July 2009

Grant Results

SUMMARY

From 2004 to 2006 a team of consultants funded through the National Partnership for Women and Families in Washington researched business models capable of supporting physician performance reporting systems.

The team identified eight existing models and used their strongest components to design two models aimed at accelerating the implementation of physician performance measurement and reporting in outpatient settings.

The work was managed by staff of the Consumer-Purchaser Disclosure Project, a coalition administered jointly by the National Partnership for Women and Families and the Pacific Business Group on Health.

Key Result

  • The research team issued a 72-page report summarizing the research process and describing the two business models developed by the team. The report was made available online.

Key Findings

  • The researchers proposed two alternative models to promote performance measurement and reporting:
    • Federal Action-State Implementation Model: The federal government would serve as the initial driver of change and create strong incentives for states to implement a measurement and reporting system.
    • Accreditation-Certification Model: Private and public purchasers would drive the measurement and reporting system. They would collaborate with health plan accreditors to require physician performance measurement and reporting as a condition of health plan accreditation.

Funding
The Robert Wood Johnson Foundation (RWJF) supported this unsolicited project from October 2004 through July 2006 with a $279,690 grant to the National Partnership for Women and Families.

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THE PROBLEM

Research shows significant variation in the quality of health care received by Americans. One strategy to address the problem is to use information on the quality of care provided by physicians and hospitals in: consumer decision-making, paying for health care, and driving improvements.

By 2004, a number of efforts were underway to develop a national reporting system on provider performance. However, the leadership of the Consumer-Purchaser Disclosure Project were concerned that progress was being slowed by a lack of coordination and other factors.

The Consumer-Purchaser Disclosure Project is a coalition of employer, labor and consumer organizations that promotes national, standardized reporting of health care performance data and its use in quality improvement, consumer choice, and payment reform. RWJF provided funding for the coalition after its formation in 2002. See Grant Results on ID# 045585.

The National Partnership for Women and Families, a Washington organization that supports fairness for women in employment and health care, administers and staffs the coalition in collaboration with the Pacific Business Group on Health, a San Francisco-based organization of employers.

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RWJF STRATEGY

As stated in RWJF's 2004 Annual Report, "[e]nsuring that all Americans, especially those with chronic conditions, receive high-quality care is central to the Foundation's mission of improving health and health care."

In 2004, the year when RWJF issued this grant, the Foundation "pursued a four-pronged approach to improve the quality of care for chronic disease in outpatient settings:

  • National Measures for Quality. To improve the quality of care, we need to first agree on what 'quality' means and how to measure it. To that end, we provided support to the National Quality Forum, a group of providers, patients, purchasers/payers and researchers, to build consensus around reliable measures of quality.
  • Engage Patients and Purchasers in Assessing Quality. Patients and purchasers need to be involved to ensure that the care they receive and pay for meets quality standards. The Foundation's Rewarding Results national program continued to help purchasers test the effectiveness of incentives for higher quality care. In 2004 we awarded a grant to the National Partnership for Women and Families to plan an effort to engage consumers in demanding quality care.
  • Demonstrate that High Quality is Achievable Where Providers, Purchasers and Patients are Aligned Around Common Quality Standards. Working with multiple partners in selected markets, we will launch demonstration projects that align providers, purchasers and patients around common quality goals to raise the standard of care so that outpatient quality standards are met most of the time rather than only half the time. If successful, consumers in these markets will have access to information about the quality of care, and providers will have demonstrated skills in adopting the principles of the Chronic Care Model.
  • Track Progress. It remains critical to track progress toward achieving better care. The Foundation is supporting work to examine whether more purchasers are making decisions based on quality; whether more patients are becoming engaged in managing their own care and ensuring the care they receive is of high quality; and whether more providers are adopting the tools and systems they need to provide high-quality care. For example, through a 2004 grant to the University of California, Berkeley School of Public Health, researcher Stephen Shortell is tracking the implementation and use of preventive services and evidence-based care management processes in the care of asthma, congestive heart failure, depression and diabetes."

The grant described in this report fit into the second of these approaches.

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THE PROJECT

A team of consultants researched business models capable of supporting physician performance reporting systems. The team identified eight existing models and used the strongest components to design two models to serve as a basis for widespread implementation of physician performance measurement and reporting in outpatient settings.

The purpose was to speed the process of making robust information about providers' performance widely accessible. Although initially the scope included hospital performance reporting, the project focused solely on ambulatory care because the need for guidance in that area was considered most pressing.

