1.3.2 Experience of Care: Clinical Quality

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En provenance du cours de University of Minnesota

Healthcare Delivery Providers

144 notes

University of Minnesota

Healthcare Delivery Providers

144 notes

Cours 2 sur 5 dans Specialization Healthcare Marketplace

Welcome to the exciting world of Healthcare Delivery Providers! This second course in the Healthcare Marketplace Specialization will help you understand the various providers of healthcare across the U.S. delivery continuum. We will explore the unique value proposition of the various providers- from hospitals and clinics to physicians to community based providers. We will dissect this important value chain using various lenses such as- site of care delivery, people who provide the care and payers who pay for care. You will also learn about the challenges facing these providers and the innovations they are creating in order to help transform this important industry. I will use readings such as a case study and videos to make this learning more experiential for you, so that you can see and feel the world of healthcare delivery. I will also explain the various acronyms and specialized terms used in healthcare, so that you become more proficient and familiar with the language. Given the fact that Healthcare is one of the largest industries in the U.S. and growing at an rapid pace, it is critical that current and future leaders understand the internal and external drivers that are shaping this industry. Current and future leaders will need to constantly innovate in order to sustain this industry into the future- by creating value for the end customer and the entire population, as well as increasing engagement of the humans who work within this industry. Get ready to take a deep dive into the complex ocean that is U.S. healthcare delivery- and make sure your oxygen tank is securely fastened!

À partir de la leçon

INTRODUCTION TO U.S. HEALTHCARE DELIVERY

Welcome to the world of healthcare delivery providers! In this first module, I will introduce important concepts in this field including how value in healthcare is measured, what some key influencers of healthcare are and how the healthcare delivery system will be examined in this course. We will use various lenses such as: site of care delivery, payment models, payers and humans that work in the delivery system to dissect this value chain. I will also discuss emerging paradigms like the Triple and Quadruple Aims and Accountable Care, which are rapidly spreading across the US healthcare industry.

1.3.1 What is the Quadruple Aim? (Overview)9:19

1.3.2 Experience of Care: Clinical Quality13:02

1.3.3 Experience of Care: Patient Satisfaction10:56

1.3.4 Cost of Care8:36

1.3.5 Population Health14:10

1.3.6 Healthcare Worker Satisfaction5:26

Rencontrer les enseignants

Dr. Rahul Koranne
Faculty
Carlson School of Management, Department of Finance

This is the healthcare delivery providers part of the healthcare market place

specialization.

This is module 1.3.2, Experience of Care, Clinical Quality.

The learning outcomes for this particular lesson are that we will understand some

of the metrics for this first trip will aim around

patient experience of care, and that would be the clinical quality realm.

And then we will understand a high level of quality measure framework in

the United States.

So this is the Institute for Healthcare Improvement, IHI,

triple aim paradigm that we have already discussed, and as we've discussed,

the clinical quality falls under the patient experience of care domain.

And this is where it sits.

So let's start by looking at some of the quality measures that are being

looked at in the United States.

And I want to begin with the ambulatory quality measures.

And these are the ambulatory settings.

Or the pre-acute settings that come before the acute care hospital.

So, for example, the primary care clinics or

other clinics that are out in the community.

So, let's look at some of those quality metrics.

So, the first reporting system

that exists is called the Physician Quality Reporting System.

There is another system under the Medicare Shared Savings Program.

So this is another paradigm that collects

many ambulatory sensitive quality measures.

Another paradigm that exists is under the electronic health record or

information technology meaningful use.

And so there are metrics that need to be looked at and

reported as part of that meaningful use program.

Another program called the Healthcare Effectiveness Data and Information Set,

or HEDIS, is a tool that is used by more than 90% of the U.S.

Health plans or the insurance plans to measure performance and

important dimensions of a clinical quality.

So that's HEDIS.

So here sits the clinic, primary care clinic, or the physicians office.

And these are the various programs or methodologies through

which the various clinical quality metrics are reported.

And some of the clinical quality metrics that underlie, or

lie under these various programs are, for example, the diabetes measures.

Diabetes is a medical condition.

So there are clinical quality metrics around that that might lie

under some of these reporting systems.

There might be measures around smoking.

There might be measures around depression, or some of the other

cancer screening, for example, or many other quality metrics.

Another metric might be around medications.

So, are the patients taking any high risk medications?

There could be immunization status metrics.

So, is the patient being given the correct immunization at the correct time?

For example, high blood pressure metric might be another one.

So a lot of these metrics are mixed and matched between these various programs.

Sometimes they might be collected in more than one program.

And there is definitely a move trying to standardize

the collection of these metrics through these various programs.

And lead to an overall program

of simplification so that it's easier for the clinics to collect the metrics,

report the metrics, and then afford the federal government or

other regulatory bodies to look at these metrics in a meaningful way.

