ahrq and the science of public reporting presentation to national advisory council irene fraser and...

AHRQ and the Science of Public Reporting

Presentation to National Advisory Council

Irene Fraser and Carol SniegoskiJuly 22, 2011

Public ReportingOne Potential Strategy to Improve

Quality

Two Theories of Impact– Consumer pathway

Consumers use info. to choose providers Market shares shift, providers respond

– Provider pathway Providers value their reputations and/or

market shares so strive to improve scores– More evidence on second pathway – But science is nascent

Transparency also an end in itselfGrowing comparative reporting by CMS, states,

communities, othersRole grows under the ACA

Goals for Discussion

Summarize AHRQ role in public reporting

Present one new tool: MONAHRQ– Your ideas on priorities for enhancement?

Discuss new multi-year initiative on the Science of Public Reporting– Your ideas on strategies, themes, issues?

AHRQ Has a Significant Role in Public Reporting

1. Does NOT do provider-level reporting, but2. Develops measures

– CAHPS– Quality Indicators– Readmissions measures– CHIPRA and Adult Medicaid Measures

3. Reports national and state data– National Healthcare Quality and Disparities

Reports– State Snapshots

4. Provides tools for CMS, states, others to use

CMS, States, Others Use AHRQ Measures for Public Reporting

CMS – Uses H-CAHPS, Quality Indicators for Hospital Compare and Value-Based Purchasing

States – also use H-CAHPS and Quality Indicators for Public Reporting

25 states use Quality Indicators for public reporting

AHRQ Has a Significant Role in Public Reporting (cont’d)

5. Provides clearinghouse, inventories– National Quality Measures Clearinghouse

6. Improves data for public reporting7. Conducts (some) research on public reporting8. Provides TA, learning networks for users of

public reports– Example: 24 Chartered Value Exchanges

Multi-stakeholder Represent over 124 million lives Major activity is public reporting AHRQ leads learning network

Learning Network Example: 24 Chartered Value Exchanges

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AHRQ Role in Measures Reporting: An Example from HCUP and the

Quality Indicators

Statewide Orgs

(government or private)•Set rules on data collection and use•Collect all-payer data from hospitals•Process data•Create claims databases•Manage use of data

AHRQ•Standardizes data across states•Develops national and regional statistics,

benchmarks•Funds data improvements•Develops, validates, maintains, improves measures•Seeks NQF endorsement •Creates software tools•Creates downloadable website-builder

States, Communities, CMS, others•Decide whether to do public reporting•Establish structure and governance structure•Select measures to report•Display data

Goals for Discussion

Summarize AHRQ role in public reporting

Present one new tool: MONAHRQ– Your ideas on priorities for enhancement?

Discuss new multi-year initiative on the Science of Public Reporting– Your ideas on strategies, themes, issues?

MONAHRQ overview

Tour of MONAHRQ

MONAHRQ introduction

MONAHRQ goals and future directions

Report from MONAHRQ users: Keely Cofrin Allen, Utah Department of Health

MONAHRQ motivation

But … building a reporting site is tough

Why does every organization have to reinvent the wheel?

Growing need to publicly report healthcare quality and costs at the local level

Building an effective reporting site is even tougher

Introducing MONAHRQ

Software that quickly generates your own local public reporting website

• Fast• Easy• Automatic• Free• Use your local data or use publicly available measures• Designed by AHRQ to follow best practices in reporting

– Selected as finalist in the Fall 2010/Winter 2011

HHSinnovates competition –

MONAHRQ origins

AHRQ Quality Indicators

MONAHRQHospital Costs and Utilization Project

MONAHRQ builds on other AHRQ programs

• AHRQ QI software tools• MONAHRQ

benchmarks

• Online data query (HCUPnet)

(HCUP)

• AHRQ QI R&D

(QIs)

Community health collaboratives

• Potential adopters• Reporting experience

• AHRQ QI users(CVEs)

Download MONAHRQ from monahrq.ahrq.gov

MONAHRQ makes reporting easier

MONAHRQ

Load your local hospital

discharge data

Load CMS Hospital Compare

measures*

MONAHRQ makes reporting easier

* Publicly available from Hospital Compare

MONAHRQ

Download MONAHRQ from monahrq.ahrq.gov

MONAHRQ

Output a healthcare reporting website

You host: internal, password-protected, or public

MONAHRQ makes reporting easier

Download MONAHRQ from monahrq.ahrq.govLoad your local

hospital discharge data

MONAHRQ runs on your desktop

Load CMS Hospital Compare

measures*

* Publicly available from Hospital Compare

The MONAHRQ reporting website

■ Hospital Quality Ratings■ Maps of Avoidable Hospital

Stays

■ Hospital Utilization■ County Rates of Hospital

Use

MONAHRQ adoption

• First released June 2010• 4 live statewide reporting

sites, plus 2 expected soon

MONAHRQ tour:Hospital Quality Ratings

• AHRQ Quality Indicators• CMS Hospital Compare

measures• HCAHPS measures

Hospital Quality Ratings:Search page

Choose hospitals and a health topic

[Search page]

