Using Health Data to Measure Performance:Are We Going to be Successful?

Sourcing Data to Describe Health Care Quality and Performance

Quality MetricsFrom Paid Claims

EHR Sourced Quality Metrics

• Each source is driven by a very different purpose.• The questions is: are EHR data better?

Sourcing Health Data

• Claims-based reporting is a view through the rear view mirror. It has little or no effect on clinical decision-making– Data have been available, so we have constructed “quality

measures” from this source [when HEDIS started in 1991, EMRs were rudimentary and claims data ruled].

– It has shaped our thinking about what’s broken in the industry and what to focus on for improvement.

– But does it really lead to improvement in clinical outcomes in populations?

• If not, then why continue doing it?

Industry Symptoms

• Clinicians do not reference the Washington Health Alliance Community Checkup reports (claims data). Administrators do.

• Clinicians complain that claims based reporting is not clinically relevant.

• Little evidence that claims-based performance reporting leads to improved clinical outcomes.

Improving Population Health with the Wrong Tool is Like:

EHRs as the Data Source

• Harvest desired data to a warehouse on a daily basis

• Each practice has a dashboard that profiles real time performance (% complete) on each “quality” measure of interest for all patient groups of interest

• Missing your target? - click to a view listing patient names and contact for follow up.

• Work flow self correction results in improved performance in reporting

Barriers…and Solutions

• Not everyone uses Epic (!)• In an IPA of 520 providers (Northwest Physicians) 49

different EMR platforms are in use.

• NPN is beginning to use a SaaS solution using semantic technologies to suck out, digest and report back clinically meaningful information from non-standard platforms with an ability to modify or adapt measures easily.

• Measurement selection is driven in part by clinical interest and relevancy to the practice.

The Assumption

Does Population Health hold the keys to increasing Value?

Value Increases WHEN: Quality increases, even if expenditures are constant

ORValue Increases WHEN: Costs are reduced, but

quality is held constant

Value = Quality ÷ Cost

ACO Cost-Quality Comparison…

• Y axis - Average annual Medicare cost per patient.

• X axis- Average quality percentile score on 22 MSSP CQMs.

• Each dot represents a practice in the ACO.

ACO Clinical Quality Measurement Scorecard…

• Snapshot of one ACO’s performance on the 22 CQMs under MSSP.

• Identifies clinical areas that need improvement.

ACO Practice Scorecard…

• Compares performance of practices within an ACO.

• Helps identify underperforming practices and is a tool to drive improvement.

Stratifying Patients by Gaps…

• Patient stratification based on urgency of preventing and/or closing specific gaps in care.

Caution Ahead• EHR data are only as good as the coding detail.• For many common disease groups (e.g. T2 diabetes, asthma, CHF) ~

50% of the codes submitted with billing are NOS or lack significant detail, offering little relevance for profiling, intervention and clinical management improvement.

• To date, coding performance has been miserable; ICD-10 will be a real challenge.

• Improvement in coding specificity is a key to population health improvement.

• Coding precision needs to become valued for clinical reasons; it’s not just a business intrusion in medicine.

• The clinical relevance of population data is determined by their specificity.