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Frequently Asked Questions About the Report on Health Care Performance
What is the Alliance? The Alliance is a 501(c)3 non-profit focused on encouraging and supporting improvement in our local health care system. More than 160 medical clinics, hospitals, employers, unions, consumer groups, government agencies, health plans and others have joined the Alliance. Together we are defining, measuring, reporting and rewarding high quality, efficient, patient-centered health care.
Who started the Alliance? The Alliance was founded at the end of 2004, based on a report from the King County Health Task Force convened by King County Executive Ron Sims. Read more about the history of the Alliance.
What geographic area does the Alliance cover? The Alliance work, including health care reports to the public, currently focuses on five counties in the Puget Sound region: Snohomish, King, Kitsap, Pierce and Thurston counties. Several Alliance participants are statewide, national and international organizations, so there is interest in expanding the Alliance statewide.
Many organizations have joined, but can individuals get involved too? Definitely! Everyone is encouraged to join. For individuals who don't represent an organization, the cost to join is $25 per year. Your contribution helps support the development of better information for the public comparing quality, efficiency and patient experience in local health care. As a participating individual, you'll receive the same Updates that go to all who join the Alliance — including doctors, hospitals, employers, unions, health plans and government agencies — so you stay up-to-date on our progress. As a member, you can access Alliance information anytime through the participant-only section of our website. We also have volunteer opportunities if you’d like to join a committee or a workgroup. Join the Alliance now.
What is “quality” health care?
According to the Institute of Medicine, quality health care is Safe, Timely, Effective, Efficient, Equitable and Patient-centered (remember it as STEEEP). Others sum up 'quality' as care that is safe, effective and patient-centered.
Why is quality a concern — don’t we have some of the best health care providers in the country right here in Washington state? Yes. We are lucky to have very talented physicians and impressive hospitals, many of whom are leaders in the Alliance. But unnecessary variation in the effectiveness and quality of care is everywhere. Research shows that in the Puget Sound region, about 40% of the care provided is not consistent with what the medical community agrees is effective care (source: RAND, 2004 and updated in 2006). We all have room to improve, even in the Northwest.
Is quality improvement about shifting costs to help employers? We all know that cost-shifting is not a long term solution. The real issue is health system performance. To make health care better and more affordable for everyone, we need to make sure that health care dollars are spent on effective care that gets and keeps people healthy. To encourage people to seek out the most effective care, sometimes health plans may have to cover more, not less. For example, by making sure that patients with diabetes have coverage for glucose (blood-sugar) test strips and routine foot exams, it’s possible to avoid more serious problems that require more costly emergency visits or amputations. In other cases, health plan coverage may need to be designed to encourage patients to seek more affordable options, such as equally-effective generic prescription drugs rather than more expensive (highly advertised) brand-name versions of the same drug.
Is the Alliance working on improving access to care? While the Alliance is not targeting access, our efforts to make health care more efficient, effective and affordable ultimately will enable greater access and may help to reduce the number of uninsured people. Everyone should have access to safe, effective health care that is responsive to patients’ needs. Unfortunately, a big part of the reason why so many are uninsured is that our health care system is too expensive. Patients, governments (taxpayers) and employers can’t afford to keep putting more money into the current system. All across the nation groups like the Alliance are focused on getting more effective and efficient care out of every health care dollar. About the Public Report on Health Care Performance
What will be in the public report on health care performance? The first Community Checkup report measures 21 processes of care provided to patients, with focus on areas including diabetes, heart disease, back pain and depression. The measures also cover aspect of prevention and the use of pharmaceuticals. See the list of measures. For more information about the Community Checkup go to www.WACommunityCheckup.org. How were the first set of measures selected? Through Clinical Improvement Teams convened by the Alliance, local physicians and others in the medical community came together and identified national standards for effective care to promote locally and the related measures to use in the first Community Checkup report. From October 2006 through January 2007, the proposed list of measures was circulated throughout the community and the Alliance received feedback from hundreds of physicians, in addition to comments from consumers, employers, health plans and others. Staff and committees reviewed the input, made a few adjustments, and in April 2007, the Alliance Board approved this first set of measures. More measures will be added to the Community Checkup over time, to compare performance in other areas of care, efficiency and patient satisfaction. Measures of hospital care will be added too. Will the Community Checkup report be updated over time? Yes. Not only will the report be updated, but the content will be expanded with additional measures and sources of data. The first Community Checkup report was released in January 2008 and the second report is scheduled to be released in the second quarter of 2008. The Alliance Board has directed staff to try to publish an updated Community Checkup twice a year.
