1 community partnerships in quality-based purchasing roy plaeger-brockway, mpa senior program...
TRANSCRIPT
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Community Partnerships in Quality-Based Purchasing
Roy Plaeger-Brockway, MPASenior Program ManagerHealth Services Analysis
Washington State Labor & IndustriesOlympia, Washington
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Objectives
Describe two Washington State pilots Explain how pilots encourage community
based quality improvement Share results of pilots based on a University
of Washington evaluation Discuss lessons learned
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Background
L&I is a state workers’ compensation insurer Purchase $500 million of health care a year Quality of care is a top priority To improve care we engaged our customers
in designing two community-based quality improvement pilots
Centers of Occupational Health & Education 700 participating doctors 20,000 patients a year
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What was the problem?
Difficult for purchaser to influence quality Doctors with imperfect knowledge about work related
conditions No incentives for physicians to adopt occupational
health best practices
No infrastructure for community-wide disability prevention Delivery system not organized to prevent disability Lack of care coordination No education or feedback for doctors No information systems to track clinical data Not using data for health care quality improvement
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What was the solution?
Develop a community-based infrastructure Local centers and experts to provide education and support
to community physicians Health services coordinators
Align payment incentives to support quality Enhanced payment linked to quality indicators to encourage
use of occupational health best practices
Improved work force training Free CME and individualized physician training and support
More effective use of information technology Patient tracking tool with reminders and alerts
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Two providers chosen with RFP
Valley Medical CenterInland Northwest Health Services
St. Luke’s Rehab Institute
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Community-based modelsupports use of best practices
PilotCommunity
Health System
Community Physicians
State Insurer CustomerAdvisors
• Education & reminders
• Patient tracking tools
• Health services coordinators
• Payment linked to quality indicators
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Design of quality measures
Review evidence Develop seed measures (best practices) Share with practicing physicians Rank with physician leaders Establish payment levels and billing codes Develop quarterly reporting to track progress
on measures based on billing codes
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Best practices with incentives
Submit accident report within 2 days Document worker’s physical status and
limitations at each visit Contact the worker’s employer about return to
work options Assess barriers to return to work at 4 weeks
of lost time
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Example of a best practice
“Activity Prescription” Use at patient visit Script best practices Document employment issues
Work status Employer contact Light duty accommodation
Set patient expectations
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Renton
E WA
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Increased adoption of best practice
Percent of Claims Where Doctors Used Best Practice (Physical Status Form)
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Evaluation of Western WA COHE
Disability outcomes Incidence was 17.8% vs. 23.7% for control Workers on time loss at 6 months was 15.1% vs. 18.9% Workers on time loss at 12 months was 7.4% vs. 9.4%
Costs Medical costs were $1,785 per claim vs. $2,167 Disability costs were $711 per claim vs. $1,209
Satisfaction Patient satisfaction was equal to control group Physicians reported greater willingness to work with injured
workers
Based on 10,000 claims
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Evaluation of Eastern WA COHE
Disability outcomes Incidence was 15.1% vs. 21.5% for control Workers on time loss at 6 months was 20.5% vs. 20.4% Workers on time loss at 12 months was 10.2% vs. 9.7%
Costs Medical costs were $1,643 per claim vs. $2,138 Disability costs were $610 per claim vs. $930
Satisfaction Patient satisfaction was equal to control group Physicians reported greater willingness to work with injured
workers
Based on 10,000 claims
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Overall results
University of Washington evaluation shows: Reduced incidence of disability Improved patient outcomes Lower medical and disability costs High patient satisfaction Improved physician satisfaction
Overall savings $441 per claim Western WA $359 per claim Eastern WA
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Lessons Learned
Community-based partnerships between purchaser and health care leaders help:
Create infrastructure needed to improve quality and outcomes
Foster physician support for solutions by involving local leaders in program design and development
Place responsibility for quality improvement within the local marketplace, which increases adoption
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Lessons Learned
Physicians are willing and able to adopt best practices and improve quality when they have:
Local institutional support from clinical leaders Incentives for use of best practices Health services coordinators Better information tools and education Reduced administrative burden Reminders and academic detailing
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2001 IOM Report: Crossing the Quality Chasm - Similarities
Institute of MedicineInstitute of Medicine Washington State PilotWashington State Pilot
Design more effective organizational support
Local centers and experts to provide education and support
Create infrastructure to support evidence-based practice
Free CME for doctors and assistance from health services coordinators
More effective use of information technology
Patient tracking tool with reminders and alerts
Alignment of payment incentives to support quality
Enhanced payment linked to quality indicators
Improved work force training Individualized physician training