Measuring Health Care Performance in the Better Health Together Region

High-value care is high quality care, with a good patient experience and at a fair cost. Unfortunately, the quality of care patients receive varies among counties, medical groups, clinics and even within medical groups and clinics. Unwarranted variation, without a clear connection to how sick patients are, can be a signal of poor quality, or at the very least an opportunity for improvement. In a highly functioning health care delivery system, everyone would receive a similar high level of evidence-based care for the same condition. However, we know this is not the case in Washington and elsewhere around the country.

An important first step in reducing variation is measuring it and broadly sharing results to develop a common understanding of what needs to improve and where it needs to improve.

The Washington State Common Measure Set for Health Care Quality and Cost, implemented for the first time in 2015, is a “starter set” of 52 measures that enables a common way of tracking important elements of health and health care performance. These results are published on the Washington Health Alliance’s Community Checkup website.

Policymakers and health care leaders within Better Health Together can use the results from the Community Checkup to determine how well health care and community systems are performing. The results also can serve as a baseline for future reporting. Consumers within Better Health Together’s jurisdiction can look to results for medical groups, clinics and hospitals to help make informed decisions on selecting a primary care home as well as where to find high-quality hospital care.

Opportunities for improvement

When looking at results from the Community Checkup, it’s important to look at not only the results for all of Better Health Together ACH, but also at the county level, as well as the amount of variation among provider organizations within the ACH. We’ve called out some results to show where variation is especially pronounced. To compare full scores, please visit wacommunitycheckup.org.

ACH-level results

On many of the measures reported in the Community Checkup, the Better Health Together community is performing at the state average. However, when possible, we compare rates to national 90th percentile benchmarks. When we compare against these goals, there is significant opportunity for improvement across several measures, such as Avoidance of antibiotic treatment in adults with acute bronchitis (Better Health Together commercial rate = 28% compared to NCQA national 90th percentile rate = 38%).

On a few measures (for example, Well-child visits between ages three and six), we saw pronounced disparities between Medicaid and commercial enrollees. Across all payers, the Better Health Together community can improve appropriate testing for children with pharyngitis before dispensing an antibiotic for strep. This is particularly important as antibiotic overuse plays a role in the rise of antibiotic-resistant bacteria.

County-level results

If variation can be a signal of poor quality, then looking at variation within the ACH will reveal opportunities for quality improvement. We looked within the Better Health Together area to see where there was the most variation in performance. When looking at combined commercial and Medicaid enrollee data, we see the most variation among counties on the following measures:

• Almost all of the health screenings measures
• Immunizations measures. (In particular, the childhood and adolescent immunization measures, meaning more work needs to be done to make sure children and adolescents are getting their recommended vaccines.)
• Adherence for diabetes medications
• Hospitalization for COPD or asthma

We saw the most variation among medical groups on the following measures:

• Diabetes measures
• Health screenings, in particular breast cancer and colon cancer screenings

Spotlight on Spokane

Overall, Spokane County rates average (results are not significantly above or below the Washington state rate) on most of the measures reported in the Community Checkup. Spokane County is serving residents with commercial insurance pretty well. The county ranks average on most measures, and better than average on many, including health screenings, most generics prescribing measures and medication adherence. The county has room to improve in how it serves Medicaid patients. For example, we see worse than state average results for many of the measures for Medicaid enrollees, including potentially avoidable ER visits.   

 

Successes to celebrate

As the highlighted results reveal, there are many areas where targeted efforts to improve how care is delivered to residents within the Better Health Together jurisdiction. But there are also many successes to celebrate (and replicate!).

For example, the Better Health Together community overall is exceeding national benchmarks on screening for cervical cancer among Medicaid enrollees. However, as stated above, it’s important to look at variation within Better Health Together to see how all organizations and regions could be lifted up to this higher standard. As regional conveners of key stakeholders that influence local health and health care, ACHs like Better Health Together are well-positioned to prioritize and take action on these findings.

Next Steps for our ACH

More than 90 folks joined us for our Healthy People Champions Regional Gathering last month. It was an inspired day for BHT as we saw the key players in our region roll up their sleeves and get to work on moving our Accountable Community of Health work forward.

The week of February 29, we will launch our next phase of work with our Community Action Teams. We’ll be hosting ten work sessions focused on our “Community Linkage Mapping and Architecting the Ideal” for each priority area. We are building our teams now, if you have an interest in participating please let me know at Alison@betterhealthtogether.org.

Wondering why we are asking so much of you—or just wondering how these activities will actually make people healthier?

We are pleased to host an educational webinar on Tuesday, February 23 from 9:30-10:3a.m. That includes three thought leaders who are not just talking about transformation but are making it happen.

