In the lower left corner is the ACHI logo which reads "ACHI, Arkansas Center for Health Improvement"
Slide 1
Arkansas center for health improvement
This presentation uses a template with a white background. Across the bottom of the slide is a red dot connected to a blue horizontal line that fades in to a lighter blue from left to right. To the right of the line is "ACHI".
Mission:
Be a catalyst for improving the health of Arkansans through evidence-based research, public issue advocacy, and collaborative program development
Core Values:
Initiative, Trust, Commitment, and Innovation
Slide 2
ACHI's scope of work
The slide has an image of two overlapping circles. The yellow circle reads, "Health Care Financing." The blue circle reads, "Health Promotion/Disease Prevention."
Slide 3
Access to quality of care
There is no more pressing concern for the American health care system than improving the quality of care we provide. Improving quality of care not only enhances patients' lives, it saves lives.
- Tommy Thompson, Former US Secretary of Health and Human Services
Slide 4
Measuring quality of care
We now know more about the quality of our nation's health plans, hospitals and medical groups than we ever have, and public reporting of performance data has had the impact we intended: it promotes continuous improvement.
-NCQA 2004 Annual Report
Slide 5
ACHI's scope of work
The slide has an image of three overlapping circles. The yellow circle reads, "Health Care Financing." The blue circle reads, "Health Promotion/Disease Prevention." The red circle reads, "Access to Quality Care."
Slide 6
Goals in health care
The slide shows a 2x2 table. The top of the table reads, "Cost." The left side of the table reads, "Quality." The four cells read: "High quality/low cost," "Low quality, low cost," "high quality/high cost," and "low quality/high cost." The "High quality/low cost" box is highlighted in dark blue.
Slide 7
Barriers to assessing quality of care
• Cost
• Sample size
• No incentive
• Risk adjustment
• Lack of data
• Lack of clear purpose
• No pressure to do so
Slide 8
ACHI's Quality-Related Projects
Slide 9
Employer health coalition (EHC)
• Self-administered employer group based in Northwest Arkansas
• Awarded Bridges to Excellence funding to develop pay-for-performance strategies
• Lacked resources to conduct preliminary quality analysis
• Committed to making positive changes in the care received by their employee population
Slide 10
Quality of Care Assessment
• Levels of assessment
-Systems of care
-Provider groups
-Individual providers
• Methods of assessment
-Eligibility
-Denominator
-Numerator
Slide 11
Quality of care measures selected
• HEDIS measures selected to evaluate EHC data:
-Breast cancer screening
-Comprehensive diabetes care
-Beta-blocker treatment after a heart attack
Slide 12
Breast cancer screening-group level*
The slide is a bar chart. Along the x-axis is different group levels, separated by Fort Smith and Hot Springs. Along the y-axis is the percentage.
Fort Smith
G4: 75%
G5: 75%
G6: 67%
G10: 66%
G7: 64%
G3: 60%
G2: 57%
G1: 47%
G8: 46%
G9: 19%
Hot Springs:
G4: 82%
G8: 64%
G5: 59%
G1: 57%
G2: 42%
G3: 40%
G6: 29%
G7: 0%
*PCP facilities w/ largest # of women participants aged 52-69 yr
Slide 13
Diabetes care (HbA1c)-group level*
The slide is a bar chart. Along the x-axis is different group levels, separated by Fort Smith and Hot Springs. Along the y-axis is the percentage.
Fort Smith
G3: 73%
G7: 73%
G8: 67%
G6: 63%
G4: 60%
G1: 52%
G10: 52%
G2: 49%
G9: 39%
G9: 25%
Hot Springs:
G1: 90%
G6: 90%
G4: 89%
G3: 85%
G5: 71%
G2: 58%
G7: 50%
*PCP facilities w/ largest # of eligible diabetic participants aged 18-75 yr
Slide 14
Overall system-level performance
The slide is a bar chart. Along the x-axis are results for the number of eligible who received a procedure/ the number in the system eligible for the procedure. The bars are separated by Fort Smith and Hot Springs. Along the y-axis is percentage.
