Appendix F. Strategic Prioritization Model

Key Strategies and Activities of the Alliance in 2008

1. Produce claims-based performance reports on quality (care processes) measures for physician practices. Reports in 2008 to include:

• 1st report: January 2008
• 2nd report: July 2008

Assure preparations are underway to support the 3rd report due in January 2009.

For each reporting cycle:

1. Complete data submission
2. Send draft data out for reasonableness review
3. Review and respond to feedback on reasonableness review
4. Distribute advance releases
5. Publish public report

1a. Resolve patient verification process to enable reasonableness review of performance results.

1. Determine goals for patient verification program and preferred methods for achieving these. (March 2008)
2. Determine technical mechanism for conducting patient verification (March 2008)
3. Develop implementation specifications for providing patient names. (June 2008)

1b. Incorporate new data suppliers.

1. Identify and contact new data suppliers. (January 2008)
2. Finalize data supplier agreements. (April 2008)
3. Finalize data submission. (2 rounds of data submission in 2008, to be timed to dates of reports)

1c. Apply for Community Quality Collaborative (Community Quality Collaborative) status and seek to include Medicare data in performance reporting.

1. If 2007 Community Quality Collaborative application is approved, implement process requirements as determined by AHRQ (ongoing)
2. If 2007 Community Quality Collaborative application is denied, reapply in 2008. (TBD)
3. Complete and submit Community Quality Collaborative work plan (April 2008)
4. Participate in national Community Quality Collaborative learning network and quarterly e-surveys regarding technical assistance needs. (Ongoing)

2. Develop a vision and plan for the aggregated database as a strategic asset of the Alliance and the community. Seek clear understanding among data suppliers through a revised agreement and establish processes to respond to data use requests and opportunities.

1. Convene Data Stewardship Committee. (January 2008)
2. Develop criteria for evaluating requests to analyze aggregated data base. (April 2008)
3. Develop process/procedures for submitting requests; get board approval. (June 2008)

3. Implement Phase 2 of Hospital Quality reporting (applies to 2nd and 3rd reports).

1. Finalize Phase 2 hospital quality measure set and data sources (January 2008).
2. Develop format for publishing results in Alliance reports. (April 2008)
3. Include Phase 2 hospital quality measures/reporting in 2nd report. (TBD)

4. Implement eValue8 for participating purchasers and health plans in the Puget Sound region.

1. RFIs submitted by participating health plans. (February 2008)
2. Participating purchasers convene to review results and agree upon areas for QI focus. (May 2008)
3. Health plan site visits occur with active purchaser involvement. (August 2008)

5. Create the capability for Web-accessible performance reporting, including report production, report delivery to clinic leaders, purchasers and plans, as well as interactive tools to enhance consumers' ability to access the information in a user-friendly manner.

1. Complete replication of Minnesota Community Measurement Web site for the Alliance public report. (April 2008)
2. Develop and implement plan to enable automated production and secure access to private reports for providers and data suppliers. (timed with rollout of 2nd report)
3. Refine Web site functions and update information. (timed with 2nd and 3rd reports)

6. Agree on an approach to measure and report on “relative resource use” (efficiency) for physician practices and/or hospitals (reporting to occur in 2009).

1. Convene Relative Resource Use Workgroup (February 2008)
2. Agree upon initial approach to measuring/reporting on efficiency. (June 2008)
3. Develop and finalize analytic capability. (October 2008)

7. Convene key stakeholders from the community to assess the feasibility of measuring/reporting patient experience for physician practices in a standardized fashion across medical groups. If feasible, develop an implementation and funding plan for 2009 with reporting targeted for 2010.

