Looking into Healthcare Reform:

Assuring Quality in Health Care

University of St. ThomasOctober 20, 2009

Jennifer P. Lundblad, PhD, MBAStratis Health

In This Session:

Improve our understanding of the current state of health care quality,

and how federal and state health reform efforts affect health care

quality and patient safety.

Who is Stratis Health?

• Independent, nonprofit, community-based Minnesota organization founded in 1971– Guided by 13-member Board of Directors

• Leads collaboration and innovation in health care quality and safety, and serves as a trusted expert in facilitating improvement for people and communities

• Funded by federal and state contracts, corporate and foundation grants

Health Reform Through the Quality Lens

At Stratis Health, our view is through the quality and patient safety lens.

Through this lens, we are studying and engaging on health reform with the framework that asks 4 questions in evaluating health reform ideas and actions.

The Quality Lens

• From the quality and patient safety perspective, four questions to ask in evaluating health reform ideas:– Increase access?– Reduce disparities?– Increase value?– Incent ‘right’ actions?

Does this idea or proposal increase access to health care services?• Strong correlation between health care access

and quality, enabling care to be delivered in the most appropriate setting based on medical needs and patient preferences.

• A health system that proactively promotes health and health care for everyone rather than only reactively treating illness and disease contributes to quality and patient safety.

Does this idea or proposal improve disparities in health care?

• Equity is closely linked to access, but we believe is worth calling out separately when evaluating health reform proposals, and considering whether disparities – by race, ethnicity, or language, or by socioeconomic status, or by geographic locale – are addressed and reduced in any given proposal or idea.

Does this idea or proposal improve health care value?

• Cost on its own is a tempting factor in reviewing the merits of health reform ideas, but it is really value – the relationship between cost and quality – that is the true indicator of whether health and health care are improved.

• Health reform proposals need to accurately assess not only the cost of health care, but what benefit is gained in terms of quality.

Does this idea or proposal encourage us to ‘do the right thing’?• Need to encourage and support patients to be

actively involved in their health care, to use data for informed decision-making, and to be proactively engaged in healthy behaviors.

• Need clinicians and provider organizations to be encouraged and assisted to use the most current evidence-based best practices, to approach their patients as partners, and to maximize positive quality outcomes and experiences of care.

But first…

• What is the current state of quality in Minnesota?– Generally very good compared to other states:

• AHRQ dashboard on health care quality puts Minnesota at a “Strong” rating compared to other states.

• Medicare Compare report cards show Minnesota providers are better than average, and often best in the nation

• Minnesota ranks # 4 among all states in the most recent “America’s Health” ranking by United Health Foundation

• And how can we know more?

Minnesota:Nursing Home Report Card• Co-led by state Medicaid agency (DHS) and

state health department (MDH)– Includes information on quality of life ratings, MN

quality indicators, staff retention, state inspection results, and more

• Milestones– Web site launched January 2006:

• http://www.health.state.mn.us/nhreportcard/

– State now using data for Pay for Performance

Minnesota:MN Hospital Quality Report

• Co-led Stratis Health and Minnesota Hospital Association– Includes information on care delivered in Minnesota’s

hospitals

• Milestones:– Web site launched April 2006:

• www.mnhospitalquality.org

– Appropriate Care Measures (all-or-none patient centered measure) for heart failure, pneumonia, and heart attack added in December 2006

– Surgical care measures added in April 2007– Patient experience of care measures and mortality measures

added in 2008

Minnesota:Hospital Adverse Events Report• MN legislature passed first-in-the-nation

adverse events law in 2003, implemented by MN Department of Health– Mandated hospital reporting of NQF’s 28 “never

events” (including root cause analyses and corrective action plans) for learning purposes

• Milestones– 5rd report released January 2009 with hospital-specific

results• www.health.state.mn.us/patientsafety

– Focused work done in: falls, pressure ulcers

Minnesota:Minnesota Health Scores

• Led by MN Community Measurement – Report measures of quality of clinics and medical groups

• Milestones– Annual public reporting of quality and performance

• www.mnhealthscores.org

– Includes measures such as diabetes care, asthma care, cancer screening rates, immunization rates, depression care, patient experience

Observations and Issues

• In the past 3-5 years, MN has gone from a laggard to a leader in publicly reporting health care performance data

• Many good efforts in place, but they still reflect the silos of health care delivery– Can future measurement go beyond setting-based

measures to reflect care across the continuum as a patient experiences health care?

