1999 cas seminar on health and managed care hilton head island, sc october 18-19, 1999
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1999 CAS Seminar on Health and Managed Care Hilton Head Island, SC October 18-19, 1999. Intro - Shevlin. Benchmarking Measures and Quality Control Hilton Head Island, SC October 18-19, 1999. Overview on Healthcare Benchmarks. What? Why? Examples Sources Classifications. Planning - PowerPoint PPT PresentationTRANSCRIPT
CAS Seminar on Health and Managed CareBenchmarking Measures and Quality Control
October 18-19, 1999page 1
1999 CAS Seminar onHealth and Managed Care
Hilton Head Island, SCOctober 18-19, 1999
CAS Seminar on Health and Managed CareBenchmarking Measures and Quality Control
October 18-19, 1999page 2
Intro - Shevlin
Benchmarking Measures and Quality Control
Hilton Head Island, SCOctober 18-19, 1999
CAS Seminar on Health and Managed CareBenchmarking Measures and Quality Control
October 18-19, 1999page 3
Overview on Healthcare Benchmarks
• What?
• Why?
• Examples
• Sources
• Classifications
• Planning
• Limitations
• Analysis
• Application
• Discussion
CAS Seminar on Health and Managed CareBenchmarking Measures and Quality Control
October 18-19, 1999page 4
Healthcare Benchmarks - What are they? -- What are they? -
• “Gold standards”; target results
• Easily and reproducibly measured
• Pertaining to Financial or Clinical Outcomes
• Typically involve ratios
CAS Seminar on Health and Managed CareBenchmarking Measures and Quality Control
October 18-19, 1999page 5
• Used for Comparison and Quality Improvement
• “If you cannot measure, you cannot improve”
• To provide objective measures that will drive performance to a new level of excellence
Healthcare Benchmarks - Why Do We Need Them? -- Why Do We Need Them? -
CAS Seminar on Health and Managed CareBenchmarking Measures and Quality Control
October 18-19, 1999page 6
History of Efforts in Healthcare QualityHistory of Efforts in Healthcare Quality• Early years - physician esteem/ethics/peers
• 1980s - Utilization Management (UM)
• 1990s - Case/Care Management
• Now - Disease/Health Management
Healthcare Benchmarks - Why Do We Need Them Today? -- Why Do We Need Them Today? -
CAS Seminar on Health and Managed CareBenchmarking Measures and Quality Control
October 18-19, 1999page 7
• Apply evidence-based medicine
• Establish “Best Practice”
• Monitoring results: “Report Cards”
• Target “Intervention Strategies”
• Establish Value
Healthcare Benchmarks - Why Do We Need Them? -- Why Do We Need Them? -
CAS Seminar on Health and Managed CareBenchmarking Measures and Quality Control
October 18-19, 1999page 8
Improving healthcare:
• Services
• Process
• Outcomes
• Resources
Healthcare Benchmarks - Why Do We Need Them? -- Why Do We Need Them? -
CAS Seminar on Health and Managed CareBenchmarking Measures and Quality Control
October 18-19, 1999page 9
Healthcare Benchmarks - Clinical Examples -- Clinical Examples -
Mortality - Unequivocal? - Clinical v.s. cost implication- Certain diseases and surgeries- Must be severity risk adjusted
Morbidity - Tests (lab)- Vitals signs- Physical findings (disease classes)- Trends- Manual records extraction is expensive
CAS Seminar on Health and Managed CareBenchmarking Measures and Quality Control
October 18-19, 1999page 10
Healthcare Benchmarks - Clinical Examples -- Clinical Examples -
Prevention• Primary
- Screenings/Immunizations• Secondary
- Drugs/ServicesClinical Guidelines
- Diagnostics/Therapeutics- Inappropriate
Complications - Medical/Surgical
CAS Seminar on Health and Managed CareBenchmarking Measures and Quality Control
October 18-19, 1999page 11
Healthcare Benchmarks - Other Examples -- Other Examples -
Financials - Dollars - Resources
Perception / Satisfaction / Patient Self-Assessment - Functional status- Access to care- Waiting times, time to return calls- Quality of life- In areas of concern to the patient
Proxy Measures - Length of stay - Number of visits/services/readmissions
CAS Seminar on Health and Managed CareBenchmarking Measures and Quality Control
October 18-19, 1999page 12
Intro - Shevlin
Asthma
CAS Seminar on Health and Managed CareBenchmarking Measures and Quality Control
October 18-19, 1999page 13
• Medical & pharmacy claims data• Laboratory data• Electronic medical records• Hospital information systems• Utilization review & incident reports• Surveys & direct observation• Proxy Measures: LOS, visits (billing)
Healthcare Benchmarks - Sources: for Data -- Sources: for Data -
CAS Seminar on Health and Managed CareBenchmarking Measures and Quality Control
