Dirigo Health Agency’s

Dirigo Health Agency

• Research Dissemination on quality, evidence-based medicine and patient safety

• Adoption of quality measures, coordination of collection and reporting

• Consumer education• Technology assessment• Promotion of adoption of electronic technology• Recommendations regarding State Health Plan• Annual report

• GovernanceDHA Board of Trustees

DHA Executive Director

MQF Director

• Funding– Share of DHA “SOP” Funds

• Guidance– MQF Advisory Council

MQF Advisory Council

• Physicians (3)• RN (1)• Hospital (1)• Mental Health Provider

(1)• Nonphysician Provider (1)• Consumers (4)

– Organized Labor (1)– Health Advocacy (1)– Uninsured/MaineCare (1)– Commercially Insured (1)

• Employers (4)– State Employees Health

Commission (1)– Large Employer (1)– Midsize Employer (1)– Small Employer (1)

• Private Health Plan (1)• MaineCare (1)• Maine Health Data

Organization (1, ex off.)

MQF PROJECTS Data Collection and Reporting

Discharge Data and Website Paid-claims Data and Health Dialog Project Hospital-reported Performance Indicators (Chpt 270)

Healthcare-Associated Infections Advanced Medical Home Pilot In-a-Heartbeat Voluntary Practice Assessment Website Development RWJ Projects: Quality Counts/AF4Q/RQS Critical Access Hospital Collaborative CON Assessment

Summary of Key Cost Drivers

• Utilization– Health Status – Preventable chronic illness

complications increase utilization– We use more outpatient and more ED than most

other New England states– Supply of technology (e.g. MRI)

• Inefficiency– 20-60% variation in cost to treat same patient for

same illness in different hospitals– Significant variation in how patients are treated by

different physicians for similar problems

Variation

• Discharge Data

• Voluntary Performance Indicator Reporting

• Paid Claims Database Analysis

Discharge Data

Performance Indicators

Performance Indicators

MQF-Health Dialog Project

Complete:• Warehoused the paid-claims data and assessed its

quality and capability to support population-based quality measures

• Conducted pilot provider profiling analysis– Primary care– Cardiology

• Conducted geographic variation analysis of advanced imaging utilization (CORE)

MQF Regional Variation in Effective Care

Percent of Diabetic Members Aged 18-64 Having LDL-C Test Performed

Measurement Period: 7/1/2004-6/30/2005

40.0

50.0

60.0

70.0

80.0

90.0

Hospital Service Area (HSA)

Ra

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er

10

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ible

Me

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Performance Varies Across Providers

Coronary Artery Disease Gap in Care ScoreProvider Performance and Confidence Intervals (July 2004 - June 2005)

0.0

2.8

5.6

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59 61 63 65 67 69 71 73 75

Provider Rank

Mea

n C

AD

Cap

Sco

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USING DATA TO EFFECT CHANGE

ResearchConsensus Guidelines Performance Indicators for

Providers

Benchmarking

Internal QI

Public Reporting

PHC4

NYHHC

Pay for Performance

Tiering

Steerage

Nonreimbursement

POLICYPOLICY

Advanced Medical Home Pilot

• More effective primary care, better platform for coordinated chronic disease management

• Collaborators– Maine Quality Forum– Quality Counts– Maine Health Management Coalition and Pathways to

Excellence– Martins Point Healthcare– MaineCare– Anthem, other payers

In a Heartbeat

• Standardization of Best Practices for STEMI Care

• Community Engagement• Publicity and training

• Emergency Care• EMT Systems, Cath Lab Activation from Field

• Hospitals

• Data and Metrics

Critical Access Hospital Collaborative

• Problems with standard metrics; ?”Rural-relevant” indicators

• Patient Safety issues prominent (not “n-dependent”)

• Collaborators:• MQF• USM Muskie School of Public Service• MeHAF• 14/15 Critical Access Hospitals

• Medication Safety Project(s)

RWJ: Aligning Forces for Quality,

Regional Quality Strategies• AF4Q

– Performance Measurement

– Public Reporting– Consumer

Engagement– Quality Improvement

• RQS– PM/PR of Hospital

Quality– Investigation of Racial,

Ethnic, Socioeconomic Disparities

– Nurse-centered Inpatient Quality Improvement

AF4Q/RQS

• Collaborating OrganizationsMaine Quality Forum

Maine Health Management Coalition

Quality Counts

• 50 Employer groups (MHMC)• 28 Member Organizations (QC)