1. Committee of stakeholders convened. (March 2008)
2. Finalize recommendations to Alliance board regarding feasibility and approach. (June 2008)
3. Board action on Alliance sponsoring region-wide measurement/reporting of patient experience. (August 2008)
4. Complete plan for implementation and funding to initiate measurement in 2009. (November 2008)

8. Approve the recommendations of the Affordability Workgroup due in January 2008. Implement short-term cost containment strategies in 2008 which are likely to be: (a) increasing generic prescribing, (b) reducing hospital infections, and (c) discontinuing payment for “never events.” If recommended by the AWG, develop an approach to targeted payment reform. Plan for pilot approaches to payment reform to be implemented in 2009.

1. Board approves AWG recommendations (February 2008)
2. Implementation of short-term recommendations begun (April 2008)
3. Complete plan for payment reform pilot(s) to start implementation in 2009 (November 2008)

9. Create a baseline assessment of how well stakeholders are doing in implementing the Alliance's recommendations in the areas of diabetes, heart disease, depression, low back pain, prevention, asthma, and prescription drugs.
   
   9a. Focus separate surveys on employers and providers as stakeholders and report results to Alliance participating organizations. Plan for targeted recognition of stakeholders who have been successful in implementing recommendations. [Note: Handle evaluation of health plans through eValue8.]
   
   9b. Evaluate the degree to which RWJF-led assessment of consumer behavior in the region can help set a baseline for evaluating consumer uptake of Alliance recommendations. If needed, identify other ways to efficiently evaluate the effectiveness of Alliance and stakeholder outreach to consumers.

9a:

1. Assessment survey tools developed for employers and providers. (February 2008)
2. Surveys fielded and completed. (June 2008)
3. Results shared with Alliance board and others as appropriate. (August 2008)
4. Public recognition of stakeholders doing a good job/communication strategy. (October 2008)

9b:

1. Review and ID baseline data from RWJF survey findings on local consumer health behavior. (February 2008)
2. Assess whether critical gaps in the findings exist; identify and pursue one or more low-cost methods for gathering the needed information to establish a reasonable baseline regarding consumer behavior. (June 2008)

10. Recognize medical groups and hospitals that demonstrate quality performance based on the measures included in the Alliance's performance reports; encourage sharing of ‘best practices' and successful approaches to improve quality among groups and hospitals.

1. Develop media relations plan focused on highlighting successful approaches to improving health care quality in the region (January 2008)
2. Using the public report results, identify, create and disseminate (via Web, stakeholder communication and media) profiles of high- performing clinics and hospitals (timed with each report rollout).
3. Create and disseminate Alliance-branded items recognizing participation in public reporting and quality performance achievement, such as certificates to post in reception areas (timed with rollout of 2nd and 3rd reports).

11. Co-sponsor the Washington Health Information Collaborative in 2008.

1. Assist in WHIC planning to refine coordination among stakeholders, improve efficiency of grant making process, and encourage other stakeholders to contribute. (May 2008)
2. Refine and disseminate via newsletters, Web, and media outreach information to providers regarding importance of information technology, grant requirements, and timing. (June 2008)
3. Promote award-winners to opinion leaders and the public via newsletters, Web, and media outreach. (October 2008)

12. While emphasizing Alliance strategic priorities, apply for RWJF Regional Quality Strategies grant. If funded, begin implementation in the following areas: (a) expand leadership team to include more hospitals and nurses; (b) develop community action plan for using national quality data; (c) expand nurses' role in the Alliance and have one or more hospitals participate in a learning collaborative; (d) expand reports to address hospital quality, cost and patient experience; (e) plan for how data on patient race and ethnicity will be collected and used to stratify report results; and (f) increase consumer involvement and expand consumer engagement in areas such as shared decision-making. Request additional resources for Alliance participation in payment reform efforts.

1. Submit Alliance application for three-year RWJF Regional Quality Strategy grant. (January 2008)
2. Host RWJF in local site visit as part of application process. (March 2008)
3. Begin RQS grant activities, including RWJF budget and reporting requirements, technical assistance participation, and project implementation in five required areas plus any approved optional activities. (May 2008)

13. Convene an “Improvement Team” (subgroup of QIC) specifically to (a) review detailed results of performance reporting and other data sources, and (b) make specific recommendations for targeting quality improvement areas of focus in medical groups, hospitals, and/or the community as a whole.

