Initial Findings

1
Diabetes Value Metric

• Initial Findings

• Jack Bowhan

• Manager, Performance Measurement

• ThedaCare Center for Healthcare Value
• Wisconsin Collaborative for Healthcare Quality

• September 22, 2009

2
Objectives

• My part

• Background
• Approach
• Findings to date
• Data display

Your part

• Reaction to the approach
• Identify information that is, or is not, useful
• Suggestions for additional testing to move the
  work forward

3
Robert Wood Johnson Foundation Grant

• Goal
• Develop, test, and produce a value metric and/or
  graphic display of value for management of
  diabetes by Dec. 31, 2009
• Blend WCHQ quality metric data with WHIO resource
  use data
• Report at the clinic level by department

4
Starting Point

• Wisconsin Collaborative for Healthcare Quality
  (WCHQ)
• Develops performance measures to report and
  assess the quality of healthcare services
• Source of data clinical systems
• Wisconsin Health Information Organization (WHIO)
• Building a data mart of healthcare information to
  track and measure episodes of care
• Source of data healthcare claims
• Therefore, our goal is to understand and resolve,
  if necessary, those differences in order to
  develop diabetes value metrics that are an
  accurate reflection of a clinical team's role in
  the management of diabetes for a population of
  patients who can reasonably be described as
  their patients

5
Hypothesis

• In order for physicians and clinical teams to use
  the value metric as a tool for improvement, there
  needs to be a reasonable match of patient
  populations between the resource utilization data
  queried from the WHIO data mart and the quality
  data submitted by WCHQ member organizations. 

6
Efficiency Reports www.whcq.org
7
AMI Quality Scores and Charges
8
Rank by Severity Adjusted Charges
9
Public Reporting Concerns

• Charges vs. Paid
• Hospital Comparison of Costs
• Cost Shifting
• Sample Size
• Median vs.. Mean and WI vs.. US
• Severity Adjustment
• Community vs. Academic Medical Center

10
Current WCHQ/WHIO Differences
11
Current WCHQ/WHIO Differences
12
More Testing ofValue Metric End Results

• Do modified WCHQ specs result in

• If unmodified WCHQ specs result in

Good
OR
Houston, weve got problems!
13
Pilot Organizations

• Bellin Health
• Gina Piontek
• Cheryl Czech
• ProHealth Care
• Dr. Christine Wahmhoff
• Kerri Zimmer
• Todd Behrens
• ThedaCare
• Jean Jenicek Brian Veara
• Carrie Riley Laura Owens
• Karil Simmerman Katie Roseman

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Number of Patients
See Glossary
15
WHIO Sample Sizes
16
1x Annual LDL Test Compliance
17
1x Annual Nephropathy Screening
18
Confidence Interval Testing
19
WHIO Results, LDL Testing Confidence Interval
0.95

• Start w/35 TC and PHC clinics
• 25 FP and IM clinics w/ gt30 WHIO pts
• 10 of 25 WCHQ results did not fall in the
  WHIO confidence interval.

See Glossary
20
WHIO Results, Nephropathy ScreeningConfidence
Interval 0.95

• Start w/35 TC and PHC clinics
• 25 FP and IM clinics w/ gt30 WHIO pts
• 9 of 25 WCHQ results fall in the WHIO
  confidence interval.

21
Nephropathy Screen Quality and Cost Results
(rank by Quality)
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Value QuadrantTest / Cost per Episode
Percent Compliance, Nephropathy Screening
Cost per Episode, Diabetes
23
Nephropathy Screen Quality and Cost Results
(rank by Quality)
24
Nephropathy Screen Quality and Cost Results
(rank by Cost)
25
Value QuadrantTest / Cost per Episode
Percent Compliance, Nephropathy Screening
Cost per Episode, Diabetes
26
LDL Testing Quality and Cost Results (rank by
Quality)
27
LDL Testing Quality and Cost Results (rank by
Cost)
28
Quality and Cost Display Options
29
Value Quality / Cost
30
Glossary