Roles of Regional Health Improvement Collaboratives:
Measuring Healthcare Performance
It is a well-known principle that "you can't manage what you can't measure." In the case of healthcare reform, communities need the ability to identify opportunities for reducing costs and improving quality and to monitor whether those opportunities are being successfully addressed. Regional Health Improvement Collaboratives can serve as a neutral, trusted source of actionable information about the cost and quality of healthcare services, the health of the population, and/or the extent to which state-of-the-art methods of delivery, payment, and health promotion are being used in their community.
Regional Health Improvement Collaboratives across the country are publishing reports on many aspects of the quality and cost of care that are not available to either the public or healthcare providers through any other source. These measurement and reporting initiatives are developed and operated with the active involvement and supervision of the physicians and hospitals whose performance is being measured, so those providers can ensure that the measures are meaningful and the data are accurate. This, in turn, increases the willingness of healthcare providers to change care processes in order to improve their performance.
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?).
Most of these measurement systems rely on health plan claims data, but the Wisconsin Collaborative for Healthcare Quality has pioneered a methodology to obtain clinical data directly from physicians to enable more comprehensive quality measurement. This system does not depend on physicians having electronic health record systems, thereby enabling broad-based participation. Similar approaches are now being used by other Regional Health Improvement Collaboratives, such as Minnesota Community Measurement and the Health Improvement Collaborative of Greater Cincinnati.
While Regional Health Improvement Collaboratives typically use nationally-endorsed measures where they exist, they have also pioneered the development of new and improved measures where needed. For example:
- Quality Quest for Health in Illinois uses a multi-factor composite measure to determine the quality of colonoscopies, and it is currently pilot-testing a composite measure of whether all appropriate preventive care has been performed.
- 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.
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.
- The Maine Health Management Coalition gives recognizes hospitals with the highest performance on the quality of patient care.
Many Regional Health Improvement Collaboratives also report on the quality of care delivered to patients who have health insurance from a specific health plan. For example:
- The Puget Sound Health Alliance issues an extensive analysis of health plan quality and services, rating health plans on over three dozen different items.
In addition to clinical quality measures, a growing number of Regional Health Improvement Collaboratives are also collecting and reporting information on consumers' experience with healthcare services. For example:
- Since 2005, Massachusetts Health Quality Partners (MHQP) has been collecting and reporting results from its statewide Patient Experience Survey on patients' experiences with their primary care providers, making Massachusetts the first state in the nation to publicly report about patient care experiences down to the physician practice site level.
Some Regional Health Improvement Collaboratives have also begun 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
In addition to reporting on the quality of care for all patients, some Regional Health Improvement Collaboratives are also reporting whether there are 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 Puget Sound Health Alliance compiles quality measures separately for patients with commercial insurance and patients whose health care is paid by the state Medicaid program and the Alliance highlights areas where there are significant differences.
- Better Health Greater Cleveland also compiles separate quality measures for patients who are uninsured as well as for patients who are covered by Medicaid.
Using Measurement to Improve Performance
It is important to recognize that not only are Regional Health Improvement Collaboratives collecting and publicly reporting an extensive array of quality measures, they are also actively using those measures to encourage improvements in the quality of healthcare in their communities. Indeed, 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. 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)
More information on the roles Regional Health Improvement Collaboratives are playing in helping healthcare providers improve their performance is available here.