Status

In progress. Claims collection is two months behind because of challenges with legal agreements. Data submissions proceeding on schedule. EHR data submission moving slowly.

Description

Develop a coordinated approach to measuring quality of care in Oregon's primary care clinics. Specifically:

• Aggregate pooled claims data from health plans for primary care process measures
• Aggregate clinics' EHR and registries data for clinical outcome measures
• Provide consolidated results (publicly available at the clinic level after one cycle of testing and privately available to plans and clinics at the provider level)

Deliverable & due date

• Commitment to health plans and purchasers—blinded claims data by spring 2009, unblinded claims data by end of 2009. Additional round with additional measures in 2010.
• Commitment to RWJF—publicly available data or >50% of the primary care providers in the Willamette Valley by end of 2009.

Dollars and effort

• Approximately $610K per year for three years, provided by health plans ($583k) and purchasers ($27k)
• 1.4 FTE
• Costs will not decrease (except legal) in the next 3 years, as the effort must continuously evolve to include additional measures, plans and clinics.

Gaps

• Funding is adequate through June, 2010, provided that no plans withdraw. Funding after July 2010 is uncertain.
• See other items for programmatic gaps/expansion.

Potential sources of funding

• The Oregon Health Fund Board's current draft proposes to enhance Oregon's measurement capability using claims data, including a mandatory all-payer data base. Overlap with current work is not yet established.
• Plans and purchasers typically fund this work in other communities, though providers partially fund the work in Wisconsin and California, particularly as the process evolves to greater use of EHR data and as providers have other incentives to produce and use data.
• May be able to sell the provider-clinic crosswalk lists.

Status

In Progress. On schedule.

Description

Provide consumer-friendly, trustworthy information on a website about primary care quality; incorporate additional publicly-available quality information; and provide useful links to trusted sources of related information. Market information with collateral print and other materials.

Deliverable & due date

• Commitment to purchasers and plans to provide claims quality information by end of 2009;
• Commitment to RWJ to provide claims data and publicly available hospital data by 2010
• Commitment to Regence Foundation to provide consumer-friendly enhanced website with augmented data and links by early 2009.

Dollars and effort

$80K ($45K Regence Foundation + $10K RWJF + $25K plans) and 1.1 FTE

Gaps

• Needs will decrease considerably once site is established, though updating and marketing of the information will continue.
• Regence Foundation is one-time only. RWJF ends 2011. Plans have committed through June 2010

Potential sources of funding

• Oregon Health Fund Board current draft speaks to transparency and availability of quality information, but does not provide specifics.
• Purchasers and plans typically fund this for ambulatory care in other communities. State governments publish hospital information.

Title

Report on Specialty Care (Future Priority #4)

Status

Future

Description

Expand the current claims quality reporting process to additional measures for specialist care quality

Deliverable & due date

Soft pledge to DHHS-Community Quality Collaborative to do this

Some Oregon specialists are seeking to be included.

Dollars and effort

0

Gaps

Potential sources of funding

Plans and purchasers may be interested in financing this enhancement.

Oregon Health Fund Board calls for specialist quality reporting. Moving existing measurement dollars is logical and possible.

Status

Future

Description

Expand the current claims quality reporting process to incorporate emerging standardized methodologies for measuring the efficiency and value of care using claims.

Deliverable & due date

Soft pledge to DHHS-Community Quality Collaborative to do this

Dollars and effort

0

Gaps

Staffing to reach consensus on methods is a logical extension of existing measurement staff.

Most efficiency measurement programs are proprietary. Software estimates range from $200,000 to $700,000.

Potential sources of funding

This is a logical extension of current measurement work. Plans and purchasers may be interested in financing this enhancement, particularly if linked to payment incentives.

Oregon Health Fund Board calls for efficiency and value reporting and may contract for activity.

Title

Provide Tools to Partners to Help Consumers Understand Quality (Stakeholder Current Priority #2)

Status

In Progress. On schedule.

Description

Provide consumer-tested messages and materials to consumer groups, health plans, purchasers and providers. Message: quality varies, why this matters, what you can do to be a partner for your own quality care.

