How Do We Give Consumers Informed. Kristine Thurston Toppe Director, State Affairs

Transcription

1 Quality Measurement at the Network Level: How Do We Give Consumers Informed Choice? CAHP A l M i O b CAHP Annual Meeting, October 23, 2013 Kristine Thurston Toppe Director, State Affairs

2 Key Takeaways Consumers understand and want information on quality and cost to get the most for their healthcare dollar Exchanges will provide valuable push toward more quality and cost data Plans competing on cost and quality will have greatest success Quality measurement is happening but we still have a long way to go

3 Overview Current examples: Public reporting provider-level data: California P4P via Office of the Patient Advocate Aligning Forces for Quality sites Seal of approval: provider/practice recognitions (e.g. PCMH) Value Judgment: Findings from California consumer focus groups on understanding of cost and quality information & recommendations for messaging

4 Public Reporting Efforts: AF4Q Humboldt: Publicly Reporting on the Performance of Health Care Providers To improve quality, we need better information about the performance of health care providers. Since you cannot improve what you do not measure, Aligning g Forces Humboldt provides online reports that compare how local medical offices and hospitals perform on various aspects of care. Clinical Results - Massachusetts Health Quality Partnership Clinical Results - Patient Experience: p

5 Humboldt AF4Q: Measures

6 Humboldt AF4Q: Scores

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9 Seal of Approval: Patient-Centered Practice Recognition For consumers - Encouraging enrollees to get PCMH care Lower cost sharing Feature PCMHs in provider directories i Educate enrollees on benefits of coordinated care For providers recognition incented through: Pay for Performance Base PCMH payments on Recognition levels Sponsor practices to become PCMH Cover PCMH Recognition costs/provide TA Deem PCMHs for Meaningful Use As practices, not just individual providers Build into permanent Medicare doc fix

10 NCQA Patient Centered Medical Homes America s #1 PCMH Program Growth Since Sites Clinicians Dec. 08 Dec. 09 Dec. 10 Dec. 11 Dec. 12 Sept. 13

11 Patient-Centered Specialty Practice Recognition PCSP: New PCMH-like program for specialty practices meeting rigorous standards for care coordination across settings: Timely access to care Consultation with primary care providers Managing care for individuals & population Written agreements for coordinating with primary care and other providers/facilities Aligned with Meaningful Use ncqa.org/programs/recognition/patientcenteredspecialtypracticepcsp.aspx

12 Need for Better Primary- Specialty Care Coordination Over half of all outpatient physician visits are with specialists (2004, Machlin and Carper, AHRQ, 2007) Typical PCP coordinates with 229 doctors in 117 practices (Pham et. al., Ann Int Med. 2009) Elderly on average see 7 doctors per year (Partnership for Solutions, Johns Hopkins Univ. 2002) One third of nonelderly are referred to a specialist each year (Forrest, Majeed, et al. BMJ 2002)

13 What Is Value in Health Care? Value = Quality Cost Two ways to improve value: Cheaper is not necessarily better value More costly is not necessarily better quality Better quality can prevent costly complications

14 California Consumers & the Value Proposition Key findings: Consumers with help can quickly understand that quality does not necessarily cost more and can cost less. Once understood, consumers are interested in using information when selecting a health plan or physician organization. People most interested are the uninsured who will be accessing health care coverage through the Exchanges. CHCF Issue Brief

15 Background Why did we do this research? NCQA sought to gain input from consumers to determine: Can consumers understand value (cost + quality)? Is cost and quality data actionable to consumers? What are some good ways of communicating cost and quality data and the relationship, or lack of, between the two? This effort was made possible through funding by the California Health Care Foundation.

16 Focus Group Findings Warm Up: What s important in selecting a primary care provider? How satisfied are you with the quality of care you receive? Findings: Access and communication emerge as important quality of care attributes. Being able to get an appointment talk to him on the telephone Listens to what you have to say attentive Explains what he s doing and why Most agreed the cost of care is very expensive, exorbitant and ridiculous. i Consistent with other research

17 Focus Group Findings: Quality Quality Cost Relationship What types of things does your physician do to provide quality care? How important is the cost of your care? When you think about cost how do you describe its relationship with quality? Findings: The term cost of care generally defaults to a definition of personal out of pocket expenses. A majority are able to arrive at an understanding di of value (variances in cost vs quality) regardless of whether they consider cost out-of-pocket expenses or overall cost to the system. A few participants believe that a tradeoff exists with quality and cost.

