HMO Collaboration Quality Improvement and Patient Safety

1
HMO CollaborationQuality Improvementand Patient
Safety

• Michigan Health and Safety Coalition
• April 15, 2004
• Barbara Kopasz
• Health Alliance Plan
• Inter Plan Patient Safety Council

2
Employer Health Care Concerns

• Cost
• Double digit rate increases
• Health care as growing percentage of total labor
  cost
• Hospital rate increases, drugs and new technology
  costs driving trends
• Quality
• Inefficiencies/errors in care delivery
• Patient Safety Concerns
• Poor coordination of care for people with chronic
  conditions aging population
• Limited Best Practice sharing/measurement

3
Employer Health Care Concerns

• Utilization
• Waste in the healthcare delivery system
• Inappropriate use (misuse, overuse and underuse)
  of health care services
• Wide variation in practice patterns between
  communities

4
Health Plan Role
Consumer
Purchaser
Expect to Meet Needs
Hold Accountable
Health Plan

• Provide Quality Leadership
• Hold Delivery System Accountable for Value
• Provide Delivery System With
• - Information - Coordination
• - Support - Communication
• Selection and Contracting

Delivery System
Primary Care Physician
Hospital
Pharmacy
Specialty Physician
Home Health Care
Behavioral Health
Diagnostic Services
Other Therapeutic Services
Centers of Excellence
5
Employer Framework

• Look at the data cost, quality, utilization,
  performance indicators
• RFIs
• HEDIS?
• Measure the performance of health plan and
  providers
• Share performance information with consumers
• Reward high-quality performance and penalize
  poor-quality performance

6
Health Plan Challenges

• Employer Specific Initiatives
• RFIs
• Provide comparative data to purchasers
• Plan Administration
• Health Promotion
• Chronic Disease Management
• HEDIS
• Pharmacy Management
• Patient Safety
• Customer Satisfaction
• Community Initiatives

7
Driving collaboration and change in Michigan

• Tobacco cessation benefit design
• Interplan Patient Safety Workgroup
• MI Health Safety Coalition, collaborative
  implementation of safety standards, common
  messages for members
• Interplan Behavioral Health Workgroup
• development of depression and substance abuse
  guidelines, common patient release form
• Individual plan experiences
• MQIC

8
History of Health Plan Collaboration

• History of working together to address common
  issues regarding the eValue8 RFI formerly GDAHC
• Creating the Inter-Plan Patient Safety natural
  evolution
• RFI challenges
• Employer accountability
• Many health plans worked with GM Top 11
  initiatives
• MQIC

9
Purchasers Expectations

• Foster an approach to patient safety
• Emphasis on systemic improvements
• Reward superior efforts to reduce errors
• Fulfill Leapfrog purchasing principles
• Educate and inform enrollees
• Highlight Leapfrog recommended patient safety
  practices
• Reward superior provider value

10
Purchasers Expectations

• Determine the rate at which members were at risk
  for preventable medical mistakes during a recent
  hospitalization due to the absence of one or more
  of the Leapfrog recommended patient safety
  practices.
• Calculate the admissions going to hospitals that
  have implemented one or more of the standards
  relevant to the condition and have a strategy to
  increase the rate
• Recognize and reward hospitals and encourage
  member admissions to compliant hospitals

11
Patient SafetyMichigan Inter-Plan Patient
Safety Council

• RFI Expectations
• Written Patient Safety Strategic Plan
• Activities to inform contracted hospitals,
  practitioners and members about Leapfrog
  standards and reporting requirements
• Activities to develop and disseminate information
  on what members can do to reduce the chance they
  will be subject to preventable medical errors
• Activities to monitor use of hospitals that meet
  Leapfrog standards
• Activities to increase the percentage of members
  admitted to hospitals that meet the Leapfrog
  standards.

12
RFI Expectations

• Develop and provide educational materials to
• Health Plan contracted hospitals
• Health Plan contracted practitioners
• Health Plan members
• Ability to rank hospitals based on survey scores
• Make data available to providers and members
• Develop hospital report cards
• Encourage members to seek services at hospitals
  that meet the Leapfrog standards

13
Patient Safety Expectations

• Monitor hospital compliance with JCAHO National
  Patient Safety Goals
• Support hospital quality and safety improvements
  beyond Leapfrog and JCAHO
• Support hospital performance on the National
  Quality Forum measures
• Encourage rural hospital participation in the
  survey

14
Patient Safety Future Activities

• SEM Health Plans will continue to collaborate on
  common issues to reduce burden to hospitals
• SEM Health Plans will continue to work with MHA
  on identifying common patient safety initiatives
• E.g. stroke program
• Other initiatives being discussed
• Further collaboration on development of member
  education materials
• Pharmacy workgroup coordination
• Rural hospital outreach
• Continue to identify efficiencies to reduce
  hospital burden re data collection
• Create inventory of hospital patient safety
  initiatives

15
Inter-Plan Patient Safety Council

• Health Plan Participants
• Blue Care Network
• Care Choices
• HAP
• Health Plus
• MCare
• Paramount
• Priority Health

16
Summary

• Poor quality is costly and is a problem facing
  all of us
• Failure to consider quality when purchasing
  healthcare IS part of the problem
• Employers believe the way to reduce health care
  cost is to improve qualityand provide people
  with the information on quality to make smart
  health care decisions
• Going forward we will continue to attack the
  epidemic of medical mistakes with better systems,
  accountability, more training and education and
  exchanging knowledge to advantage one another

17

• Together we can assemble a system that is
  stronger and more reliable than the sum of its
  parts not perfect but much better.
• Source Internal Bleeding
• Robert M. Wachter, M.D. and Kaveh G. Shojania,
  M.D.