measuring and reporting performance data through health it ahrq annual meeting
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Measuring and Reporting Performance Data Through Health IT
AHRQ Annual MeetingWednesday September 26, 2007
A. John Blair, III, MDPresident, Taconic IPA
Evolution Process incentives/Claims data Structure incentives
IT adoption and usage NCQA/POL
Outcomes incentives/Clinical data
Process Incentives/Claims Data
2000 2004 20082006 20102002
Report Developme
nt
Transparency
Multi-PayerP-4-P Project
Single Payer P-4-P Project
Physician Feedback and Communication Efforts
Physician Reports
Single Payer P-4-P
Transparency
Multi-Payer Reports
Multi-Payer Reports
Physician Feedback & Communication Medical Council
PCP Specialty Clinical leadership Strong quality focus
Initial report feedback Individual Group
Monthly Newsletter Physician comment period prior to incentive
payments
Structure Incentives
2000 2004 20082006 20102002
NCQA/PPC
eRx
Community Viewer
Clinical Messaging
Physician Feedback and Communication
EHR
THINC RHIO, Quality Committee
NCQA Physician Practice Connections Access / Communication Patient tracking / Registries Care management Self management support Electronic prescribing Test tracking Referral tracking Performance reporting & improvement Interoperability
THINC RHIO, Quality Committee Activities
Determine performance measures Promote standards
• HIE• Measure metrics
Coordinate payment incentives Committee composition
Physicians Hospitals Health plans Quality measures experts
Claims vs. Clinical Reporting Uninsured not captured Services delivered, not health outcomes Non-reimbursable services not captured Inaccuracy due to income maximization Difficult to risk adjust (severity, stage) Lack of continuity with one health plan Fragmented health care market (and claims) Provider resistance
Advantages of EHR-Based Measurement Better data than claims-based
More detailed clinical data (e.g. BP) More scalable than chart-reviews
Faster, cheaper Greater sample size allows better provider
comparisons Greater precision for encounter-level analyses
Paradigm shift CDSS Registry Measure
Challenges of EHR-Based Measurement
Structured data elements may not exist in EHR
Data elements not standardized (e.g. lab codes)
Outside data not available (e.g. hospitalizations)
Decision Support Tools Focus on THINC RHIO measures Passive & active alerts and reminders
Wary of “alert fatigue” Minimal set Actionable Consonant with workflows, not disruptive
Not just alerts Order sets Templates Clinical knowledge Data presentation Process reengineering
“Not Just Alerts”
Practice workflow reorganization Structured data collection Registries and panel management Alternative visit types Team-based care Case management Patient education and self-
management
Questions?
A. John Blair, III, MDPresident, Taconic IPA
Thanks for your time!
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