To look at what is happening across populations, across states, and

across the nation.

And finally, after all of these metrics have been collected,

then there is a customer-facing interface.

So in this case it's called the physician compare.

It's a website that the government maintains, and

all of these metrics are posted.

And so the customer Harland Reeves, or his wife, or his daughter or

son, if interested, they could go to this website and

look at all of these metrics for their particular clinic.

So that's the point of this, to make it very transparent to the end user.

A very similar paradigm exists for the hospital quality measures.

So here again, here is the hospital.

And what might be measured, one program of measurement is called the value

based purchasing through the Centers for Medicare and Medicaid services.

Another program is how to reduce readmissions.

Another program is the hospital acquired infections, or HAI Reduction.

Similarly there's a Meaningful Use program

which has to do with information technology for the hospitals.

So these are all in patient.

And then also, for the hospital based outpatient clinic,

there's a whole separate quality reporting measure and a program.

So here are some of the measures that underlie some of these programs.

So, mortality.

30 day readmissions.

Here's an infection called a central line associated bloodstream infection.

Here's another infection, catheter associated urinary track infection.

And there are numerous such clinical quality measures that

lie under these various programs.

And again, there is simplification and standardization,

and a development of an overall plan or

a map of what should be collected, what is in stable state and should be retired,

what equality improvements are needed, and how can regulatory bodies system

themselves start to make sense of these numerous clinical quality measures.

So, there are many more electronic health record measures as well,

some of them are directly electronically reported.

Some of them have to be abstracted from the chart and

then reported manually to the various regulatory and federal bodies.

And again, after all of these are collected, then there is a customer facing

view so that the end customer is able to look at this matrix and

judge what their hospital's quality condition or quality control Is like.

This time, let's take a short quiz.

Let's keep looking at some of the other quality metrics.

Now, we've talked about the ambulatory and pre-acute setting.

We did talk about the acute care hospital, and

let's look quickly at the post acute quality measures.

So again, here is the skilled nursing facility or

transitional care unit or home health care or hospice,

and these are some of the measurement systems that are in place.

So nursing home quality reporting, home health quality reporting,

hospice quality reporting, inpatient rehabilitation facility quality reporting.

And underneath all of these there are various measures,

just like in the hospital and the clinics.

Sometimes they may or may not align with each other and

there's work happening to do that.

And all of these metrics then are reported.

Now, one of the things that I wanted to draw your attention in each of

the previous three slides is what happens after these metrics are reported.

So as discussed previously, these metrics are reported, and

then through a customer facing website, the nursing home compare,

they are visible to the patient and the family.

So they can judge what their post acute nursing home,

home health quality condition and quality control is like.

So here's a very high level look at the quality measurement framework across

the US, and it's extremely complicated but I'll try to make it a little simple.

So here's one particular system that has a hospital, a primary care clinic,

maybe a surgery center, maybe a nursing home.

And there is the federal government, so CMS, and

the federal government that will be looking at

quality metrics that flow from all of these to the federal government.

So, here is a central corporate body that collects all of these

metrics and sends them on to the federal government.

Now there might be another body, for example, a payer,

that might be interested in these same quality metrics.

So what the system, this particular system could do, is that they could

also divert those quality metrics and report them to this particular pair.

Now, let's say this is payer one.

There could also be another payer,

payer two, insurance company that wants to also look at these metrics.

So let's say this corporate body also sends it to that particular payer.

Now, here is a state agency, or

the state government, that also wants to look at some of these quality metrics.

So again, this body sends those metrics to the state as well.

Now, as you can imagine, the more coherence

between these quality metrics there is, the more effective this body will be.

So if the metrics for CMS do not

align with the metrics for state or the payers that the system is working with,

then this particular body over here is going to become quite distraught, and

it'll have to start collecting many, many, many hundreds and thousands of metrics.

So there's working happening to try to bring coherence, or standardization,

across these metrics, so that what the payers, the regulators, the federal

government, the state government, are looking at is much more standardized.

And much of this work falls under the category of administrative simplification.

There's also pay for performance concepts in the US,

which means that a quality measurement is done.

It is reported to a payer, either governmental, federal, state, or

local commercial.

And based upon that, there are rewards that are shared with the delivery system,

for example, the hospital or the clinic.

And both carrots, so there's rewards, or sticks, so there are withholds.

So let's say X amount was supposed to be paid in incentive payments to

the hospital.

They did not meet the quality metrics, so a certain percentage of that money is

withheld and the hospital is paid less amount.

So that's a stick approach to quality reward and penalties.

In summary, clinical quality metrics are one very important component

of the experience of care triple aim.

And there's an extremely complex system of quality measurement reporting, and

also rewards and penalties, that exists in the United States.

And it is being continuously looked at for administrative simplification, and

to get the most value out of this quality measurement.

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