Page 31 - Delaware Medical Journal - May/June 2018
P. 31
TRANSFORMATION IN HEALTH CARE
facilities, and development of alerting services to smooth transitions of care; 2) establishment of a combined clinical and claims data store with analytic tools to support clinical quality measurement, evaluate the cost of care and drivers of costs, and assist provider entities contemplating risk-bearing contractual arrangements; 3) patient engagement and transparency solutions; and 4) enhanced provider tools.4,5
Input from community physicians during the development of the SHIP stressed that administrative burdens were becoming crippling. Among many examples illustrating this point were the multitude of quality measures required by the various payers and health plans, the “meaningful use” objectives, other federal programs, and in some cases, the requirements of their specialty board. The appeal was fervent — “Give us ONE set of quality measures across all payers, limit it to a manageable number of measures, and give us ONE place to see the reports of performance. Ideally, we would also like ONE place to go for two-way communication with payers about things such as disputes about pre-authorizations, claims denials, errors in attribution, etc.” This was the origin of what we now know as 6
The measures to be included in the Scorecard were selected by thought leaders serving on the Clinical Committee of the Delaware Center for Health Innovation. The measures were thoughtfully chosen for maximum overlap with federally Delaware and to meet the requirements of the SIM grant to cover all ages and address high-cost chronic conditions.
Negotiations with payers, spearheaded by the Secretary for Health and Social Services, reached concurrence on use of these measures in value-based contracts with practices. At least 70 percent overlap was achieved with all payers.
recipient of the grant on behalf of Delaware, contracted with DHIN to provide the technology platform to display the measures. DHIN and its vendors worked under the direction of DHCC and its contractors to develop an interactive platform that allows the user to see the performance of their practice on each measure vs. commercial), or aggregated across the entire practice and compared to average performance of all practices across the state.
There was much debate over the data sources to be used for the Scorecard. Ideally, clinical quality measures should be sourced from clinical systems, but at that time, no ambulatory practices were submitting electronic health record (EHR) data to DHIN. Furthermore, since the Scorecard was intended to
thus reimburses the practice, the ultimate decision was to source the Scorecard through claims data supplied by the payers. The corollary that necessarily follows is that what can be displayed on the Scorecard is limited by the information that payers actually collect and measures they can calculate.7
Present reality falls far short of the vision. Utilization of the Scorecard platform by practices has been quite low. As the DHCC and its contractors have sought the reasons, they’ve heard the following:
■ I get a report directly from each payer, and I trust it more. ■ I can’t see my own performance here, only that of my
practice, so I don’t know how to improve. ■ It isn’t real time, so it isn’t actionable.
Utilization of the interactive platform for display of the Common Provider Scorecard is simply not high enough to justify the cost, and it will be discontinued as of June 30, 2018.
While it is very disappointing that the platform has failed to yield value and will never be expanded to be the two-way communication link between physicians and payers that was envisioned, it is still a net gain that the payers have agreed to use a common set of measures selected by clinical thought leaders in Delaware. The DHCC is changing focus from reporting information to individual practices about their performance,
to public reporting of aggregate state-level (vs. practice-level) performance on Healthcare Effectiveness Data and Information Set (HEDIS) measures from the Common Provider Scorecard.
While the Common Provider Scorecard must be considered a cautionary tale of a failed technology project, other information technology tools are being used to good effect to support the drive toward practice transformation. More than 150 practices are when one of their patients has been admitted or discharged
from a hospital or emergency department in Delaware and all or
three-fourths of Delawareans have been seen by organizations
delivered, enabling early follow-up and a measurable decrease in the rates of 30-day readmissions.8
There is growing insistence at the federal level that information sharing and interoperability of health data is not just for health care professionals, but also for the patients we serve. Section 4006 of Title IV of the 21st Century Cures Act provides that
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