Deliverable & due date

• Committed to RWJF to provide a written “action packet” and facilitate its use with 3 consumer groups, 5 health plans and 4 employers.
• Commitment to plans and purchasers to market quality data to consumers when it becomes available in late 2009.

Dollars and effort

$90K from grants and 1.0 FTE

Gaps

• Totally reliant on foundations for funding; commitment ends April 2011
• Potential program activity and partnerships are limitless. Direct consumer group work is labor intensive. Other communities are conducting media campaigns, coordinating self-management campaigns for specific conditions, facilitating use of “Patient Activation Measures”, implementing the Stanford Living Well programs, working with libraries, training parish nurses and much more.
• Our evaluation is nearly non-existent; we won't know if our targeted partners are able to “spread” the message.

Potential sources of funding

Plans and employers have substantial internal programs. In a few other states private foundations fund cross-community work. No ready sources in Oregon.

Title

Assist Clinics in Using Quality Corp's Quality Information for Improvement (Stakeholder Current Priority #7)

Status

In progress. Work has just begun.

Description

Working in partnership with NWP Quality Focus and Acumentra, recruit physician groups to participate in improving and using the quality claims data for better patient care. Seeking partnerships for alignment with ABIM recertification, bonus programs, and other incentives.

Deliverable & due date

Commitment to RWJF that xx (TBD) physicians will download their data in the spring of 09.

Dollars and effort

$110K and .6 FTE

Gaps

Marketing, assistance and incentives could be greatly expanded if resources were available.

Some communities hold training sessions, visit clinics, provide measurement and IT coaching, host collaborative.

(See ICSI model below for further expansion of QI assistance).

Potential sources of funding

In several communities IPAs and large groups help fund this. Purchasers and plans also fund in some communities.

Title

Facilitate Partnership to Measure and Report Disparities (Stakeholder Current Priority #5)

Status

In progress. Ahead of schedule.

Description

Encourage voluntary standardization for race, ethnicity and language data collection across Oregon. Coordinate access to national resources available through the Robert Wood Johnson Foundation's Aligning Forces for Quality. Facilitate infrastructure for collecting and reporting racial, ethnic, and language data about the quality of health care as it becomes available.

Deliverable & due date

Commitment to RWJF to facilitate use of new toolkits in Oregon's hospitals, health plans and other settings by 2010 through webinars and meetings.

Commitment to RWJF to facilitate hospitals participation in equity and language collaboratives.

Commitment to convene interested delivery system partners for development of voluntary standardization of data collection.

Commitment to RWJF to develop a plan regarding disparities by 2011.

Dollars and effort

$10K (RWJF) and .1 FTE

Gaps

Oregon is weaker than many communities in its efforts to measure and reduce health care disparities. Potential effort is limitless; specific Quality Corp scope needs clarity for the long-term.

Potential sources of funding

Foundations?

Title

Facilitate Hospital Partnership in National QI (Stakeholder Priority #6)

Status

In progress. National leadership is 9 months behind schedule.

Description

Promote and facilitate participation of Willamette Valley hospitals in 3 national collaborative (Transforming Care at the Bedside (nursing), Expecting Success (race/ethnicity data collection) and Language. Advise RWJF on hospital selection. Facilitate spread.

Deliverable & due date

Notify hospitals about October 08 and February 09 calls for proposals; provide letters of support, advise in December 08 and March 09 on hospital selection

Dollars and effort

$10K (RWJF) and .1 FTE

Gaps

A few other communities, especially city-based ones, are doing additional hospital QI programs. Are we missing opportunities to add value to existing hospital QI, such as providing support group for participants in both IHI and VHA collaborative?

Potential sources of funding

??

Title

Disseminate Dartmouth Atlas Data (Not Evaluated by Stakeholders)

Status

Pending

Description

RWJF requirement to develop a plan to use data they will provide

Deliverable & due date

We have identified a team of analytical experts to help us. Actual expectations are unclear.

