sarah hudson scholle assistant vice president, research june 7, 2008 opportunities for improving...

Sarah Hudson ScholleAssistant Vice President, Research

June 7, 2008

Opportunities for Improving Quality Opportunities for Improving Quality Measurement in Women’s Health Measurement in Women’s Health

© 2008 National Committee for Quality Assurance

Agenda

• NCQA• Current quality measures of

particular interest to women • Opportunities for the future


NCQA: Mission and Vision

• Mission– To improve the quality of

health care • Vision

– To transform health care through measurement, transparency and accountability


• Over 500 plans report HEDIS data to NCQA (Commercial, Medicaid, Medicare)

• Over 200 commercial MCO plans are accredited by NCQA

• Over 75 Medicare Advantage plans are accredited by NCQA (more than any other accrediting body)

• Over 76.5 million patients are impacted through the plans NCQA accredits

• Over 10,000 physicians are recognized by NCQA programs

Achieving the MissionImpact of Accreditation & Certification

Programs


HEDIS® - Effectiveness of Care

• Prevention– Breast cancer screen– Cervical cancer screen– Colon cancer screen– Immunizations for

Children and Adults– Chlamydia screen– Glaucoma– Physical Activity– Falls risk management– BMI

• Chronic disease– Hypertension– Diabetes – Cardiovascular disease– Smoking cessation– Osteoporosis testing– Asthma– Depression – Urinary incontinence– Follow up after mental

illness hospitalization– Medication management– High risk medications

• Overuse/Misuse– Imaging in low back

pain– Use of antibiotics

• Relative Resource Use


Access & Utilization

• Frequency of Ongoing Prenatal Care – Reports an unduplicated count of deliveries who had <21 percent,

21–40 percent, 41–60 percent, 61–80 percent or ≥81 percent of the number of expected visits, adjusted for the month the member enrolled and the MCO and gestational age.

• Prenatal and Postpartum Care– Timeliness of Prenatal Care. The percentage of deliveries that

received a prenatal care visit as a member of the MCO in the first trimester or within 42 days of enrollment in the MCO.

– Postpartum Care. The percentage of deliveries that had a postpartum visit on or between 21 and 56 days after delivery.

• Retired– Discharges and ALOS—Maternity Care (including C-section rate)– Births and ALOS, Newborns


NCQA Physician Recognition Programs

• Identify physicians whodeliver superior care

• Measure against evidence-based standards

• Assess for diabetes, heart/stroke and back pain care, and evaluate office systems

• Publicly report Recognized physicians

• Encourage purchasers, plans and patients to reward Recognized physicians

• More than 10,000* physicians Recognized

*As of March 21, 2008

5,285*physicians

1,431*physicians

3,456* physicians

273* practices

35*physicians

5* practices


Physician Practice Connections (PPC)• Developed in Response to a Need

– To Err is Human and Crossing the Quality Chasm provide evidence on importance of practice systems

– Raise physician awareness of importance of systems in enhancing quality

– Link health services research on systems and clinical outcomes to practice

• Measures – Systematically provide preventive and

chronic care management – Actionable at physician practice level– Validated by relating them to performance


Theoretical Frameworks Informing Physician Practice Connections

Chronic Care Model

Patient Centered Care

Cultural Competence

Joint Principles of Medical

HomeClinical information

SystemsDecision SupportPatient Self-

ManagementDelivery System

RedesignCommunity LinkagesHealth Systems

Respect Patient ValuesAccessible Family-Centered Continuous Coordinated Community LinkagesCompassionate Culturally Appropriate Emotional Support Information and

Education Physical ComfortQuality Improvement

Culturally competent interactions

Language services

Reducing disparities

Personal physicianPhysician directed

teamWhole person

orientationCare is coordinated

and integratedQuality and safetyEnhanced access


PPC-PCMH Content and ScoringStandard 1: Access and CommunicationA. Has written standards for patient access and

patient communication**B. Uses data to show it meets its standards for

patient access and communication**

Pts

45

9

Standard 2: Patient Tracking and Registry Functions A. Uses data system for basic patient information