When will the report compare patient experience or satisfaction levels? We’re working on it. While many health plans and physician groups survey patients to measure satisfaction with their experience — including wait times and communication skills — the surveys are different so the results cannot be compared across groups. The Alliance is working on identifying a good source for measuring and reporting on patient experience. Do other communities produce reports like the Community Checkup? Yes. Several communities around the country publish public reports comparing local health care quality. The Puget Sound Health Alliance is unique in that all stakeholders (physicians, hospitals, employers, individuals, unions, health plans, and others) have been at the table from the beginning to develop the report for this region. The Alliance is working closely with others around the country, with help from the Robert Wood Johnson Foundation. By learning from others' experiences, we can adopt proven programs to get results for the Puget Sound area as quickly as possible.
Where can I find examples of public health care comparison reports for other regions? California Office of the Patient Advocate www.opa.ca.gov Greater Detroit Area Health Council www.gdahc.org Health & Human Services Hospital Compare www.hospitalcompare.hhs.gov Health Partners Quality Measurement www.healthpartners.com/portal/143.html Health Scope (CA Health Care Quality Ratings) www.healthscope.org Healthgrades www.healthgrades.com JCAHO Quality Check www.qualitycheck.org Leapfrog Group www.leapfroggroup.org/cp Massachusetts Health Quality Partners www.mhqp.org Minnesota Community Measurement www.mnhealthcare.org National Committee for Quality Assurance www.ncqa.org NY Health Accountability Foundation www.nyshaf.org/index/hmo_report_card OR Assn of Hospitals & Health Systems Price Point www.orpricepoint.org Premera Quality Scorecard www.premera.com (link in lower right corner) Wisconsin Collaborative for Health Care Quality www.wchq.org
Who decides what “quality care” is and how to measure it?
Where did the information in the Community Checkup come from? Initially, the report is based on claims data from health plans, self-insured employers, union trusts and government programs. De-identified data has been supplied from fourteen organizations -- including all of the major health plans in the state (e.g., Aetna, Group Health, Molina, Premera Blue Cross, and Regence Blue Shield). The data does not include information that personally identifies any individual patient. Over time, we would like to add data from other sources to make the report even more comprehensive. As data from medical charts, labs, pharmacies and patient satisfaction surveys become available in electronic format, the reports will be able to compare elements such as the percentage of all patients with heart disease whose cholesterol is at an acceptable level. Doctors, clinics, hospitals, labs and others interested in quality reports that reflect more clinical and outcome data are helping with the progress toward that goal by, among other things, transitioning away from paper recordkeeping toward health information systems such as electronic medical records.
How will you know if the data in the report is accurate? The data will be aggregated and analyzed by experienced information technology experts at the Alliance and Milliman consultants in consultation with the Alliance Health Information & Technology Committee. Results have been submitted to and validated by the organizations that supplied the data, then reviewed with clinics to verify that the results are reasonable. How will my personal health information be protected if the report is public? None of the data being provided nor the reports being produced by the Alliance include information that reveals the identity of individual patients. The report will compare information across an entire population of patients, such as “For this clinic, what percentage of patients with heart disease had their cholesterol tested in the past 12 months?” Don’t federal privacy laws prevent you from acquiring and using my health information? The Health Insurance Portability and Accountability Act (HIPAA) does protect the privacy of your health information, and the data for our reports is being gathered in accordance with HIPPA requirements. None of the data being provided for the reports nor the reports being produced by the Alliance contain information that identifies individual patients. Without data identifying individual patients, how do you know that results in the Community Checkup are based on care provided to the actual patients of each clinic?
The Alliance worked closely with clinic systems who volunteered to help verify that the results were based on their actual patients. In collaboration with a large health plan that agreed to provide individual patient names directly back to each of those clinic systems, the clinic systems first ran an automated process which matched about 90% of the patients from the list as theirs. Then the clinic systems manually reviewed the remaining patient names on the list, and concluded that about 99% of the patients were correctly attributed to their clinic. This feedback confirmed that the technical algorithms used by the Alliance were appropriately attributing patients to the right clinics and clinic systems. This process will be repeated as a key step in producing the second Community Checkup report.
