Healthcare Quality: How will Data Transparency Make a Difference?
How does transparency of healthcare data information lead to improvements in quality and affordability of healthcare? How is healthcare data used and interpreted (and specifically comprehensive Medicare claims data recently made available by the Centers for Medicare & Medicaid Services - CMS)? Has healthcare in Oregon improved?
The Lund Report posed these and other questions to Mylia Christensen, Executive Director of the Oregon Health Care Quality Corporation (Q Corp), an organization working with stakeholders to improve healthcare quality, transparency, and affordability in Oregon since its inception in 2000.
Medicare Prescribed Drug Data
To begin this discussion, The Lund Report asked Christensen to comment on the recently published article, “Oregon Physicians Prescribed $1 Billion in Drugs in 2013.” The analysis reported results of the first-time release of CMS Medicare drug claims data. Of the $1 billion drugs prescribed in Oregon under Medicare’s plan D in 2013, approximately 80 percent of the claims were generic yet the costs only represented about 30 percent of the total.
From the top 15 list of physicians who prescribed the highest drug costs, Christensen observed there were a few notable specialists who work with high-cost drugs in treating Multiple Sclerosis and Parkinson’s patients. Also on the list was Maria Kosmetatos, a nurse practitioner in Hood River who specializes in HIV/AIDs treatments (recognized as nurse practitioner of the year in 2001).
However, also in the top 15 were primary care physicians. In this case, the higher cost of brand drugs might not be so easily explained.
To interpret the data, Christensen noted that the CMS data provides “an opportunity for us all to be very thoughtful in looking at this information, and from our perspectives what we want to learn from it.”
With the release of this data, CMS is encouraging a deeper look. It’s important to consider how the data is compared, the profile of specialists, and mix of patients giving physicians, providers, and other organizations the ability to drill down and conduct more comprehensive analyses.
For a number of years, industry professionals had hoped that more transparent information - enabling stakeholders to assess healthcare quality - would help providers make actionable steps toward improving health outcomes.
According to Christensen, the healthcare industry has been making much progress in the area of transparency and data interpretation. However, the data (and corresponding analysis) has to be good, and must be understandable.
Providers and other interested parties should approach both the analysis and the results from the perspective of “what information is relevant, what can we learn and what can we improve” to tailor the kind of improvements most needed, she said.
Christensen emphasized: “Q Corp is not promoting a ‘gotcha’ mentality but rather the use of good quality information and how it can help us improve healthcare. What it means is working side by side with all stakeholders including providers, health systems, employers, consumers, policy makers, and trying to find ways to make sure the information is available and useful.”
Considering Q Corp’s industry track record it’s plausible they mean business. It was one of the first organizations to be certified under the “Qualified Entity Program,” and has access to fee-for-service medical claims data submitted by Oregon clinics to Medicare.
Use of Healthcare Data
Q Corp uses the prescribed data to evaluate performance of providers and the quality of healthcare. The goal of CMS for the Quality Entity Program is to drive improvements to quality and reduce the cost of Medicare as well as the overall healthcare system.
One of Q Corp’s goals is to analyze costs and utilization to help identify methods for reducing costs while improving care. It works with the data’s attributes to measure a clinic’s quality of care, cost of care and identify areas for improvement.
Although there has been some criticism in using administrative claims data for its use in quality measures, the majority of the quality and cost measures have been endorsed nationally to enable comparison across clinics. Christensen noted:
“At this point, as the data is used for multiple purposes including performance improvement, contracting and financial incentives, people are more interested in getting the claims information coded correctly. There can be issues and challenges but we do a lot of our own quality checks of the data. We also have a portal that offers a way for physicians to review the data before it is publically reported.”
Q Corp produces an annual statewide report providing a snap shot of healthcare quality across Oregon. This report represents care for 2.6 million Oregonians and contains healthcare claims information from 100 percent of the Medicaid population, 92 percent of the Medicare population, 80% of fully insured commercial population and 35 percent of the self-insured commercial population.
Q Corp has released its new Total Cost of Care report this spring and plans for a second release in fall of 2015. Those reports look at inpatient, outpatient, and total costs for a clinic’s commercial population. Christensen noted that providers are “thirsty for this data because it gives them a picture of how they are managing their patient population compared to other clinics across Oregon.”
To date, Q Corp has analyzed the total cost of care for about 40 percent of the commercially insured population in Oregon, and is in the process of working with national partners developing equivalent cost of care analyses for Medicare and Medicaid data.
Status of Healthcare Quality in Oregon
Q Corp’s statewide report for 2014 highlighted certain areas of healthcare quality improvements in Oregon, for example Chlamydia screenings increased from 28.8 percent in 2009 to 45.5 percent in 2014. On the other hand, there were some measures tracked for several years that are still below the rest of the country.
For example, page seven of the report listed clinics with several measures that are below the national mean. In areas such as well-child visits, even with many organizations working hard on this measure, there is still an opportunity for progress, Christensen said.
While there is marked interest in improving quality, transparency, and affordability of healthcare in Oregon, Christensen speculated there is never just one easy answer. Everyone is looking for better measures that tell us how we’re doing overall in improving the health of our communities and the general population.
Kathryn can be reached at firstname.lastname@example.org.