RWJF funded the work from October 2004 through July 2006 with a $279,690 grant (ID# 051755) to the National Partnership for Women and Families. Staff of the Consumer-Purchaser Disclosure Project managed the consulting team, which was headed by Kathryn L. Coltin, M.P.H.

Methodology Overview

To gather information on measurement/reporting systems, the team interviewed and surveyed 80 individuals from a variety of stakeholder groups, including leaders of organizations engaged in the measurement and/or reporting of physician performance. The data-gathering effort included two interactive webcasts in February 2005 that drew about 40 participants.

The team identified key components necessary in a business model supporting physician performance measurement/reporting systems and established three "threshold criteria" that a model should meet:

  • Be able to be scaled to a national level.
  • Be able to aggregate data across all payers.
  • Be financially sustainable.

The team identified eight existing business models as candidate models for national performance measurement and reporting and evaluated their weaknesses and strengths against these threshold criteria.

Using various components of each of the eight as building blocks, the team created two models designed to promote national performance measurement and reporting in ambulatory care.

See Appendix 1 for the team's definition of the term business model and brief descriptions of the eight evaluated models.

Challenges

Obtaining data on the business cost of measurement/reporting systems was difficult in some instances, the Consumer-Purchaser Disclosure Project staff reported to RWJF.

Some organizations with systems were reluctant to share financial information while others were unable to track costs associated with their measurement/reporting activities. An assurance of confidentiality overcame the problem to some extent, staff said.

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RESULTS

  • In November 2006, the Consumer-Purchaser Disclosure Project issued a 72-page report that summarized the research team's activities, methodologies and findings.
    • The report—Measures to Market: Accelerating Progress toward Sustainable Business Models for Physician Performance Measurement and Reporting in Ambulatory Health Care—outlined the two business models developed by the team. See Findings.
    • The Consumer-Purchaser Disclosure Project made the report accessible online through its Web site and distributed copies to "several hundred" leaders and members of organizations active in the movement to measure provider performance, staff reported.

Findings

  • The researchers proposed two alternative models to promote performance measurement and reporting. Both models would rely heavily on collaboration between the private and public sectors, but government agencies would be the primary organizer in one and private-sector organizations the primary organizer in the other.
    • Federal Action-State Implementation Model: The federal government would serve as the initial "driver of change" and create strong incentives for states to implement a measurement and reporting system.

      The catalyzing federal action could take the form of regulatory requirements or voluntary incentives. For example, the Centers for Medicare and Medicaid Services could make participation a condition for obtaining Medicaid matching funds or, alternatively, provide participating states with enhanced Medicaid funding.
    • Accreditation-Certification Model: Private and public purchasers would drive the measurement and reporting system. They would collaborate with health plan accreditors to require physician performance measurement and reporting as a condition of health plan accreditation.

      The catalyzing event would be a commitment by a significant majority of purchasers to contract only with accredited health plans participating in state or local performance reporting efforts.
    Although the two models differ in financing strategies and other aspects, they have similarities. For example, both envision that performance measures would be developed by a single national organization funded through federal revenue. They also share a similar approach to dissemination and reporting. For a detailed description of each model, see the online report.

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GRANT DETAILS & CONTACT INFORMATION

Project

Developing a business model for measuring and reporting quality

Grantee

National Partnership for Women and Families (Washington,  DC)

  • Amount: $ 279,690
    Dates: October 2004 to July 2006
    ID#:  051755

Contact

Project Coordinator: Jennifer L. Eames, M.P.H.
(415) 615-6307
jeames@healthcaredisclosure.org
Project Director: Debra L. Ness, M.S.
(202) 986-2600
dln@nationalpartnership.org

Web Site

http://healthcaredisclosure.org/docs/files/MeasurestoMarketReport.pdf

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APPENDICES


Appendix 1

Definition of the Term Business Model and Identification of the Eight Evaluated Models

For the purposes of its work, the research team adopted the following definition for the term business model:

  • "The organizational structure(s), revenue stream(s) and major expense categories for supporting business processes, products and services related to performance measurement and reporting."

The team evaluated these eight models: (The following is excerpted from the team's November 2006 report. See the online report for a more comprehensive explanation of each model.)

  • Health Plan Model. Examples: Numerous national and regional health plans.

    "Financially, this model depends on using a small percentage of pre-paid premium dollars to support operations related to performance measurement and reporting."

