It’s Not About The Box Improving Care at Group Health with People, Process and Technology

November 13, 2008

Puget Sound Health Alliance – Community Checkup 2008

Filed under: Measurement — Tags: , — Matt Handley @ 1:37 pm

The Puget Sound Health Alliance (PSHA) has posted the updated community checkup report (link).  While HEDIS reports the performance of health plans, PSHA reports the comparative effectiveness of care delivery systems – our first direct comparison of the Group Practice with our local competitors.  Last year we were the hands down winner – this year we are still out front, but if we listen carefully we can hear footsteps.

We are far in front of other clinics and systems in our ability to measure our performance – this report uses claims date only and a model of “attribution” – pairing a patient with a doc and clinic – that is an approximation of what we can do with our clinic data and assignment of PCP.  The data about our performance is directionally correct, but the numbers for our populations (e.g., number of diabetics, asthmatics, etc) is off a bit, as we might expect from claims data.

The plans to improve our HEDIS performance – taking full advantage of every touch or visit to close care gaps, making outreach more effective and eventually intervening at specialty visits as well as visits in primary care – will help us maintain or increase our advantage in providing excellent care to our patients.  We will have to improve considerably to do so as other clinics put in place systems to improve care.

You can see the relative performance of all of the clinics in the pdf through the link below.  You can access the community check up directly through this link –

PSHA Clinic Performance 2008

October 3, 2008

A change in Quality measures

Filed under: After Visit Summary,Lean,Measurement — Tags: , — Matt Handley @ 8:06 am

This fall GHC is considering a pretty big shift in how we plan for our quality work.  We have traditionally set targets for performance in  things like HEDIS measures, that are steps toward our goal of being in the top 10% of health plans in the US.  so – specific quantified targets for all of the HEDIS measures, or a defined subset are usually our focus for clinical targets.  The challenges with this approach are several:

  1. There are too many measures to keep track of – we end up with a collection of projects that are confusing to clinical teams
  2. The measures don’t change quickly, even with concerted actions.  Because of the rolling year data, even good work doesn’t bear fruit quickly.  This makes the measures difficult to use to improve our processes.
  3. The focus tends to be on a “get it done any way you want” approach, or as Al Davis (owner of the Oakland Raiders is famous for saying “Just win, baby”).  The problem with this approach is that it usually relies on heroism rather than systematic improvement, and is almost never transportable – so if one clinic does well, other clinics are unlikely to be able to replicate their success.

the other way to approach measurement for improvement is to define a standard process, and then measure how reliably you meet the standard.  we have one measure like this now – the printing of an AVS.  We have defined the printing of an AVS as a standard that should happen at all visits, and report how reliably we meet that standard (still room for improvement, but many departments at about 100% in both specialty and primary care).  Simple.  Actionable.

The next step is to invite operational leaders int he delivery system to define thier standard work that keeps patients at the center and addresses quality, the care experience and affordability simultaneously.  The starter set likely includes the things liek fulfillment of HEDIS activities at all visits, with defined roles for flow staff and clinicians, and AVS printing.  Some organizations have mroe detailed standard work that includes things like rooming within 5 minutes of the appointment atime, and clinician entry into the exam room on time.

The meausre then is a “defects measure” – what percentage of times did a patient fulfuill thier HEDIS activities within a month of a visit?  KP Southern California has done great work with this, and have rates of cancer screening that boggle the mind – their mammography rates and pap smear rates are over 90%.

Defining standard work and managing to it, with reports of process measures driving improvement across many clinical conditions sounds a lot like lean, and is a big step forward if we can swing it.

I will spend more time on the KP S Cal work (the proactive office encounter, or POE) in another post.

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