Hospital Quality Ratings:Search page

Hospital Quality Ratings:Classification table

* Available from HealthData.gov

Compare hospital quality ratings

Hospital Quality Ratings:Bar charts

Drill down to bar charts with benchmarks

– Synthetic data –

Hospital Quality Ratings:Detailed statistics tables

Drill down to underlying measure statistics

– Synthetic data –

MONAHRQ tour:Maps of Avoidable Hospital Stays

AHRQ area-level Quality Indicators

Reflect quality of community care, not hospital care

[Search page]

Choose a measure

Maps of Avoidable Stays: Search page

Maps of Avoidable Stays: County maps

Compare rates of potentially avoidable

hospital stays by county

– Synthetic data –

Maps of Avoidable Stays: Potential cost savings

– Synthetic data –

Drill down to estimated cost savings from reducing

avoidable stays

Visit our new live MONAHRQ demo site

monahrq.ahrq.gov/demo/index.html

– Synthetic data –

Report from MONAHRQ users

Keely Cofrin AllenUtah Department of Health

MONAHRQ goals

Encourage local reporting

Encourage use of endorsed measures (without enforcing it)

Disseminate best practices in reporting

Help to harmonize local reporting

Provide options to help tailor local reports to local needs

Future plans

Add new content– Additional Compare measures– Custom measures– Plans, ACOs, or exchanges– Cost and quality– Summaries or composites– EHR meaningful use– All-payer claims data

Add new features– Time trends– Custom benchmarks– Summary pages– Targeted reports (e.g.,

pediatrics)– More customization options

Add best practices– New initiative on Building the

Science of Public Reporting

Collaborate, assist and assess

– Stakeholder feedback– Technical support– User groups

Email us:carol.sniegoski@ahrq.hhs.gov anne.elixhauser@ahrq.hhs.gov

For assistance or to join the MONAHRQ mailing list:

monahrq.ahrq.gov

email monahrq@ahrq.gov

Contact us

For more information or to visit our live demo site:

Input Your Data. Output Your Website.

Discussion

Questions about MONAHRQ?

Suggestions for future directions?

How to guide MONAHRQ planning or facilitate MONAHRQ adoption?

Input Your Data. Output Your Website.

Goals for Discussion

Summarize AHRQ role in public reporting

Present one new tool: MONAHRQ– Your ideas on priorities for enhancement?

Discuss new multi-year initiative on the Science of Public Reporting– Your ideas on strategies, themes, issues?

The Science of Public Reporting Initiative

Goals: Forge a coordinated, evidence-based

strategy for public reporting at the national and local levels

Improve science of public reporting Incorporate this science in national and

local reports Improve data for public reporting Assess impact

First Step: AHRQ Summit on Public Reporting for Consumers

March 23, 2011

130 participants:– NAC members – Public and

private funders of research

– Federal or state policymakers

– Consumer organizations

– Providers – Purchasers and

plans– Report hosts

Key questions: How do we advance public

reporting of provider performance for consumers?

Where do we want to be tomorrow?

Where do we want to be in 2025?

What are the challenges and how do we address them?

Survey to Inform Summit: Do you think the best current public reports of provider performance information to consumers:

Meredith Rosenthal, presentation at AHRQ Summit on Public Reporting for Consumers, March 23, 2011, work funded by AHRQ and Commonwealth Fund.

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Science of Public Reporting Initiative: The Structure

A partnership among AHRQ, ASPE, CMS Funded through ACA Section 3014 for 2011-2014 Combination of grants, contracts, FTEs to:

– Build the science– Create a user’s group– Facilitate use of new evidence

Related Activities: – Coordination Group from ASPE, AHRQ, CMS to

Create a national reporting strategy Coordinate on quality measurement and assessment

– DHHS Quality Measures inventory– Inventory of potential data sources for public reporting – Analyses to track changes in provider performance on

reported measures

#1 Build the Science: Pilots and Evaluations to Fill Evidence Gaps

What kinds of data do consumers/patients want, and how do we get it?

What display format is most effective?

How can we maximize consumer engagement (what timing, what type of medium, etc.)

How does the impact of a public report vary depending on other incentives and market forces such as payment strategy, market competitiveness, and payment?

#2 Form User’s Group: CMS, States, Consumers, CVEs, other Community

Initiatives

Aligning Forces for Quality

Other NRHI Members

Chartered ValueExchange

Beacon Communities Other Collaboratives

#3 Facilitate Use of New Evidence

Enhance National Quality Measures Clearinghouse Establish a coordinating center to

– Distill and synthesize existing evidence on “what works” in public reporting and under what circumstances.

– Identify promising advances in website design and medium of public reporting.

– Identify promising advances in the content of websites and other public reporting.

– Facilitate collaboration across grant sites and dissemination of early findings.

Enhance MONAHRQ– Report new measure set– Add or refine reporting features– Enhance use and usability

Questions and Discussion:Science of Public Reporting Initiative

Building the Science: – What are highest priority key questions,

issues? How to balance need for comprehensiveness and speed?

User’s Group:– What are most important stakeholders?

How to keep the group representative yet manageable in size?

Facilitate Use:– How to balance tension between need for

consistent national measures and need/desire for local innovation?