You cannot manage what you cannot measure. In the case of healthcare, communities must be able to identify opportunities for reducing costs and improving quality, and monitor whether those opportunities are being successfully addressed. RHICs can serve as a trusted source of actionable information about the cost and quality of healthcare services, the health of the population, and/or the extent to which innovative methods of delivery, payment, and health promotion are being used in their community.
RHICs across the country are publishing reports on many aspects of quality and cost that are unavailable to the public and healthcare providers through any other source. These measurement and reporting initiatives are developed and operated with the active involvement of the physicians and hospitals whose performance is being measured, who ensure that the measures are meaningful and the data are accurate. This involvement increases the willingness of providers to change care processes in order to improve their performance.
Types of Performance Measurement: quality of physician services, quality of hospital services, quality of health plans, patient experience of care, cost of healthcare services, disparities in performance.
Quality of Physician Services
Most Regional Health Improvement Collaboratives collect and publicly report data on the quality of care delivered by physician practices. The types of measures reported include both clinical processes of care (e.g., did all diabetic patients receive a test to measure their level of blood sugar?) and care outcomes (e.g., how many diabetic patients had well-controlled blood sugar levels?), as well as patient experience of care.
Most of these measurement systems rely on health plan claims data, but some include clinical data. The Wisconsin Collaborative for Healthcare Quality has pioneered a methodology to obtain clinical data directly from physicians, thus enabling more comprehensive quality measurement. This methodology does not depend on physicians having electronic health record systems, thereby allowing broad-based participation. Similar approaches are now being used by other RHICs, such as Minnesota Community Measurement and The Health Collaborative. While RHICs typically use nationally-endorsed measures where they exist, they have also pioneered the development of new and improved measures where needed.
Pioneering New Measures to Determine the Quality and Cost of Care
- The California Cooperative Healthcare Reporting Initiative conducts a telephone survey of primary care physician offices to assess after-hours physician availability and access to appropriate emergency and urgent care information.
- Minnesota Community Measurement has developed MN Healthscores, a website produced by Minnesota Community Measurement to report information about the healthcare provided in clinics, medical groups and hospitals to share comparable, useful and trusted information about healthcare quality.
Quality of Hospital Services
A number of Regional Health Improvement Collaboratives also report on the quality of care delivered in the hospitals in their community. Here again, the measures range from processes (e.g., how quickly heart attack patients were treated) to outcomes (e.g., infection rates and mortality rates). For example:
- The Iowa Healthcare Collaborative issues a detailed report with extensive measures of the quality and safety of patient care in hospitals in Iowa.
- The Greater Detroit Area Health Council issues reports on a wide range of measures of the quality and safety of patient care in hospitals in southeastern Michigan.
Quality of Health Plans
Many RHICs also report on the quality of care delivered to patients who have health insurance from a specific health plan. For example:
- The Washington Health Alliance issues an extensive analysis of health plan quality and services, rating health plans on over three dozen different items.
Some RHICs also are developing and producing health plan performance measures for the state-level Health Insurance Exchanges.
The Oregon Health Care Quality Corporation (Q Corp)
As an independent non-profit organization, the Oregon Health Care Quality Corporation (Q Corp) brings stakeholders together to produce transparent information measuring the quality, utilization and costs of health care in the state. Information for more than 20 measures are available to consumers, employers, providers, policymakers, health insurers and others. Q Corp’s annual report, Information for a Healthy Oregon, provides a statewide snapshot of those measures to highlight opportunities for improvements in health care. Many of the measures are publicly reported on the website www.PartnerforQualityCare.org. Q Corp has also built a provider portal with clinic, provider and patient-level detail for the measures to help primary care practices improve care. For more information about Q Corp’s reports, visit www.Q-Corp.org/reports.
Patient Experience of Care
A growing number of RHICs are also collecting and reporting information that focuses on consumers’ experience with healthcare services. For example:
- In 2013, Minnesota Community Measurement released the results of the nation’s first and largest statewide patient experience survey. It included more than 230,000 patient-completed surveys on patient experience of care from 651 clinics around Minnesota. It utilized the CG-CAHPS survey, a national standard for objective reporting of patient experience and the results were posted on MNCM’s MN HealthScores website (link to http://www.mnhealthscores.org). The next round of results will be released in 2015.
Regional Health Improvement Collaborative reports on patient experience: Albuquerque, California, Detroit, Iowa, Massachusetts, Memphis, Minnesota, Seattle, Health Care Improvement Foundation, Wisconsin
Cost of Healthcare Services
Some RHICs are developing measures of the cost of healthcare services, such as the prices charged for individual services, the extent to which the most cost-effective services are used, and the total number of services used to address a particular healthcare issue. For example:
- Minnesota Community Measurement reports on the costs at different healthcare providers for procedures ranging from colonoscopies to labor and delivery.
- Quality Quest for Health reports on the rate at which physicians prescribe generic drugs for their patients. Generic prescribing rates are reported for primary care physicians and a number of specialties.
- Washington Health Alliance was chosen by the state of Washington’s Bureau of Insurance to produce transparent pricing information. Read article
Disparities in Performance
Some RHICs are reporting on differences in the quality of care for different types of patients. For example:
- The Louisiana Health Care Quality Forum shows how cost and quality measures vary by patients’ age, gender, and geographic location.
- The Washington Health Alliance compiles quality measures separately for patients with commercial insurance and patients whose healthcare is paid for by the state Medicaid program, and the Alliance highlights areas where there are significant differences.
- Better Health Greater Cleveland compiles separate quality measures for patients who are uninsured as well as for patients who are covered by Medicaid.
- Minnesota Community Measurement annual healthcare disparities report
Using Measurement to Improve Performance
It is important to recognize that Regional Health Improvement Collaboratives are not only collecting and publicly reporting an extensive array of quality measures, they are also actively using those measures with providers to encourage improvements in the quality of healthcare in their communities. In many cases, the measures have been developed specifically to support a local quality improvement initiative, rather than the other way around. For example:
- Minnesota Community Measurement is measuring the remission rate from depression as part of a major, successful community initiative to improve the treatment of individuals with depression.
- The Integrated Healthcare Association (IHA) in California assembles quality and utilization information to support the largest non-government pay-for-performance (P4P) system in the country, involving 221 physician organizations and 35,000 physicians. IHA runs the program on behalf of eight commercial health plans representing 10 million insured persons. IHA is responsible for collecting and aggregating data, deplying a common measure set, and producing results that are used for health plan incentives to physician organizations, public reporting, and awards. Integrated Healthcare Association (IHA) has been measuring the total cost of care and resource use for over a year and reporting the results to physicians. The quality measures developed by IHA are available to the public through the California Office of the Patient Advocate.
- The Oregon Health Care Quality Corporation’s Partner for Quality Care system has helped physicians better understand their patient populations and how to better manage their care. As one physician said:
“Sometimes you just don’t know what you don’t know. I was able to use the data from Partner for Quality Care and compare it to my own patient registry. I discovered that I have patients with asthma and didn’t even know it. The bottom line is that the Partner for Quality Care data picked up patients that truly do have asthma that we’re managing inappropriately and missed by our data pull. Our office has already instituted a change in our phone advice protocol that affect how asthma medication refills are handled.”
– RJ Gillespie, MD, FAAP, Children’s Health Alliance
- GAO Report praises RHICs for their physician-feedback systems. Download Report
More information on the roles Regional Health Improvement Collaboratives are playing in helping healthcare providers improve their performance is available here.