7 FTE, total; 1.6 FTE.
New: Report on specialty care—F4, executive director; 0.0 FTE, staff; 0.2 FTE, contractor; 0.3 FTE, new–funding needed; 1, total; 1.5 FTE..
New: Report on efficiency and value: Priority rank—F2, executive director; 0.0 FTE, staff; 0.2 FTE, contractor; 0.3, new–funding needed; 1, FTE total; 1.5 FTE..

Track 2: Foundation commitments (includes publishing quality information)
Partnership to engage consumers—Priority rank; C2, executive director; 0.1 FTE, staff; 0.7 FTE, contractor; 0.7 FTE, total; 1.5 FTE
Partnership to report on disparities—Priority rank; C5, executive director; 0.0 FTE, staff; 0.1 FTE, contractor; 0.0 FTE, total; 0.1 FTE.
Facilitate hospital partnership in National Q1—Priority rank; C6, executive director; 0.0 FTE, staff; 0.1 FTE, contractor; 0.0 FTE, total; 0.1 FTE.
Assist clinics in using quality information—Priority rank; C7, executive director; 0.0 FTE, staff; 0.6 FTE, contractor; 0.5 FTE, total; 1.1 FTE.
Dissemination and use of Dartmouth Atlas Data—Priority rank; XX, total; 0.0 FTE.

Track 3: Organizational development
Shaping of health policy—Priority rank; C4, executive director; 0.1 FTE, staff; 0.0 FTE, contractor; 0.0 FTE, total; 0.1 FTE.
Development and Sustainability-Priority rank; XX—executive director; 0.4 FTE, staff; 0.0 FTE, contractor; 0.0 FTE, total; 0.4 FTE.

Track 4: New program development
New: Explore ICSI Model—Priority rank; F1, executive director; 0.2 FTE, staff; 0.2 FTE, contractor; 0.0 FTE, new–funding needed; 1.6, total; 2.0 FTE.
New: Explore provider incentives—Priority rank; F3, executive director; 0.0 FTE, staff; 0.0 FTE, contractor; 0.3 FTE, new–funding needed; 1.2, total; 1.5 FTE.

Total: 14.3 FTE

Slide 12: Evolution of Priorities— 2010 and beyond

Slide 12: Evolution of Priorities &8212; 2010 and beyond

Longer Term Strategic Direction

Bar chart showing the distribution of work effort by program track. The tracks are shown as follows:

Track 1: Measurement and public reporting
Aggregate data—Priority rank; C1, executive director; 0.1 FTE, staff; 1.1 FTE, contractor; 1.7 FTE, total: 2.9 FTE.
Publish quality information—Priority rank; C3, executive director; 0.1 FTE, staff; 0.8 FTE, contractor; 0.7 FTE, total; 1.6 FTE.
New: Report on specialty care—Priority rank; F4, executive director; 0.0 FTE, staff; 0.2 FTE, contractor; 0.3 FTE total; 0.5 FTE.
New: Report on efficiency and value: Priority rank—F2, executive director; 0.0 FTE, staff; 0.2 FTE, contractor; 0.3 FTE total; 0.5 FTE.

Track 2: Foundation commitments (includes publishing quality information)
Partnership to engage consumers—Priority rank; C2, executive director; 0.1 FTE, staff; 0.7 FTE, contractor; 0.7 FTE, total; 1.5 FTE
Partnership to report on disparities—Priority rank; C5, executive director; 0.0 FTE, staff; 0.1 FTE, contractor; 0.0 FTE, total; 0.1 FTE.
Facilitate hospital partnership in National Q1—Priority rank; C6, executive director; 0.0 FTE, staff; 0.1 FTE, contractor; 0.0 FTE, total; 0.1 FTE.
Assist clinics in using quality information—Priority rank; C7, executive director; 0.0 FTE, staff; 0.6 FTE, contractor; 0.5 FTE, total; 1.1 FTE.
Dissemination and use of Dartmouth Atlas Data—Priority rank; XX, total; 0.0 FTE.

Track 3: Organizational development
Shaping of health policy—Priority rank; C4, executive director; 0.1 FTE, staff; 0.0 FTE, contractor; 0.0 FTE, total; 0.1 FTE.
Development and Sustainability-Priority rank; XX—executive director; 0.4 FTE, staff; 0.0 FTE, contractor; 0.0 FTE, total; 0.4 FTE.

Track 4: New program development
New: Explore ICSI Model—Priority rank; F1, executive director; 0.2 FTE, staff; 0.2 FTE, contractor; 0.0 FTE, total; 0.4 FTE.
New: Explore provider incentives—Priority rank; F3, executive director; 0.0 FTE, staff; 0.0 FTE, contractor; 0.3 FTE, total; 0.3 FTE.

Total: 9.5 FTE

Slide 13: Next Steps

Slide 13: Next Steps

Complete Project Deliverables (Q4 08)

  • Sustainability Plan Document.
  • Implementation Workplan.
  • Dashboard to track progress.

