Measuring the Value of Community-Based ServicesJane Brock, MD, MSPHTelligenQIO National Coordinating Center

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“If you cannot measure it you cannot improve it”

Lord Kelvin – before 1900

In reality, if you can’t prove you improved it, you cannot participate

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Value-Based Payment in Medical Services

• Quality/Efficiency and XX COMPARE• Physicians and Resource Utilization (2015)• Readmissions a key

– MSPB (http://www.medicare.gov/hospitalcompare/Data/spending-per-hospital-patient.html?)

– Post acute bundled payment demonstration

• Total resource use:– ACOs– Other bundled payment models– Maryland hospital payment demonstrationQuality – from clinical informationEfficiency/Resource Use – from claims data

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The Limitations for CBOs

The current/frequent state:

• Clinical data – unintegrated and therefore unaccounted for

• Claims - ?? The goal is to not have as many

But we do really good work…

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Better Health for

the Population

Better Carefor Individuals

Lower Cost

Through Improve

ment

Better Health forthe Population

‘The Future’ which is now The Present

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The 3 huge opportunities that community services have..

Better Health forthe Population

*10% of health is medicalYou are in the secondary prevention businessMeasure health, or at least function

#1

Medical utilization is not a ‘patient centered’ outcomeBut being at home isMeasure what matters to people

#2

#3Neighborhood mattersTarget/Measure impact among those living in challenging environments

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• Health, function and quality of life – all part of Healthy People 2020

• Community Tenure– Being tracked by QIO program– ? Experiment with small areas in association with medical-

community programs

• Neighborhood matters– Residence in a deprived neighborhood – Annals of Internal Medicine– file:///C:/Users/jbp/Downloads/HIPxChange.org.html

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Interventions/Program

Hospital 30-day readmission rate

# Served

Ensuring a quality product

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Latest Greatest Idea for Improvement

‘Uptake’‘Penetration’‘Dissemination’

(But in the real world will people/can people do it?)

(but it may not be solving the real problem.. Research is one thing and reality is entirely another..)

Impact of this intervention on the targeted driver of readmissions

(is it working?? What makes me think it will affect readmissions? What can I know now ?)

‘Spot-check’ utilization measure

Readmission data from CMS

Ensuring a quality product

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Intervention = CTI

How often did it happen?

Process measure = number of times intervention occurred; e.g. # of patients coached/month

Interim outcome measure = Number of times the intervention did what it was intended to do; e.g. improvement in PAM scores

Proximal Utilization Outcome measure = Utilization among those receiving the intervention; e.g. # readmissions among those with improved PAM scores vs. those without improved scores

Is the intervention working?

Are we getting the expected outcome?

Final Utilization measure = readmission rate in the entire target population

Is it enough to make a difference?

EXAMPLE

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‘One’ piece of advice

• For the work you do now..– Ask partners (and QIOs) to share outcomes data– Identify measures of interim progress/product that you can

capture Test capturing – can spot check

– Ask medical partners if you can help them spot check measures of progress (you are in the home..)

• For the business you are in– Develop partnerships in public health and housing– Become familiar with potential hospital partners’ MSPBs– Experiment with adjusting your outcomes by neighborhood