Competing on Quality: 6 Barriers to a Healthy Health Care Market
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1 Competing on Quality: 6 Barriers to a Healthy Health Care Market Irene Fraser, Ph.D. Director, Center for Delivery, Organization & Markets FTC Roundtable on Competitive Significance of Healthcare Provider Quality Information
2 Competition as a Path to Quality Can Be a Bumpy Road
3 The Bad News: It s s More Difficult in Health Care Other Industries Health Care
4 Competition on Quality: Three Paths, Similar (Not Identical) Hurdles Three Paths: Consumers choose higher-quality providers, who then get more market share and potentially higher rewards Payers choose higher-quality providers, who then get more market share and potentially higher rewards Providers compete among themselves for intrinsic reasons, or because of publicity Hurdles: Six Hurdles on Each Path, but Play out differently for each
5 Hurdle #1: Awareness Problem: Many consumers, and some payers, do not know that quality differences exist Strategies: IOM Report, well-publicized horror stories are beginning to change that But most believe their own provider is good
6 Hurdle #2: Measures Issue: For informed choice, need valid, uniform measures that are relevant and credible to the consumer, payer, and provider Barriers: : too many measures, and too few measures. Most are process or diagnosis- specific; different players value different measures Progress: NQF focus, increased adoption by Medicare, Medicaid, states, private payers Example: : More than 50 Quality Indicators from AHRQ accepted by NQF, in widespread use by states, CMS
7 Example: AHRQ Quality Indicators (QIs) Use existing hospital discharge data, based on readily available data elements Growing use for reporting and P4P NQF endorsement for 50+ so far CMS using 9 under new Inpatient Payment rule 12 states use AHRQ QIs for public reporting Oregon Utah Colorado New York Wisconsin Vermont Massachusetts Iowa Ohio Kentucky Texas Florida
8 Hurdle #3: Data The challenge Measures without data are useless to the market Need market-level data BUT also need national benchmarks. Why compete on mediocrity? Measures and data can improve with use good measures and data can get better (though not perfect) BUT Even good measures with bad data can create mischief Data must be good AND cheap There is no gold standard Clinical, administrative, patient experience of care data all have strengths, weaknesses EHR no data panacea
9 Hurdle #3: Data (cont d) Some Progress Moving toward hybrid data for hospitals Pine study shows adding POA and Laboratory Values approximates accuracy of chart review States building improved all-payer datasets AQA, others working to improve physician data NQF, others targeting episode data
10 Administrative/Hybrid Data: The Future Improve timeliness Provide on-line all-payer market-level data on cost, quality, efficiency, price. Add clinical detail, data links for accuracy, credibility Expand outpatient reach (e.g. physician, episode) Pilot cross-site site data, new data links New tools for expanded data Additional states,, as feasible Develop, validate, maintain, deploy measures in priority areas Expand data elements to align with levers of change Tools for change
11 Good Data Not Enough: Need Customer-Friendly Tools
12 Hurdle #4: Understanding The bad news: Most quality reports are not very good Don t t present information simply, effectively, in ways the reader understands and cares about The good news: A growing evidence base on this Tested models in AHRQ s CAHPS, Quality Indicator reports NQF Guidance for web-based based comparative quality available soon Links and aids: includes QI Model Report and Sponsor Guide soon on AHRQ website Source: Shoshanna Sofaer, Presentation to Chartered Value Exchanges, October 3, 2008
13 Hurdle # 5: Effective Choice Barriers and limitations Geography (one- hospital towns) Insurance (limited provider options) Money and/or lack of insurance Time (no web access in the ambulance)
14 Hurdle #6: Other Market Realities Barriers: Multiple markets e.g. hospitals vs. physicians Multiple Product Lines Quality Scores Don t Generalize Market segmentation by payer source Facilitating Progress Episode measures Cross-cutting measures Payer Cooperation on measures
15 The Challenge: Addressing Multiple Barriers at the Same Time
16 Home Page
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