Collaborative Learnings from the School of Hard Knocks

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Slide 1

Collaborative Learnings from the School of Hard Knocks

Melinda Karp
Director of Strategic Planning and Development, Massachusetts Health Quality Partners (MHQP)
AHRQ Annual Meeting
September 10, 2012

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About MHQP

MHQP's mission is to drive measureable improvements in health care quality, patients' experiences of care, and use of resources in Massachusetts through patient and public engagement and broad-based collaboration among health care stakeholders.

MHQP was first established in 1995 by a group of Massachusetts health care leaders who identified the importance of valid, comparable measures to drive improvement.

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MHQP Background

• MHQP has been in operation as a collaborative for over fifteen years, demonstrating success at bringing diverse stakeholders together for meaningful dialogue and results.
• MHQP has a long track record working with health plans to develop common priorities and address issues that are best addressed across plans.
• MHQP has earned the trust of the physician community and is well positioned to communicate with physicians about their performance.
• MHQP established a Patient and Public Engagement Council to leverage the important role patients, families, and the public have in developing a high quality affordable healthcare system in Massachusetts.

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MHQP's Measurement and Public Reporting Foundation

• Clinical Quality:
  • Annual report on primary care performance in Commercial plans for over 150 medical groups in Massachusetts.
    • Publicly reported since 2005 on over 30 measures of preventative and chronic health care.
  • Clinical reporting for Mass Health in 2011.
• Patient Experience:
  • Biennial report on over 500 practice sites in Commercial plans.
    • Publicly reported since 2006 on 10 aspects of the doctor—patient relationship.
    • Over 80,000 Massachusetts patients respond to survey about their primary care experience.
  • Fielding Massachusetts aligned Patient Experience Survey on behalf of the Executive Office of Health and Human Services in 2011.

Images: MHQP's logo is shown. Photographs show a black female physician with an older black female patient, an elderly Asian couple sitting on the grass holding two little girls in their laps, a white couple standing in the back yard, each holding a little girl, and a black woman holding an infant up to her face so their noses are touching.

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Images: The cover of the Consumer Reports special report for Massachusetts, "How Does Your Doctor Compare?", is shown. Headlines from boston.com. the Boston Business Journal, SouthCoastToday.com, CommonHealth, the Wall Street Journal's Market Watch, and WGBH News and OCABR Twitters are also shown referring to this report.

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Impact of MHQP's Clinical Performance Reporting

Impact of seven years of public release of physician performance of 150 MA medical groups using clinical HEDIS measures.

• Statewide improvement on all 8 measures that can be trended over last seven years.
• Public release has influenced physician organization investments in information systems to support quality.
• Physician organizations use MHQP's internal performance reports to reward individual physicians within the group.

MHQP is the independent, trusted source for tracking the performance of MA physicians statewide.

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Impact of MHQP's Patient Experience Performance Reporting

Impact of public release of physician performance on patient experience surveys with over 400 MA practice sites.

• Public release has motivated physician organizations to focus on improvements in patient experience.
• Physician organizations use MHQP's internal performance reports to reward individual physicians within the group.
• Health plan adoption of patient experience in physician incentive programs.
• Most recent release with Consumer Reports reached hundreds of thousands of consumers.

MHQP is the only entity that broadly tracks the experience of patients in MA through delivery and payment system changes.

Slide 8

The Long and Winding Road Toward Financial Sustainability... Where We Find Ourselves Now

Despite relevance and demonstrated impact... financial sustainability remains elusive:

• MHQP funding model hasn't kept pace with current strategic directions/objectives.
• Perceived inequities in current funding model have created strain among collaborative members.
• Changing financing and delivery models in the health care system, including new performance based incentives and organizational structures (i.e. ACOs, PCMHs), create new opportunities to leverage MHQP value.
• Widespread health care system cost pressures.

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The Long and Winding Road Toward Financial Sustainability...

"The Collaborative by its very nature is fragile... in the best of times".

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Image: A cartoon from the New Yorker shows two men seated at a table with a computer. One man is speaking to the other; the caption reads, "Sometimes I think the collaborative process would work better without you."

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Image: A cartoon shows people in a conference room. Two are gazing out of the window. One is asleep. Another is reading a newspaper, and another is making and flying paper airplanes. Two other people are standing and talking in the foreground; the caption reads, "We like to bring together people from radically different fields and wait for the friction to produce heat, light, and magic. Sometimes it takes awhile."

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The Long and Winding Road Toward Financial Sustainability... The Vision

A sustainable financing model that:

• Brings in ongoing revenues from diverse sources and results in outputs of great interest/relevance to individual, diverse collaborative members.
• Maintains a structure for Collaborative member contributions that feels equitable to all members—direct value for the $$.
• Supports the public good mission of the collaborative.
• Aligns effectively with the Collaborative's Governance model.

Slide 13

Breakdown of MHQP 2011 Revenues

Images: Two pie charts are shown. The first presents the breakdown of revenues by funding model:

• FFS, 27%
• Contracts, 38%.
• Grants, 26%.
• Dues, 9%.

The second pie chart presents the breakdown of revenues by funding source:

• Foundation, 26%.
• Federal Gov't, 24%.
• Health Plan, 23%.
• State, 14%.
• Providers, 3%.
• Researchers/other, 10%.

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Lessons Learned: the Beauty of the Vision versus the Challenges of the Reality

The Reality (for MHQP):

• Creating value for one member stakeholder can lead to divisive challenges with others around "high stakes" use of the data.
• Strategic direction and funding model must be aligned with local market trends, needs.
• Ongoing, effective communication is critical and sometimes difficult to achieve.
• It can be hard to disentangle governance from financing.

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For more information about MHQP...

Melinda Karp
Director of Strategic Planning and Development
mkarp@mhqp.org
617-600-4875
http://www.mhqp.org