Improving Quality Through Systems Change

National Health Policy Conference, Washington, DC

Stephanie Alexander, Sr. VP, Premier Healthcare Informatics

February 12, 2007

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CMS/Premier Demo Pay for PerformanceIn 2003,CMS partnered with Premier for the first national pay-for-performance demonstration for hospitals. Over 260 Premier hospitals volunteered.

Focus on Quality - The P4P Program financial incentives did focus hospital executive attention on measuring quality and refining care processes according to the study infrastructure.

Premier is the Change Agent - The Premier Infrastructure and measurements were actually the change agents in focusing quality improvement efforts. The more hospitals were monitored, the better performance improved over time.

Financial Incentives improve hospital quality performance

Findings

Hypothesis

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• Quality improvement across all hospitals and clinical areas

• HQID raised overall quality by 11.8% in 2 years

• Quality incentive payments of $8.7 Million paid to 115 hospitals

• AMI improvements saved 1,284 AMI patients

• Patients received ~150,000 add’l treatments

• Premier P4P hospitals quality scores are higher than national average – 85% compared to 79%

HQID Year 2 – Final ResultsReleased January 26, 2007

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Dramatic Improvement Continues

Composite Quality Score

CMS/Premier HQID Project Participants Composite Quality Score:

Trend of Quarterly Median (5th Decile) by Clinical Focus AreaOctober 1, 2003 - June 30, 2006 (Year 1 and Year 2 Final Data, and Yr 3 YTD Preliminary)

89

.62

%

85

.14

%

70

.00

%

63

.96

%

85

.13

%

89

.95

%

85

.92

%

73

.06

%

68

.11

%

86

.69

%

91

.50

%

89

.45

%

78

.07

%

73

.05

%

88

.68

%92

.55

%

90

.57

%

80

.00

%

76

.14

%

90

.93

%

93

.50

%

93

.70

%

82

.49

%

78

.22

%

91

.63

%

93

.36

%

94

.89

%

82

.72

%

81

.57

%

93

.40

%

95

.08

%

96

.16

%

84

.81

%

82

.98

%

95

.20

%

95

.77

%

97

.01

%

86

.30

%

84

.38

%

95

.92

%

95

.98

%

96

.77

%

88

.54

%

86

.73

%

96

.05

%

96

.14

%

98

.28

%

89

.28

%

88

.79

%

96

.89

%

96

.84

%

98

.44

%

90

.09

%

90

.00

%

97

.50

%

60%

65%

70%

75%

80%

85%

90%

95%

100%

105%

AMI CABG Pneumonia Heart Failure Hip and Knee

Clinical Focus Area

Co

mp

os

ite

Qu

alit

y S

co

re

4Q03 1Q04 2Q04 3Q04 4Q04 1Q05 2Q05 3Q05 4Q05 1Q06 2Q06

5

Example of decile movement (by year)

6

Why such movement in quality?

• Not just “one” reason - a combination

• National alignment of evidence-based quality measures

• Transparency (public reporting)

• Rewards for improvement

• Leadership

• System-level change

Building a Quality Culture

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• “Quality” core value of institution

• Priority of executive team

• Physician engagement

• Improvement methodology

• Prioritization methodology

• Dedicated resources

• Committed “knowledge transfer”

Top Performer Characteristics

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Premier Performance Pays Study

Premier’s Performance Pays study proves that when evidence-based processes are delivered, quality is higher and costs are lower. First study of its kind over 400,000 patient discharges studied.

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Increased process reliability results in lower costs

10

Increased process reliability results in fewer complications

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Shorter Length of Stay

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Fewer Readmissions

13

Improvement Opportunity

For Pneumonia, Heart Bypass Surgery,

Hip and Knee Surgery, and AMI Patients

in One Year Alone

$1.4 Billion

6,000 Avoidable Deaths

6,000 Complications

10,000 Readmissions

800,000 Days

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53%

95%

72%

50%

60%

70%

80%

90%

100%

Q4 03 Q4 04 Q4 05

Com

posit

e Q

uality

Score

75%

95%

88%

50%

60%

70%

80%

90%

100%

Q4 03 Q4 04 Q4 05

Com

posit

e Q

uality

Score

66%

97%96%

50%

60%

70%

80%

90%

100%

Q4 03 Q4 04 Q4 05

Com

posit

e Q

uality

Score

68%

89%

79%

50%

60%

70%

80%

90%

100%

Q4 03 Q4 04 Q4 05

Com

posit

e Q

uality

Score

Quality a core value, executive priority, physician engagement, improvement methodology,prioritization methodology, dedicated resources, committed knowledge transfer

Hip and Knee Pneumonia

Acute Myocardial Infarction Heart Failure

Example:

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Example: Health System Improvement

• A decision to participate as a system

• A proxy for system connectivity

• A few surprises . .

• And the most important decision we’ve made for cultural advancement around quality

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Why such movement in quality?

• Not just “one” reason - a combination

• National alignment of evidence-based quality measures

• Transparency (public reporting)

• Rewards for improvement

• Leadership

• System-level change

Building a Quality Culture