18 Focus Group Findings: Quality Quality Cost Relationship Cont d A few are willing to accept mediocre care if it costs less. I live paycheck to paycheck I don t necessarily need the best care. I feel guilty when doctors spend too much time with me when I know other patients are waiting. I don t need the best doctor if an average one will cost me less.

19 Focus Group Findings Data Presentation Scale - Star Chart Which health plan / physician organization did you find most desirable and why? How important is this information to you? Most comprehensible display

20 Focus Group Findings Data Presentation Scale - Data Spectrum Which health plan / physician organization did you find most desirable and why? How important is this information to you? High Quality High Quality Low Cost High Cost Low Quality Low Cost Low Quality Low Cost A few detail-oriented participants preferred the data spectrum

21 Focus Group Findings Upon data presentation, a majority of participants clearly understood PO quality of care and cost: I would selected the physicians group who is high quality, low cost it s a no brainer. Importantly, some participant would be motivated to change based on the data: Where are these physicians located? I will change.

22 Focus Group Findings Participants highlighted the most important words or phrases from key messages: Messages that resonate most include personal costs implications, that is, Over-use increases the cost of care which is passed on higher premiums, deductibles, and co-pays. Terms such as avoid, keep out of the hospital, and generic drugs cause skepticism; a prevention and wellness focused language is suggested. Likewise, terms such as inappropriate are preferred over unnecessary. Including messages that validate a common feeling that health care is exorbitant may enhance engagement and expedite comprehension.

23 Focus Group Findings Message 1: The cost of health care is a concern for everyone. Quality care for [diabetes] means you receive the best care recommended d by your doctor but avoids unnecessary tests, t treatments, or medications. As most participants desire the best care and feel a conflict sometimes exists between procedures their doctors recommend and what health plans agree to pay, the inclusion of recommended by your doctor emerges as compelling. Avoids unnecessary tests, t treatments t t or medications introduces the value message for most participants, although a few feel their personal physicians would never recommend anything unnecessary unnecessary.

24 Focus Group Findings Message 2: Quality care for [diabetes] keeps you healthy with proactive recommendations that are preventative. Prevention lessens opportunities for sickness and can alleviate unnecessary complications. Prevention is a desired clinical approach and participants p find the related messages meaningful Message 3: Over-use of unnecessary tests, medications and treatments increases the cost of care, which is passed on to you in the form of higher insurance premiums, deductibles and copays. This statement is essential to participants comprehension of value. As the personal implications of cost resonate most strongly it creates a concrete understanding previously absent. Preferred Language

25 The Uninsured Higher awareness level of, and greater sensitivity to, the impact of health care value. Those who believed they d had unnecessary or repeat tests or visits to specialists saw it as a waste of time, and recognize the value concept more quickly. Uninsured focus group participants It [quality care] doesn t cost as much as we think. To get the best care at the best price that s the idea. We need to realize that we all pay more when doctors don t pay attention to what s needed

26 The Uninsured At the end of the discussion, participants were asked to create a list of questions Uninsured participants questions were related to the new healthcare reform: How will rates we pay be determined? Are pre-existing conditions covered? Do we have a choice of HMO or PPO? Will I get better care with this plan then I m getting for free? Who is running the new program? An NCQA representative in both Phases was brought in to answer questions.

27 Summary Findings Understand how to engage consumers in thinking about the value of health care. Initially many participants i t associated high h quality with high h cost. However once presented with the information, most drew on their personal experiences and could understand and use value data. Explore how consumers speak about quality of care and its relationship with cost to learn language used when communicating the concept. Regardless of how consumers view cost (out of pocket, cost to the overall system) most appreciated and understood value concept the uninsured were most receptive to value.

28 Summary Findings Determine which quality and resource use information is meaningful to consumers. Consumers can understand the idea of value if its presented in a way that is relatable to other choices they make outside of health care. I want to have Nordstrom s [care] at the Target price. Explore how consumers speak about quality of care and its relationship with cost to learn language used when communicating the concept. Clear, easy-to-understand data must demonstrate that high- quality, low-cost health care exists as a viable choice for consumers. Overwhelming majority prefer the data star chart for a few detail oriented participants preferred the data spectrum

29 What Does This Mean? Particularly through Exchanges, as consumers have choices, information about the relationship between cost and quality will be important context. Consumers can relate health care to other retail contexts. The information needs of the uninsured may be different than those of the currently insured. RWJ Study Jan 2013 Consumers attitudes about costs suggests consumers want to know more about cost of care and are increasingly gyfrustrated with the increased financial burden.

30 Contact Information Kristine Thurston Toppe Director, State Affairs NCQA s 8 th Annual National Policy Conference: Forging Ahead on Health Reform November 8,