• A multitude of data reporting Web sites– Confusion? Comparability of data?

Observations and Issues (cont.)

• How we are doing on the big picture goals for transparency?– Effective at bringing the attention of health care leaders to

quality and patient safety, and driving improvement? Yes!– Helping consumers be more informed decision makers and

activated patients? Not yet, and much more to be done to understand how quality data can be meaningful to consumers and patients.

– Effectively helping get us where we want to be as a system (better quality and safety, value, 6 IOM aims)? Too early to tell?

Converging Forces in Quality…

• Transparency and public reporting• Pay for performance and value-based

purchasing• Health Information Technology (HIT)• Engaging boards/trustees in quality and

safety• Consumerism (or not…)• General dissatisfaction about cost and quality

of health care

Converging Forces in Politics…• New President and Democratically-dominated

Congress with five health reform bills currently on the table

• Nearly every national health care trade association and professional society and almost all health care purchaser associations lined up with a plan for reform

• State legislatures actively engaged in improving health care quality and lowering costs

Converging forces…

Could these converging forces – in quality, and in politics -- create a

window of opportunity for true health reform?

If yes, what are the implications for health care quality and patient

safety?

Federal Health Reform Components Related to Quality

• Shifting from delivery, measurement and payment in silos, to more comprehensive and patient-centered approaches, such as:– Accountable Care Organizations– Medical Homes– Bundled payments

• Better and increased quality measure reporting to the public, and incentive payments for improving quality

Federal Health Reform Components Related to Quality (cont.)• Reducing potentially preventable hospital

admissions• Reducing health disparities

– Promoting cultural competence and improving language access

• Studying the geographic adjustment factors in Medicare– An issue especially important to the Minnesota

Congressional delegation

Minnesota Health Care Reform Initiative

• Statewide Health Improvement Program (SHIP)• Health care homes• Payment reform, quality measurement, and

cost/quality transparency• Insurance coverage and affordability• eHealth

http://www.health.state.mn.us/healthreform/

Minnesota:SHIP

• SHIP will improve health and reduce demands on the health care system by decreasing the percentage of Minnesotans who are obese or overweight or use tobacco.

Minnesota:Health Care Homes

• Minnesotans with complex or chronic conditions will receive coordinated care through health care homes. These “homes” are not facilities; they are systems that promote coordinated care from a team of health care providers focusing on common goals.

Minnesota:Reporting and Incentives

• These parts of the health reform bill are aimed at making sure the right financial incentives are in place to encourage changes in health care that reduce cost and improve quality. The reforms will make available more information for consumers on health care cost and quality and begin to change the way that health care providers are paid.

Minnesota:Coverage and Affordability

• The bill makes it easier for people to get information about state health care programs, promotes the use of Section 125 plans for employees to buy health insurance with pre-tax money, and requires reports to the Legislature on subsidies for employer-based health insurance coverage and value-based benefit sets.

Minnesota:eHealth

• Legislates a state mandate that all health care providers have interoperable electronic health records by 2011, establish uniform health data standards by 2009, develop a statewide plan to meet the 2015 mandate, and have an electronic prescription drug program by January 2011.

Could these converging forces – in quality, and in politics -- create a

window of opportunity for true health reform?

If yes, what are the implications for health care quality and patient

safety?

• We look forward to continuing to be actively involved in dialogue, planning, and action in transforming our health system to be the safest and highest

quality possible.

Contact Information

Jennifer P. Lundblad, PhD, MBAPresident and CEO

Jlundblad@stratishealth.org

Stratis Health is a non-profit organization that leads collaboration and innovation in health care quality and safety,

and serves as a trusted expert in facilitating improvement for people and communities.