• Göran Henriks, Chief Executive of Learning and Innovation, Qulturum, County Council of Jönköping, Sweden, will join us to share the success and possibility Jönköping, Sweden,  has achieved by transforming health through the alignment of programs and resources within the community. I am especially inspired by their work because it has very little to do with their funding and more to do with how they work together as a community
   
• Alisha Fehrenbacher, Chief Strategy Officer for Empire Health Foundation, is the former Oregon Care Coordination Organization CEO. The Oregon CCO movement preceded the creation of Healthier Washington and our ACH movement. I am intrigued by some of their lessons learned and making sure we learn in our development.
   
• Dr Marc Pierson, an ER doc turned visionary health transformer, who has led some of the most innovative health work in Washington through his home base in Whatcom County.

I promise we will structure this session to be fast-paced and informational, leaving time for questions. We hope you will join us.

Great Results from Open Enrollment

Wow, according to the Health Benefit Exchange, Washington state enrolled or re-enrolled over 200,000 people in health insurance during Open Enrollment (November-January). This number is up 35% over last year during this time period.

We could not have achieved these results without our robust Navigator Network as well as the hard working team at BHT. I am grateful to our friends at CHAS and Columbia Basin Health Association who were some of our biggest producers!

Remember: if your clients, patients or friends have any life-changing event (have a baby, lose a job, retire), it will likely make them eligible for a special enrollment period; we are here to help.

Free Tax Services

In Spokane County, in 2013, 36% or 13,485 of families who were eligible for the Earned Income Tax Credit (EITC) used a paid tax preparer. If these families utilized free tax preparation alternatives an additional $1,928,355 would have been saved (figure based on the National Society of Accountants average cost for a return prepared without itemized deductions).

That’s why Spokane County United Way is encouraging eligible households to use local, free tax preparation resources. The organization is working with employers to provide employees information about tax preparation services available in our community. There are two available options for free tax preparation.

1. Free Tax Preparation Sites are available for low to moderate income wage earners (tax site appointments can be made now at 509-353-4851, walk in appointments starting February 1, 2016).

2. MyFreeTaxes is a free online program with a call in helpline available to those earning less than $62,000 in 2015. Visit www.myfreetaxes.com for more information. Check out these resources about MyFreeTaxes:

• MyFreeTax Flyer
• Payroll Stuffer
• Alternate Payroll Stuffer

If you wish to have a representative from Spokane County United Way come to speak with your employees about these options, call 509-838-6581.

SHA Provides Rental Assistance for 2016

Spokane Housing Authority (SHA) will accept online pre-applications for The 2016 Open Waiting List of the Housing Choice Voucher Program from 12 a.m. on January 19 to 3 p.m. on January 21.

The pre-application can be found at www.spokanehousing.org.

Only one pre-application per household will be accepted. Applications must be at least 18 years old. Pre-applications will be placed on the waiting list by time and date of receipt of the pre-application and preference. Applicants without a preference will be placed at the bottom of the waiting list according the date of receipt of the application.

Preferences are:

1. A family whose head, cohead, spouse, or sole member is a person with disabilities; two or more persons with disabilities living together; or one or more persons with disabilities living with one or more live-in aides.
2. A family whose head, cohead, spouse, or sole member is a person who is at least 62 years of age; two or more persons who are at least 62 years of age living together; or one or more persons who are at least 62 years of age living with one or more live-in aides.
3. Applicant families with dependent children. Preferences will be verified and must be valid when an applicant reaches the top of the waiting list.

For assistance applying online, visit:

• SHA at 55 West Mission during regular lobby hours (8:30 a.m. to 4 p.m. Tuesday and Thursday, 1 p.m. to 4 p.m. on Wednesday).
• SHA’s booth at Homeless Connect on January 19 at Salvation Army, 222 East Indiana Avenue.

Note: After placement on the 2016 waiting list, applicants must notify Spokane Housing Authority of any mailing address changes in writing otherwise you may be removed from the waiting list.

An important deadline is just hours away!

If your clients, friends, family need health insurance coverage in 2016 coverage, you must enroll by December 23 at www.wahealthplanfinder.org.

We know this is a busy time of year, but you won’t want to miss this deadline. Our BHT Navigator Team stands ready to help, call us at (509) 321 7500. 

What you need to know:

• Join the millions. Since Open Enrollment began, already almost 3 million Americans have signed up for coverage that will start on January 1.
• Financial Help is available to make coverage more affordable. About 8 in 10 of the uninsured who are eligible for coverage qualify for financial assistance to lower the cost of their monthly premiums.
• For current Washington Healthplanfinder consumers, this is the time when you can come back, shop and compare your current plan with others available in your area for 2016 and select the plan that’s right for you.
• It pays to shop. There may be plans available that offer the services you need, include more doctors, or save you money.

BHT’s ACH Medicaid Waiver Endorsement Criteria

Over the past few weeks, we have seen increased conversation around the proposed Medicaid Waiver. Many of us realize the waiver is a game-changer for our communities. 

