The Maine MONAHRQ Experience AHRQ Annual Conference September 19, 2011 Susan Schow MPH, Epidemiologist Maine Health Data Organization

MHDO Interest in MONAHRQ Maine Health Data Organization (MHDO) is a small independent state agency –Director and 9 employees Governing Board of Directors –21 members representing consumers, employers, 3 rd party payers, providers and the State of Maine

Representation on MHDO Board Consumers –Consumers for Affordable Health Care, Muskie School of Public Service, Center for Economic Policy Providers –Hospitals, Medical, Osteopathic, Primary Care, Chiropractic, Mental Health Svcs, Pharmacy, Federally Qualified Hlth Ctr, and Home Health

Representation on MHDO Board Employers –Chamber of Commerce, Maine Health Management Coalition, Bath Iron Works State of Maine –Dept of Professional & Financial Regulations (Bureau of Insurance), DHHS/Maine CDC Third-Party Payers –ME Assoc. of Health Plans: Anthem BCBS, CIGNA, Aetna, Harvard Pilgrim,

MHDO Interest in MONAHRQ AHRQ Updates to HCUP members –August 2009 notification of MONAHRQ autumn launch National Charter Value Exchange Meeting –February 2010 presentation by Anne Elixhauser (AHRQ)

MHDO Interest in MONAHRQ Maine Revised Statutes Annotated §8712 Act to Protect Consumers and Small Business Owners from Rising Health Care Costs “…report comparative health care quality information to consumers, purchases, providers, insurers and policy makers….and make provider-specific information regarding quality of services available on its publicly accessible website”

MHDO History with QIs Long history with AHRQ Quality Indicators and QI software First presented QIs for Maine in 2004 –Used 2001 Maine data from AHRQ HCUP Project (via Medstat) –Posted to MHDO website

MHDO History with QIs First calculated QIs for Maine in 2006 –Used 2004 ME data and AHRQ QI Windows software (v3.0) –Presented to the Maine Quality Forum’s Advisory Council –Posted to a hidden URL on MQF’s website (for hospitals only) –Later password protected

MHDO History with QIs Added Maine’s Public Health Districts to QI graphics (in addition to counties) in 2006 and 2007 Charts becoming increasingly complex and “user unfriendly”

MHDO History with QIs Thomson Medstat developed custom software to calculate PQIs by Maine Hospital Service Areas –groups of cities or towns that include one or more hospitals to which local residents have the majority of their inpatient admissions –Included numerators for hospitals Posted publically on MQF website –2006 compared to 2007 data

PQI 90: Overall Prevention Quality Indicator composite, age 18 and over, age and gender adjusted rate per 1,000 population by Maine Hospital Service Areas

MHDO History with QIs Used the Preventable Hospitalization Costs Mapping Tool –Generated GIS maps of the PQIs by county

MHDO History with QIs Also ran Preventable Hospitalization Costs Mapping Tool with 5 years of Maine data ( ) –Demonstrate trends –Show potential cost savings by reducing numerators by 10%, 20%, 30%, 40%, 50% –Used by the Governor’s Office - Advisory Council on Health Systems Development Published in the 2010 State Health Plan Posted on the ME CDC website

NQF Endorses Many QIs Learned of AHRQ efforts to receive National Quality Forum endorsement of QIs at 2007 HCUP Partners Meeting Certain key stakeholders still nervous about public reporting of individual hospital quality indicators Became a powerful incentive for public reporting

Advantages to MONAHRQ/ Obstacles Resolved for MHDO Due to limited resources – time, money, personnel (especially IT staff) –Unable to create a website from scratch –Unable to maintain current Inpatient data website (queryable) –Unable to convene focus groups MONAHRQ provides a template pretested with consumers –plain understandable language and graphics

Maine’s MONAHRQ Version 1.0 Applied Maine 2008 Inpatient Data to the MONAHRQ v1.0 software in August 2010 Analyzed resulting reports Website created on MHDO local pc server Included everything but the “experimental” QIs

Involved Stakeholders Presented website to MHDO Board at their September 2010 Meeting Voted to approve public posting after review period for hospitals

Testing IT performed a security scan and ADA accessibility test –Multi-select issue, cross site scripting Website made available for review by Maine hospitals for four weeks (extended extra week) –Via private URL (password protected) –Also opportunity for user testing After review and tests successful, site available to the public

Questions from Hospitals Six hospitals contacted us with questions or to verify data/QI measures –Where data verification requested, all QIs were substantiated Used “Provider Reports” and “Patient Level” reports and linked back to hospital medical record numbers Hospitals pulled charts/records Conference call with MHDO staff to review on case-by-case basis

“Patient Level” Reports

Maine’s MONAHRQ Version 2.0 New and improved with user friendly icons! CMS Hospital Compare data available Applied Maine 2009 Inpatient Data to the MONAHRQ v2.0 software in August 2011 Maine included “Present On Admission” (POA) field

Maine MONAHRQ Version 2.0

Testing Version 2.0 IT performed a security scan and ADA accessibility test Will present to MHDO Board for approval Website again initially available for review by Maine hospitals only –via password protected private URL

Going Forward Plan to create a separate MONAHRQ website for each year (until MONAHRQ available for multiple years) –Trending very important to users Load 2010 data in January 2012 Update annually each July with previous year’s data