using patient experiences surveys in health plan and practice evaluation sarah hudson scholle...

Using Patient Experiences Surveys in Health Plan and Practice Evaluation

Sarah Hudson ScholleAssistant Vice President, Research

AHRQ 2009 Conference September 15, 2009

2AHRQ Research Conference9/15/09

Agenda

• NCQA• Health plan accreditation model

and CAHPS• Incorporating patient experiences

surveys into evaluation of physician practices


• Private, independent non-profit health care quality oversight organization founded in 1990

• Committed to measurement, transparency and accountability

• Unites diverse groups around common goal: improving health care quality

NCQA: A Brief Introduction


NCQA Health Plan Accreditation

• Key Components– Rigorous on-site review of key systems and

processes – Evaluation of clinical performance through

HEDIS® measures– Member experience surveys - CAHPS® 4.0H

for adults and children


NCQA ACCREDITATION: BASED ON PERFORMANCE

Clinical Performance(HEDIS)

Member Experience(CAHPS) + = 43%

Health Plan Systems(Accreditation Standards)

= 57%

Accreditation is Performance-based:NCQA Accreditation is the only health plan Accreditation that

requires reporting on clinical performance


What is NCQA’s HEDIS?

The Healthcare Effectiveness Data and Information Set:

• Process and outcomes measures

• Standardized member experience surveys

• Used by commercial, Medicare, and Medicaid plans alike

• Allows plan-to-plan comparisons by quality, not just by price


CAHPS® 4.0H Surveys Development and Reporting

• Quality Compass® (plan-to-plan comparisons)

• State of Health Care Quality Report• National CAHPS Benchmarking

Database (NCBD)• Other products—report cards,

Quality Dividend Calculator, etc.


• >14,000 physicians Recognized nationally across all Recognition programs

• Clinical programs– Diabetes Recognition Program (DRP)– Heart/Stroke Recognition Program (HSRP)– Back Pain Recognition Program (BPRP)

• Medical practice process and structural measures– Physician Practice Connections – Physician Practice Connections-Patient-Centered

Medical Home (PPC-PCMH)

NCQA Recognition Programs

7534 physicians*

2072 physicians*

3440 physicians*254 practices*

121physicians*24 practices*

1001 physicians*178 practices*

* As of 7/31/09


Goals forPhysician Practice Connections (PPC)• Evaluate systematic approach to delivering

preventive and chronic care (Wagner Chronic Care Model)

• Build on IOM’s recommendation to shift from “blaming” individual clinicians to improving systems

• Create measures that are actionable for physician practices

• Validate measures by relating them to clinical performance and patient experience results


Theoretical Frameworks Informing Development of PPC-PCMH

Based on best available empiric evidence in each area and on testing of reliability and validity of elements in field tests using on site audit as “gold”

standard

Chronic Care Model

Patient Centered Care

Cultural Competence

Medical Home

Clinical information Systems

Decision 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

PRIMARY CAREFirst contact-comprehensive-continuous-coordinated


Adapting PPC for thePatient-Centered Medical Home

• New PPC-PCMH version released in January 2008– Aligned standards with Joint Principles– Incorporated critical attributes of PCMH – Defined foundational elements (“must pass”

requirements)

• PPC-PCMH endorsed by ACP, AAFP, AAP, AOA, other specialties and PCPCC for use in demos

Endorsed by National Quality Forum Sept 2008 (as “Medical Home System Survey”)


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


Examples of Initiatives Using PPC-PCMH

•Multi-payer - Colorado, Pennsylvania, Rhode Island

•State-wide – Pennsylvania, Vermont, Maine

•Single payer – EmblemHealth, Humana

•Government – Medicare, New York City, Louisiana


“Measures of

Meaningful Use” inside

• How to further assess patient-centeredness, including patient survey results?– How to engage patients?– How to make name resonate positively?

• When should performance results be part of scoring?

• How to adapt to promote quality and cost gains across settings?– Primary care—subspecialty– Physician—hospital, other facilities

• How to streamline requirements, documentation?– For all practices– For practices renewing

Significant PPC-PCMH Issues for Future


Timeline, Evolution of PPC-PCMH

2009 2010

ConveneAdvisoryCommittee;develop draftchanges

Solicitinput:Website,calls, meetings

Reviewdraftchangeswith CPP;Public Comment

AdvisoryCommitteeRec’s

CPP, BODapproval

Oct April July Oct Dec


Barriers to Incorporating Patient Experiences Results

• Lack of agreement on core content• Whether existing tools are able to

detect change in performance • The burden of conducting patient

experiences surveys• Conflicting priority of accountability

versus quality improvement goals• Structure/process versus outcome

scoring


Aims of Proposed Research

• Identify a core set of survey items • Explore feasibility of alternative

sampling and other data collection strategies

• Examine the impact of alternative scoring approaches in blending results from the PPC-PCMH and patient experience surveys


Getting to Core Set of Measures

• Identify possible domains/items– Access– Communication– Coordination– Shared decision-making– Self Management – Whole person orientation

• Ranking exercise involving broad stakeholder participation

• Review of psychometric properties• Recommendations to PPC-PCMH review

panel


Getting to Standardized Data Collection

• Profiles of existing efforts to collect, analyze and report patient experiences survey results – Purpose of survey– Unit of Analysis– Sampling – Data collection– Analysis– Quality assurance– Tool– Cost/Finance

• Review of literature on impact of different methods

• Recommendations to PPC-PCMH review panel


Summary

• Patient’s views are critical to evaluations of health care, both at health plan and physician level

• Standardized tools and methodology needed to allow fair, national comparisons

• Feasibility and relevance to key stakeholders must be addressed


For more information:

Sarah Hudson Scholle, MPH, [email protected]

202 955 1726

http://www.ncqa.org

using patient experiences surveys in health plan and practice evaluation sarah hudson scholle...

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