(mostly non-clinical data) B. Has clinical data system with clinical data in

searchable data fields C. Uses the clinical data system D. Uses paper or electronic-based charting

tools to organize clinical information**E. Uses data to identify important diagnoses

and conditions in practice**F. Generates lists of patients and reminds patients

and clinicians of services needed (population management)

Pts

2

33

64

3

21

Standard 3: Care ManagementA. Adopts and implements evidence-based

guidelines for three conditions **B. Generates reminders about preventive services

for clinicians C. Uses non-physician staff to manage patient care D. Conducts care management, including care plans,

assessing progress, addressing barriers E. Coordinates care//follow-up for patients who

receive care in inpatient and outpatient facilities

Pts

3

4

35

5

20

Standard 4: Patient Self-Management Support A. Assesses language preference and other

communication barriersB. Actively supports patient self-management**

Pts

24

6

Standard 5: Electronic Prescribing A. Uses electronic system to write prescriptions B. Has electronic prescription writer with safety

checksC. Has electronic prescription writer with cost

checks

Pts33

2

8

Standard 6: Test Tracking A. Tracks tests and identifies abnormal

results systematically** B. Uses electronic systems to order and retrieve

tests and flag duplicate tests

Pts7

6

13

Standard 7: Referral Tracking A. Tracks referrals using paper-based or

electronic system**

PT4

4

Standard 8: Performance Reporting and Improvement

A. Measures clinical and/or service performance by physician or across the practice**

B. Survey of patients’ care experience C. Reports performance across the practice

or by physician **D. Sets goals and takes action to improve

performance E. Produces reports using standardized

measures F. Transmits reports with standardized measures

electronically to external entities

Pts

3

33

3

21

15

Standard 9: Advanced Electronic Communications A. Availability of Interactive Website B. Electronic Patient Identification C. Electronic Care Management Support

Pts121

4

**Must Pass Elements


PCMH Must Pass Elements1. PPC1A: Written standards for patient access and patient

communication

2. PPC1B: Use of data to show meeting this standard

3. PPC2D: Use of paper or electronic-based charting tools to organize clinical information

4. PPC2E: Use of data to identify important diagnoses and conditions in practice

5. PPC3A: Adoption and implementation of evidence-based guidelines for three conditions

6. PPC4B: Active support of patient self-management

7. PPC6A: Tracking system to test and identify abnormal results

8. PPC7A: Tracking referrals with paper-based or electronic system

9. PPC8A: Measurement of clinical and/or service performance

10. PPC8C: Performance reporting by physician or across the practice


Priorities

• Composite measures– Prenatal and postpartum care– Child well care

• Coordination/Continuity– Transitions across settings – Primary and specialty care– Medication reconciliation

• Overuse• Disparities


Gender Disparities Notably Absent in Blood Pressure, Diabetes Control

Measures

CVD: Cholesterol

Control

White Males

African-American Males

African-American Females

White Females Blood Pressure Control

White MalesWhite Females



Diabetes: Poor A1c Control

(Lower is better)

White MalesWhite Females



10

20

30

40

50

60

70

Un

ad

jus

ted

Rat

e (

%)


Voluntary Accreditation Standards on Culturally and Linguistically Appropriate

Services (CLAS)• Project designed to develop consensus-based

standards for addressing cultural competence, language needs and disparities for health plans, DMOs and MBHOs

• Activities include – Analysis of current state and federal rules – Assessment of market opportunities– Development of draft standards with input from

stakeholder advisory panel– Testing of standards

• Goal is to have standards ready for public comment by December 2008 with final standards by April 2009

• Supported by The California Endowment

sarah hudson scholle assistant vice president, research june 7, 2008 opportunities for improving...

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