Dollars and effort

0

Gaps

Potential sources of funding

Title

Shaping of Health Policy—Position to be Partner of Choice (Stakeholder Current Priority #4)

Status

In progress.

Description

• Executive Director provides input to Oregon Health Fund Board Quality Institute workgroup, the OHPR-DHS-Governors Commonwealth Fund Quality Institute, and Governors Health Information Advisory Committee.
• Board members and Medical Director participate in numerous state and national committees for both public sector and private sector policy.

Deliverable & due date

• No formal deliverables. Legislative session in 2009.
• Historically Quality Corp has been partner of choice for some HIT and public health contracts; none current.

Dollars and effort

$10K (from plans) and .1 FTE

Gaps

State and local government have contributed $5,000 to the Quality Corp to support making ambulatory care quality information available in Oregon. (Comparison: King County provides >$1M annually to Puget Sound effort as a purchaser; New York, Minnesota, Massachusetts and Wisconsin have substantial government funding ($300K to several million) to provide health care quality data to the public, public health, and policy makers.

Potential sources of funding

Office of Health Policy and Research, public health, Department of Medical Assistance Programs, PEBB/OEBB

Title

Quality Corporation Development  (Not Evaluated by Stakeholders)

Status

In progress

Description

Marketing and Sustainability Committee is guiding strategic planning process.

Deliverable & due date

Draft plan to be completed December 2008, implementation in 2009.

Dollars and effort

Planning supported by US-DHHS—Community Quality Collaborative pilot, and grant from AstraZeneca, and general funds.

Gaps

Implementation will be challenging. In such a small-employer state, purchaser resources are hard to leverage. Foundation funding is scarce.

Potential sources of funding

Board member expertise and time are the most critical resources needed.

Could we get a loaned “development coordinator”?

Title

Explore Deliver System Quality Improvement Support, e.g. ICSI Model (Future Priority #1)

Status

Future

Description

This is a collection of ideas related to improving quality improvement assistance to clinics. A single clear focus has not been established. Ideas under discussion include:

• Original RWJF proposal objective to better align health plans' pilot financing and support for clinic improvement projects. Also to identify and coordinate QI technical assistance resources across the community.
• Enthusiasm for Minnesota's ICSI organization which establishes guidelines of care and assists with implementation, including organizing financial incentives. Recent projects include depression management and appropriate radiology use.
• Oregon's emerging HIPMO group that proposes comprehensive solutions to specific quality issues that plans, patients and physicians share (similar to ICSI's depression project). First effort relates to treatment of back pain.
• Emerging delivery system change efforts such as medical home.

Deliverable & due date

None

Dollars and effort

No Quality Corp funds, but considerable health plan and medical group resources

Gaps

Needs clear focus, leadership and funding. Ranks very high as a community need.

Potential sources of funding

This work is funded by plans in Minnesota; by purchasers, plans and IPAs in California.

Health Fund Board plan calls for increasing state leadership in QI.

Title

Further Explore Provider Incentives (Future Priority #3)

Status

Future

Description

Explore Quality Corp role in organizing a collective approach to provider improvement incentives

Deliverable & due date

None

Dollars and effort

None

Gaps

Would health plan pilot programs be more effective if coordinated/ consolidated/ augmented? Some communities select specific quality measures for which plans will independently offer incentive payments.

Potential sources of funding

?

Title

Report on Patient Experience (Future Priority #8)

Status

Stalled

Description

Patient experience data, collected through standardized surveys, about their health and care, provides publicly available information about quality from the patients' perspective and helps providers improve delivery.

Deliverable & due date

Committed to RWJF to collect this information in the Willamette Valley by 2011. Multiple communities are having difficulty raising sufficient resources for this.

Dollars and effort

$0 and minimal FTE.

Gaps

Would require about $450K to make information available at the provider level for the Willamette Valley; clinic-level data of minimal value.

Potential sources of funding

• Many physician groups already survey members, but with non-standard instruments and methods. Could this be redirected to a community approach?
• RWJF communities exploring a cooperative purchasing arrangement with CheckBook.
• Would foundations be interested?