The Wisconsin Story. Brett Davis Medicaid Director Wisconsin Department of Health Services (DHS) January 7, 2014

Transcription

1 The Wisconsin Story Brett Davis Medicaid Director Wisconsin Department of Health Services (DHS) January 7, 2014

2 Topics 1. Background 2. Current efforts Medicaid Statewide Value Committee (SVC) Wisconsin Health Information Organization (WHIO) Public reporting 3. Key challenges and lessons 4. Three questions from the Institute of Medicine 2

3 1. Wisconsin - Background Many quality measurement initiatives exist across the State Public (Medicaid), Not-for-profit (WCHQ, WHIO, WHA), etc. Mixture of measures provider quality and public health Most operate in silos, leading to diffused priorities for providers and health plans It is difficult to compare providers or health plans due to segmented data Active efforts are underway to address the above issues 3

4 2. Current Efforts - Medicaid Medicaid Three-pronged approach Provider quality Consumer education and literacy Payment reform models Medicaid Provider Pay-for-Performance long history Providers and health plans Focus: Value = balanced ratio of Quality and Cost Continuous evolution and alignment HMO Hospitals Total Venn Diagrams 4

5 2013 Medicaid P4P Measures BC+ (Regions 1-4) HMO P4P BC+ (Regions 5, 6) Assessment P4P Hospital P4P Withhold P4P AMM 1, 2 PPC 1, 2 Tobacco (C+Rx) LSC BCS ASM CIS Diabetes 1,2 Blood Lead 1,2 Tobacco (C only) Dental 1-4 ED 1,2 7 P4R (perinatal) 12 P4P: 1 composite of 3 perinatal 10 customer satisfaction 1 heart care discharge instructions 1 P4R HCPIV 5 P4P: Readmission Mental health follow-up Asthma for kids Surgical care index Pneumonia AAP IET 1,2 FUH 7, 30 5 SSI 25 different measures 25 different measures

6 2014 Medicaid P4P Measures BC+ HMO P4P Assessment P4P Hospital P4P Withhold P4P CIS PPC 1,2 Dental kids, adults (Region 5,6 only) AMM 2 BCS Diabetes 1,2 IET 2 Tobacco FUH-30 AMB (ED) 5 P4R (perinatal) 12 P4P: 1 composite of 3 perinatal 10 customer satisfaction 1 heart care discharge instructions 1 P4R Early elective induced delivery 6 P4P: Readmission Mental health follow-up Asthma for kids Surgical care index Pneumonia HCP immunization 6 SSI 13 different measures 24 different measures

7 2. Current Efforts - SVC Movement towards alignment of measurement Statewide Value Committee (SVC) Goal: Better customer value by: Clear expectations to improve value Agreed upon measures of value across all stakeholders Providers rewarded to improve health, not manage sickness 7

8 SVC continued Many meetings, discussions 2012, 2013 Formed WIMAP (Wisconsin Measure Alignment Project) sub-group with diverse stakeholders Initially, 200 measures, converged to 17 initial measures for Inpatient and Ambulatory care Current structure: Leadership Council Measurement Steering Committee, with subcommittees Next step: Finalize future vision Operationalize measures (e.g., Qualified Clinical Data Registry) 8

9 2. Current Efforts WHIO Public Reporting Wisconsin Health Information Organization (WHIO) Public-Private effort since 2005 Health insurance claims data for 3.8 million Wisconsin residents, from 16 major payers, including Medicaid HEDIS and other measures Public reporting (web) in 2014 To assist patients in their health care decision-making Star rating system applied to practices with 3 or more physicians in family medicine, internal medicine or pediatrics with over 150 episodes of care 9

10 3. Key Challenges and Lessons 10 Challenge Organizations in own silos; Too many different measures; No common measure for value; Lack of trust of data No cost of care data Resistance to changes in systems / tools already in place or planned; Diverse national vs. state measures Prevention and wellness not perceived as high priorities Translating complex quality and cost measures for consumers Lesson Build cross-organizational consensus early on, iteratively, to focus quality improvement efforts Essential for stakeholder buy-in no $, no priority! Negotiations from start; Build flexibility to adapt, as appropriate (e.g., use CMS Qualified Clinical Data Registry) Measures should facilitate patient education and responsibility Extensive focus group sessions with target audience

11 4. Three Questions from IOM Where and how can IOM help? Numerators and denominators matter! Help align state/ regional measures with national measures to avoid unnecessary infrastructure expenditures Why pursue a core measurement set? Addressed in Key Challenges slide What will be different this time? Technology advancements Funding pressures and focus on value improvement Broad based coalition Leadership by State and key stakeholders Clear vision of how measures will be used (mandatory and optional in progress) 11