Why are these measures important? The initial performance measures focus on conditions that affect significant portions of our community. Heart disease is the number one cause of death in the U.S. and in Washington State, and diabetes is the fifth leading cause of death. Many people are living with back pain and depression, and the use of prescription drugs is one of the fastest growing areas of health care treatment. The Community Checkup report also include preventive measures, such as cancer screenings, that are important for everyone. See the list of measures. Future reports will contain additional measures such as treatment of asthma.
Can I choose a doctor based on the Community Checkup report? The purpose of the Community Checkup is to encourage everyone to do their part to improve health care quality. Of course, all doctors and clinics have a critically important role to play in that process, but so do you. We encourage all people to use the report to talk with their doctors about how to get the most effective care possible to be as healthy as possible. If you don't have a doctor, you could use the Community Checkup to look at results for entire clinics (medical practices), but remember that the report measures certain aspects of care, and there are many other factors to consider when choosing a doctor who is right for you. The Alliance Board has expressed interest in eventually publishing reports comparing care provided by individual doctors, but no decision has been made about going to that level of reporting.
How can I use the Community Checkup when it compares clinics, not specific doctors? Use the Community Checkup to talk with your doctor about getting the most effective care possible. Look at the types of care being measured in the report and ask your doctor about what is right for you and your health needs.
What if my doctor’s clinic isn’t in the Community Checkup? The first Community Checkup shows results for 14 clinic systems who volunteered to have their results included. This translates to more than 81 clinic locations or doctors' offices in the region. The second report, due later in 2008, will include results for more clinics in the region that are over a certain size. There will still be instances when results aren't shown for a given clinic because many doctors offices or medical practices are very small. Results will not be shown for those offices for which we don't have enough data to ensure that the results are statistically valid. If your doctors' office isn’t in the report, you can still use the Community Checkup as a way to talk with your doctor or nurse about treatment options. One of the keys to the Alliance’s approach is to get everyone involved (including YOU) to do their part to help improve the quality of health care provided and received locally. What if I haven’t received the care these reports recommend? Talk with your doctor or nurse about whether the treatments mentioned in the report are appropriate for you. While people have unique health situations that may require different approaches to treatment, this first Community Checkup focuses on basic levels of care, particulary for people with chronic conditions. The report shows results for aspects of care that are appropriate in nearly all circumstances for patients with certain health conditions.
Who are the top 10 doctors in Seattle? Can’t help you there. The Community Checkup helps everyone identify which clinics are most consistent in providing care that is known to be effective, particularly for people with chronic conditions such as heart disease, depression and diabetes. The report should be used by everyone to do their part to improve health care quality over time.
Can doctors pay to get good ratings like they do in some of those “Top 100” magazine articles? No. The Alliance is a non-profit organization funded by anyone who joins (and all are welcome to join!). We focus on recognizing and rewarding quality health care. The Alliance Policy on Funding, Contributions or Collaborative Programs Involving Commercial Interests prohibits any financial transactions that affect the objectivity of the Alliance in accomplishing these goals.
Why is it so hard to find useful and understandable information comparing doctors and comparing hospitals? As consumers, we assume that when something is expensive, it must be high quality for it to be a good value. That's what people look for when they use information comparing travel services and car mechanics. However, the complicated and high-stakes nature of medicine and health care make it difficult to weigh in on health care quality and value. Health care costs spiral upward, yet research increasingly reveals the poor health status of Americans, a tremendous amount of inefficiency and waste, and too much variation in who gets health care services that are known to be effective, especially for patients with chronic conditions. In fact, when high quality care is provided, in many instances it is actually less expensive than care that is ineffective, wasteful or unsafe. The Alliance Community Checkup is a step in the direction of opening up information about health care performance so everyone can begin to make decisions that improve and reward real value in health care.
How can I provide comments about the public reports or other work of the Alliance? Send us your ideas and comments anytime. Our goal is to ensure that the Community Checkup report is as useful as possible for improving the quality of health care, for supporting and rewarding such improvement, and for increasing the ability of each of us as patients to make informed decisions about our own health and health care. Still have questions? Contact us. |
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© 2008 Puget Sound Health Alliance
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