As you know, the Health Care Authority has released an “all call” for potential Medicaid Transformation Projects. This is a great opportunity to ensure the good work happening in our region can be scaled across the full region as well as the state.

On Thursday, the BHT Board (serving as the governing body for our region’s ACH), approved ACH Medicaid Waiver Transformation Project endorsement criteria.  We believe it’s critical to put forward a set of projects that aligns with our Regional Health Priorities so that we can dramatically improve the health of our region.  The BHT ACH will submit an endorsed list of projects (our version of a “Good Housekeeping Seal of Approval”) on January 15.

Directions to seek a BHT ACH endorsement
If you are interested, please submit your completed HCA Project Template to alison@betterhealthtogether.org by 3pm on January 12. A review committee consisting of Tom Martin, Lincoln Public Hospital District; Dr Joel McCoullough, Spokane Regional Health District; Pam Tietz, Spokane Housing Authority; Kristen West Fisher, Empire Health Foundation; and Dean Larsen, Spokane Medical Society, will review applications for alignment with our criteria and will consider endorsement on behalf of the BHT ACH.

What does a BHT ACH endorsement mean?
BHT is undertaking this process to demonstrate to the Health Care Authority the power and alignment of our region. The Board would like to endorse the most promising, most aligned projects. This will demonstrate how well our region is cooperating in the development of our ACH as well as ensure we have a set of projects that are aligned with our Regional Priorities.

Does that mean I cannot submit my own projects?
Of course not. We encourage everyone to think about how the waiver could have a transformative effect on our region.

Questions?
Let Alison know at alison@betterhealthtogether.org or 509.499.0482

Resources

• HCA Waiver Project Template
• HCA Project Template Webinar
• Medicaid Transformation Waiver Slide Deck 
• ACH Priorities for BHT

Understanding quality in health care

From Washington Health Alliance | November 23, 2015

Quality varies widely from one provider’s office to another and even from one doctor’s patient to another. Not all care is equally good. Learn what you can do to find a provider that will help you stay healthy and care for you when you need it.

What is high-quality care?

Good health care is the right care, at the right time, for the right reason. The quality of health care varies, but trustworthy, public information can help you decide what test or treatment is best for you and if the care meets accepted standards.

• Your doctor should be using the appropriate tests or procedures for your age, gender and medical history.
• You should get health services when you need them and before you get sicker.
• You should get health services you actually need, nothing more and nothing less.

Doctors committed to quality will not only welcome your involvement but also encourage it. While your doctor should be able to direct you to reliable information on a health topic that affects you and talk to you about your options, you have a major role to play when it comes to your health and well-being.

How can you get what you need?

Compare care. Finding a good primary care team is the first step in getting high-quality care. Go to the Community Checkup website where you can “shop” for a clinic in your health plan’s network to see how well they rate on quality measures that matter to you. The quality measures that were chosen for this website serve as a proxy for the overall quality of the care delivered by that clinic. For example, even if you don’t have diabetes, seeing how well a clinic is following recommended care guidelines for that disease can signal to you how well they treat any chronic disease.

Make an informed choice. After you’ve looked at options on the website, contact the clinic and ask questions to see if they would be a good fit. Do they offer hours that are convenient to you? Do they accept your insurance? Do the providers have knowledge or specialized expertise in the health areas that matter to you or your family?

Be an active member of your health care team. Do your homework. Go online or use the library to learn more about your condition and treatment options before your doctor’s appointment. Talk to your doctor about what you’ve learned. After your visit, take an active role in your health and health care so you can stay as healthy as you can. Your primary care doctor may tell you to exercise more or eat better, but it’s up to you to follow through on this advice.

Get the right amount of care. Unnecessary care costs money and can be harmful. Patients with chronic conditions do not always get the recommended care. Many people don’t get regular screenings, which can detect disease earlier. Certain drugs, treatments and tests are sometimes offered for common health complaints even though they aren’t really effective. Learn more about the value and effectiveness of specific tests and procedures at Choosing Wisely® patient resources.

Work with your doctor to make decisions about your care. This is sometimes known as “shared decision-making.” It’s important to ask questions, such as:

1. Do I really need this test or procedure?
2. What are the downsides?
3. Are there simpler, safer options?
4. What happens if I do nothing?
5. How much does it cost?

While health care consumers have a big role to play in ensuring they get the right care, you are not alone. Providers are the ones ultimately responsible for making sure they are delivering the right care at the right time.

Know you have options. If your expectations aren’t being met, talk to your doctor about your concerns. And if necessary, look for a new doctor.

Quality should be part of the equation for good, high-value health care, as much as patient experience and cost. 

Download the infographic about how to find high-quality care and be a savvy health care shopper.

Infographic: Washington Health Alliance.

This post is second of a series called The Savvy Health Care Shopper. The Washington Health Alliance is partnering with the Washington State Health Care Authority’s Healthier Washington initiative to educate consumers on finding value in health care.