Breast Cancer Screening
- Fort Smith: 45%
- Hot Springs: 36%
Comprehensive Diabetes Care:
- Fort Smith: 41%
- Hot Springs: 64%
Slide 15
Comparison with national rates
This slide is a bar chart. Along the x-axis is breast cancer screening (mammograms) and comprehensive diabetes care (HbA1c monitoring). The bars are categorized by Fort Smith, Hot Springs, U.S. Commercial Plans, U.S. Medicaid, and AR ConnectCare. Along the y-axis is percentage.
Breast Cancer Screening (mammograms)
- Fort Smith: 45%
- Hot Springs: 36%
- U.S. Commercial Plans: 75%
- U.S. Medicaid: 56%
-AR ConnectCare: 40%
Comprehensive Diabetes Care (HbA1c monitoring)
- Fort Smith: 41%
- Hot Springs: 64%
- U.S. Commercial Plans: 85%
- U.S. Medicaid: 75%
-AR ConnectCare: 53%
Slide 16
EHC group and provider performance
• The group and provider level results may not accurately attribute quality results to specific groups/providers
-Events credited to any group/provider who treated participants
-No explicit PCP assignment available
• Wide variations at group and provider level observed
Slide 17
Creation of Quality Subcommittee
Slide 18
Arkansas 2005 general assembly
• Arkansas State Employees Benefits Division
-Largest employer group in the state
• Passed legislation to established the Employee Benefits Division (EBD) Quality Sub Committee (Arkansas Code 21-5-404)
-Review and recommend quality performance indicators for use
-Recommend baseline performance goals
-Recommend alignment of financial incentives to improve performance
-Track improvements in delivery of care
http://www.arkleg.state.ar.us/NXT/gateway.dll?f=templates&fn=default.htm&vid=blr:code
Slide 19
Arkansas employee benefits division (EBD)
• Lacked data to establish baseline for improvement
• Lacked infrastructure to perform analysis on existing data
• Agency lacked resources to fulfill duties of set forth by the legislation
• Challenge of obtaining by-in from appropriate stakeholders
Slide 20
Use of AHRQ Data
Slide 21
AHRQ state snapshots
• Provided access to data and information to establish baseline for tracking improvement.
• Established mechanism for obtaining by-in from all stakeholders involved.
-Things were as bad as we thought. United by desire to improve the system.
• Created a "snapshot" of the quality of care provided by the Arkansas healthcare system.
Slide 22
Arkansas employee benefits division (EBD)
• Created a plan for performing analysis utilizing existing medical claims and pharmacy data.
• Established relationship with ACHI to provide analytic and program development resources to develop a plan to assess and improve the quality of the care provided to the EBD enrollee population.
• Engaged the appropriate stakeholders to develop coordinated efforts in areas related to healthcare and healthcare system quality.
Slide 23
New & Future Quality Initiatives
Slide 24
EBD quality sub-committee
- Develop a quality report to the EBD Board
-Assist with plan and benefits development
-Assist with the development of a "worksite wellness" program
-Assist with developing preventative care benefits
- Develop a consumer focused report for the purpose of making decisions around healthcare and health system utilization
- Develop pay-for-performance strategies
Slide 25
Regional quality initiatives (RQI)
- Multi Stakeholder Collaborative with the AR Foundation for Medical Care and the AR Departments of Health and Human Services
- Unify Performance Measurement
• Share Data for Greater Accuracy
• Discuss Incentive Opportunities
• Explore Models of HIE
• Research, Design Local Plan for Future
• Health Information Security and Privacy Collaboration (HISPC), phases 1 and 2
Slide 26
Arkansas Governor's taskforce on health
• Lead by the Arkansas Surgeon General
- Joe Thompson, MD, MPH - Director, ACHI
• Staffed by the Arkansas Center for Health Improvement (ACHI)
• Comprised of public and private stakeholders
• Tasked with addressing healthcare and health related issues faced by Arkansans
Slide 27
Contact information
Shirley Tyson
Research Associate/Policy Specialist
Arkansas Center for Health Improvement
1401 West Capitol Avenue
Suite 300, Victory Building
Little Rock, Arkansas 72201
ACHI Main Phone: 501-526-2244
Direct Phone: 501-526-2257
E-mail: tysonshirley@uams.edu
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