Board Activities

  • Convene new working groups (Q1 09).
  • Support Nancy & Staff in executing plan; removing obstacles.
  • Monitor progress via ongoing status reporting.
  • Revisit on 6-month planning cycle.

Slide 14: Reference Section

Slide 14: Reference Section

This section includes material from previous discussions, for easy reference.

Slide 15: Sustainability Plan Criteria

Slide 15: Sustainability Plan Criteria

Builds a sustainable position for the Quality Corporation mission and organization by:

  • Advancing the Mission: Leads to real solutions for improving health care quality through better information and increased community-wide collaboration.
  • Acknowledging and responding to compelling circumstances.
  • Leveraging the unique value of the Quality Corporation.
  • Delivering tangible value to stakeholders within a timeframe that will keep their attention.
  • Meeting the expectations of current funders.
  • Attracting the attention of potential new funders.

Slide 16: Part II: Market Scan

Slide 16: Part II: Market Scan

Summary Points

  • Quality Corporation Niche: Recognition and respect for multi-stakeholder approach; not aware of "competitors" having that qualification.
  • Hoping that Quality Corporation doesn't think "too small."
  • Several cautions against taking on too much.
  • Frequent perception that "nobody" leading or innovating across stakeholder groups in key areas; innovations may be viewed as internally focused.
  • Increasing interest in access, value, and affordability out of necessity.
  • "Good ideas have come out of Oregon, but collaborative execution has been a challenge."

Slide 17: Market Scan Highlights

Slide 17: Market Scan Highlights

State Health Reform

  • Considerable energy around reform recommendations; expecting some key components to move forward.
  • Expecting nonprofits and public-private partnerships to have a significant role in executing on those recommendations.
  • Expect state to take “partner/buy” vs. “design/build” approach.
  • Differing opinions about the Quality Institute.
  • Suggested additional promotion of Quality Corporation to position for future opportunities.

Slide 18: Part III: Survey Results

Slide 18: Part III: Survey Results

Feedback on Current Programs

Bar chart showing ratings for the current programs based on high value, or high or moderate value by number of raters. The data is as follows:

1. Aggregate data for primary care-number of raters rating as high or moderate: 26, number of raters rating as high value: 16.
2. Provide tools to partners to help consumers understand quality-number of raters rating as high or moderate: 25, number of raters rating as high value: 18.
3. Publish quality information: Trusted link-number of raters rating as high or moderate: 25, number of raters rating as high value: 13.
4. Shaping of health policy: Advisory role-number of raters rating as high or moderate 24, number of raters rating as high value: 13.
5. Facilitate partnership to report on disparities-number of raters rating as high or moderate: 23, number of raters rating as high value: 9.
6. Facilitate hospital partnership in National Q1-number of raters rating as high or moderate: 22, number of raters rating as high value: 7.
7. Assist clinics in using Q-Corp quality information-number of raters rating as high or moderate: 22, number of raters rating as high value: 7.

Slide 19: Highest Value Current Programs by Type of Stakeholder

Slide 19: Highest Value Current Programs by Type of Stakeholder

This slide presents value assigned to seven current programs by seven types of stakeholders. Only the highest and lowest values are noted on the slide. The table is presented as follows:

Stakeholder TypeProviders (8)Health Plans (4)Purchasers (3)Health Services (4)Consumer Advocates (4)Public Policy (3)All Others (4)
1. Aggregate data for primary care*X* *  *
2. Provide tools to partners to help consumers understand qualityXX* * *
3. Publish quality informationX      
4. Shaping of health policyXX    *
5. Facilitate partnership to report on disparitiesXXXX** 
6. Facilitate hospital partnership in National Q1X  X X 
7. Assist clinics in using Q-Corp quality informationX  XXX 

Key: * = Highest rating within that stakeholder group (may be tied).
X = Noted by at least one respondent as "low/no value".

Caution: number of respondents in each category is small.

Slide 20: Survey Results

Slide 20: Survey Results

Value of Future Programs

Bar chart showing ratings for future programs. The chart variables are total ratings and rated #1. The data is described below:

1. Clinical quality improvement-ICSI Model: total ratings-12, rated number-4.
2. Report on efficiency and value: total ratings-12, rated number-3.
3. Provider incentives: total ratings-11, rated number-3.
4. Report on specialty care: total ratings-9, rated number-4.
5. Interoperability of electronic health records: total ratings-8, rated number-3.
6. Consumer incentives: total ratings-7, rated number-4.
7. Increase provider use and access to EMRs: total ratings-7, rated number-1
8. Report on patient experience: total ratings-6, rated number-2.
9. Monitor quality of care to publicly advocate: total ratings-3, rated number-2.

Current as of January 2009
Internet Citation: Market Scan and Sustainability Recommendations: November 19, 2008. January 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/value/suscqcollab/marketscan2.html