October 18-19, 1999page 14
0
20
40
60
80
100
0% 25% 50% 75% 100%
Healthcare Benchmarks - Sources: Market Characteristics -- Sources: Market Characteristics -
CAS Seminar on Health and Managed CareBenchmarking Measures and Quality Control
October 18-19, 1999page 15
Drivers Drivers – Purchasers
– Comparatives among suppliers
– Financial and quality objectives
– Lacking knowledge and/or resource for measures and outcomes
Healthcare Benchmarks - Sources: Accreditation/Measurements -- Sources: Accreditation/Measurements -
CAS Seminar on Health and Managed CareBenchmarking Measures and Quality Control
October 18-19, 1999page 16
Healthcare Benchmarks - Sources: The Accreditation Industry -- Sources: The Accreditation Industry -
OrganizationsOrganizations•The “Joint Commission” on Accreditation of Healthcare Organizations (JCAHO)•National Committee for Quality Assurance (NCQA)•Accreditation Association for Ambulatory Health Care (AAAHC)•Utilization Review Accreditation Commission (URAC)
CAS Seminar on Health and Managed CareBenchmarking Measures and Quality Control
October 18-19, 1999page 17
OrganizationsOrganizations• Foundation for Accountability (FACCT)• University of Wisconsin• University of California• Association for Healthcare and Policy
Research (AHCPR)
Healthcare Benchmarks - Sources: The Measurement Industry -- Sources: The Measurement Industry -
CAS Seminar on Health and Managed CareBenchmarking Measures and Quality Control
October 18-19, 1999page 18
Review Review
– Customers care about “value”
– Suppliers care about customers
– Third parties make it happen
Healthcare Benchmarks - Sources -- Sources -
CAS Seminar on Health and Managed CareBenchmarking Measures and Quality Control
October 18-19, 1999page 19
• CodesCodes – ICD
– CPT
– DRG
Healthcare Benchmarks - Classifications -- Classifications -
• GroupersGroupers – MDCs
– ACGs
– DCGs
CAS Seminar on Health and Managed CareBenchmarking Measures and Quality Control
October 18-19, 1999page 20
• Relevant Outcomes (desirable or not)
• Measurable (reproducibly)
• Impact Sensitive
• Achievable
• Return on Investment
Healthcare Benchmarks - Planning: Choosing the Right Ones -- Planning: Choosing the Right Ones -
CAS Seminar on Health and Managed CareBenchmarking Measures and Quality Control
October 18-19, 1999page 21
• Time Requirements
• Volume Requirements
• Scope Management
• Buy-In
• Realistic, Incremental Goals
Healthcare Benchmarks - Planning: Achievability -- Planning: Achievability -
CAS Seminar on Health and Managed CareBenchmarking Measures and Quality Control
October 18-19, 1999page 22
• General – Case matched
– Temporal issues
• Internal– Most similar
– Randomized
Healthcare Benchmarks - Planning: Controls -- Planning: Controls -
• External– Availability/Quality
– Industry ‘Best Practice’
– Improvement priorities
– Historical perspective
CAS Seminar on Health and Managed CareBenchmarking Measures and Quality Control
October 18-19, 1999page 23
Intro - Shevlin
Don’t Forget to Plan
Don’t Forget to Update
CAS Seminar on Health and Managed CareBenchmarking Measures and Quality Control
October 18-19, 1999page 24
• Regularly (annually)
• New measurement or coding procedures
• New technology or diagnostics
• New therapeutic modalities or interventions
Healthcare Benchmarks - Planning: Reevaluation -- Planning: Reevaluation -
CAS Seminar on Health and Managed CareBenchmarking Measures and Quality Control
October 18-19, 1999page 25
• Population drift/differences
• Environmental issues
• Collection process/irregularity
• Storage process/irregularity
• Integrity indicators
Healthcare Benchmarks - Data Limitations -- Data Limitations -
CAS Seminar on Health and Managed CareBenchmarking Measures and Quality Control
October 18-19, 1999page 26
• Data limitations
• Barriers
• Be suspicious– Skewed or broken axes
– Missing data
– Sub-populations
– Undisclosed methods
Healthcare Benchmarks - Analysis -- Analysis -
CAS Seminar on Health and Managed CareBenchmarking Measures and Quality Control
October 18-19, 1999page 27
• Physicians do not need more medical school
• Practice Guidelines and Outcomes Data
• Benchmarks and Peer Profiling
• Physicians do not like to be outliers
• Physicians are uncomfortable with change
Healthcare Benchmarks - Application: How to make it work -- Application: How to make it work -
CAS Seminar on Health and Managed CareBenchmarking Measures and Quality Control
October 18-19, 1999page 28
Intro - Shevlin
“If You Can Not Measure, You Can Not Improve”