1. Subgroup of QIC chartered by Alliance Board. (January 2008)
2. Subgroup convenes. (March 2008)
3. Finalize recommendations based on 1st and 2nd performance reports. (timed with release of reports).

14. Serve as convener for providers, purchasers, and plans to identify proven initiatives and programs that improve delivery for chronic disease management (e.g., promote the use of registries) and/or increase participation in prevention-related activities, then engage providers and other stakeholders to adopt or participate in those specific activities in a coordinated fashion to maximize the impact of interventions across the community.

1. Develop plan for convening multiple outside organizations to share ideas/promote coordination. (February 2008)
2. Convene group(s) - initial meeting. (April 2008)
3. Group(s) to meet at least two times in 2008.
4. As recommendations are developed, report to QIC and Board. ( Ongoing)

15. Raise awareness of quality variation and performance reports by: (a) developing messages informed by RWJF research on consumer attitudes; and (b) holding a series of meetings with community groups.

1. Develop talking points based on RWJF research on consumer attitudes. (February 2008)
2. Hold a series of meetings with consumer groups in the five-county region to discuss health care variation, quality and the performance reports. (June 2008)
3. Refine messages based on further RWJF research and community discussions. (ongoing)

16. Promote consumer activation and improved health behaviors through the use of Health Risk Assessments and related tools and supports.

1. Develop materials to help consumers understand the benefits of health risk assessments (HRAs) and how to use HRA results to interact with providers. (February 2008)
2. Develop and maintain Web pages featuring information on HRAs and supporting materials. (ongoing)
3. Partner with other organizations to promote effective use of HRAs (ongoing).

17. Promote self-management and consumer engagement by sponsoring health literacy initiative with CMS.

1. Develop and maintain Web pages highlighting health literacy resources for consumers and providers. (ongoing)
2. Partner with libraries and other consumer organizations to make health information more accessible to the public. (March 2008)
3. Promote community resources such as patient navigators and health communication training. (May 2008)

18. Co-sponsor and promote Washington Collaborative 6 that will focus on small practices (adult and pediatric) and improving care in the areas of asthma, diabetes, and hypertension.

1. Serve on advisory board for Washington Collaborative 6. (ongoing)
2. Washington Collaborative 6 commences in February 2008 with first learning session by June 2008.

19. Recruit and hire new executive director.

1. Board selects final candidate who is in the position by July 2008.

20. Develop a model for sustainable funding for the Alliance, particularly given the completion of special funding from King County and projections around grant funding.

1. Complete study of other collaboratives' sustainable funding models. (May 2008)
2. Develop alternative models. (June 2008)
3. Executive committee considers alternatives and formulates recommendation to board. (July 2008)
4. Board action on approach. (September 2008)

21. Recruit new Alliance members and apply for additional grants.

1. Assess and identify board members and other Alliance participants willing to encourage target companies, agencies and organizations to join the Alliance. (January 2008, activities ongoing)
2. Update recruitment materials to show milestones achieved and endorsements from participants about membership value. (February 2008)
3. Recruit purchasers, with a focus on value of reports and eValue8 opportunities. (timed with 2nd and 3rd reports, and eValue8 results for participating purchasers)

22. Continue to build an effective governance and board structure.

1. Plan for and hold two board retreats (May 2008, September 2008)

23. Assure focused and effective involvement in the public policy arena.

1. Monitor proposals and participate in public policy discussions, consistent with the board-adopted Public Policy Guidelines, to promote and protect the ability of the Alliance to achieve its strategic priorities. (ongoing)
2. Communicate with elected officials, policy staff and opinion leaders, Alliance goals and vision, with focus on topics that have public policy implications such as value-based purchasing, performance reporting, and payment reform. (ongoing)