Quality outcomes as a measure of healthcare efficiency

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Quality outcomes as a measure of healthcare
efficiency

• BHF Conference 12th July 2006

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Risk management tools
What do trustees need to know?

• All utilisation cost measures and cost drivers
• Risk adjusted benchmarking
• Utilisation and costs
• Hospital performance
• Benchmarking quality outcomes

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Why measure quality ?

• Quality is a measure of healthcare efficiency

Access
Outcomes
Cost
Efficiency
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Objectives of the quality measurement tool

• To supplement existing risk management tools so
  as to assess both quality and efficiency of
  healthcare delivery at scheme and option level
• To identify specific areas of healthcare which
  need addressing
• To adapt the methodology to measure specific
  outcomes and efficiencies of contracted doctor
  networks e.g. efficiency of management of chronic
  diseases

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Comparing apples with apples

• Benchmarking requires adjusting for variables
  over which there is no control
• Data is risk adjusted for age, gender, chronic
  disease profile including HIV, hospital case mix,
  type of cover, region, ethnicity

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Risk adjustment

• For each measure a risk adjusted expected value
  is calculated
• A risk adjusted index is calculated from Actual
  value / Expected value
• Statistical regional limits are set based on
  standard deviation of the risk index
• The risk adjusted index is compared with the rest
  of the database

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Quality measurement principles

• Data source clinical and claims data from
  integrated data warehouse
• 62 measures of clinical outcomes , access or both
• Measures aligned with Industry with additional
  clinical data and some new measures
• Measures cover major chronic diseases, preventive
  health, specific hospital procedures, maternity
  neonatal care and indicators of resource
  allocation

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Methodology

• Measures are ranked according to their clinical
  significance, potential for cost saving from an
  outcome or intervention, and robustness of data
• An aggregate score of the ranked measures is
  calculated as a risk adjusted quality score
• Risk adjusted quality scores are shown relative
  to other schemes or options standards are not
  measured

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Methodology

• Efficiency is assessed by the relationship
  between the risk adjusted quality score of a
  scheme or option and its contribution index,
  based on the percentage of the average Medscheme
  contribution
• This methodology can also be adapted to measure
  quality scores of specific diseases at practice
  or practice network level

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Overall Quality Score
Poorer quality
Better quality
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Quality Score per Option Scheme A
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Quality Score per Option Scheme A
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Chronic disease outcomes
Diabetes Scheme D
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Chronic disease outcomes
Diabetes Scheme D
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Chronic disease outcomes
Diabetes Scheme D
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Chronic disease outcomes
Asthma Scheme E
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Chronic disease outcomes
Asthma Scheme E
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Chronic disease outcomes
Asthma Scheme E
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Healthcare efficiency dynamics
Benefit Design
Access
Outcomes
Cost
Doctor Patient Choices
Managed Care
Efficiency
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Summary

• Measurement of quality outcomes is fundamental to
  evaluation of efficient healthcare
• As important as access to appropriate benefits
  and quality directed managed care may be,
  sustainable efficient healthcare can only be
  achieved through appropriate patient doctor
  choices
• A management tool to facilitate this is desirable