    Features of the Model Adopted by the Research Team: Operational expertise in data collection and aggregation and in reporting and dissemination of results.
  • Purchaser Model. Examples: Massachusetts Group Insurance Commission, Maine Health Management Coalition and CMS Physician Voluntary Reporting Program (now called Physician Quality Reporting Initiative).

    "Financial sustainability of the model depends on the willingness of purchasers to accept pricing that covers the costs of measurement and reporting activities."

    Adopted Features: Purchaser requirements as a catalyst for measurement and reporting, and the ability of purchasers to play an important role in dissemination of performance results to employees and public.
  • State-Agency Model. Examples: Pennsylvania Health Care Cost Containment Council, New York Cardiac Outcomes Model and Massachusetts Data Analysis Center.

    "Sustainability of programs relies on state revenues and budget allocations that may be unpredictable."

    Adopted Features: State legislation and regulation as a driver of change, and mechanisms for data collection, audit and verification.
  • Commercial Vendor Model. Examples: WebMD Quality Services, Thomson Medstat, Health Benchmarks and Resolution Health.

    "Some private commercial vendors have developed successful business models for specific tasks of performance measurement and reporting…Sustainable models appear to rely on product sales, licensing or achieving advertising revenue."

    Adopted Features: Potential for innovation, mechanisms for audit and verification and reporting and dissemination.
  • Regional Quality Collaborative Model. Examples: California Cooperative Healthcare Reporting Initiative, Massachusetts Health Quality Partners, Minnesota Community Measurement and Wisconsin Collaborative for Healthcare Quality.

    "In some areas of the United States, purchasers, health plans, providers and other stakeholders have formed voluntary collaborative associations to develop performance measurement and reporting systems."

    Adopted Features: Regional responsiveness and consensus-building capacity and mechanism for all-payer data aggregation, dissemination and reporting.
  • Accreditation/Recognition Model. Examples: National Committee for Quality Assurance and Joint Commission on Accreditation of Healthcare Organizations.

    These two organizations "have demonstrated that it is possible to [include] performance measurement and reporting activities on a platform of accreditation."

    Adopted Features: National standardization of measures, leverage for provider participation and other features that made this model the "cornerstone" of the research team's proposed Accreditation-Certification Model.
  • Professional Organization Certification Model. Examples: American Board of Internal Medicine and American Board of Medical Specialties.

    Some professional boards, such as the American Board of Internal Medicine, collaborate with professional societies (for example, the American College of Physicians) "to augment the traditional written examination with an assessment of clinical performance on samples of patients."

    Adopted Features: National standardization of measures, leverage for professional participation and potential for innovation.
  • IOM National Quality Coordination Board Model. Example: A proposal by the Institute of Medicine for creation of a federal coordinating body called the National Quality Coordination Board (NQCB).

    While independent, the NQCB would be "federally centered, meaning it would require potentially contentious new federal legislation and a substantial budget allocation."

    Adopted Features: Federal coordinating role, federal funding for measure development and consensus activities, and leadership drawn from the public and private sectors. (The research team's Federal Action-State Implementation Model has some similarity to the NQCB model.)

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Reports

Measures to Market: Accelerating Progress toward Sustainable Business Models for Physician Performance Measurement and Reporting in Ambulatory Health Care. Washington: Consumer-Purchaser Disclosure Project, November 2006. Available online.

Survey Instruments

"Final Interview Guide: Module for organizations currently engaged in supporting and/or conducting health care provider performance measurement and reporting," Consumer-Purchaser Disclosure Project, fielded April–July 2005.

"Final Interview Guide: Module for consumer organizations," Consumer-Purchaser Disclosure Project, fielded April–July 2005.

"Final Interview Guide: Module for organizations that have been transformed or have sunset over time," Consumer-Purchaser Disclosure Project, fielded April–July 2005.

World Wide Web Sites

http://healthcaredisclosure.org/activities/publications. A page on the Consumer-Purchaser Disclosure Project Web site that includes a summary of the "Measures to Market" research project with links to the full report, the executive summary and a February 2005 webcast presentation. Washington and San Francisco: Consumer-Purchaser Disclosure Project, November 2006.

Presentations and Testimony

Consumer-Purchaser Disclosure Project, "Welcome to the Measure to Market Project, Stakeholder Webcast," online presentation by the project team, February 1 and February 8, 2005. Presentation available online.

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Report prepared by: Margaret O. Kirk
Reviewed by: Michael H. Brown
Reviewed by: Marian Bass
Program Officer: Anne F. Weiss

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