1. Healthcare Quality Data:
Consumers, Employers,
and Underwriters
Professional Liability Underwriting Society Meeting
March 15, 2006
Chicago, IL
How many people saw a new health care provider in the past year? How did you choose a provider?

2. “Never go to a doctor whose office plants have died.”
- Erma Louise Bombeck

3. Source: The New Yorker November 29, 2004

4. High Variability in the
Quality of Care

5. Jacob Bigelow, in a speech to
the Massachusetts Medical Society in 1835

7. Compliance with Evidence Based Medicine
Survey by Duke Clinical Research Institute revealed that only 45% of cardiologists and 15% of EM docs had reviewed the latest ACC/AHA guidelines AND most clinicians do NOT have feedback performance data
Hospitals that were least compliant (<=65%) with EBM guidelines had an in-hospital mortality rate for eligible patients of ~ 6%. Hospitals that were the most compliant (>=80%) had an all-cause mortality rate of only 3.6%.

8. Medical mistakes cause as many as 98,000 deaths per year
To Err is Human, Institute of Medicine, 1999

9. Would You Buy A Car Without Doing Research?
Between , a typical patient would have, on average, a 65% lower chance of dying in a 5-star rated hospital compared to a 1-star rated hospital.
A typical patient would have, on average, a 45% lower chance of dying in a 5-star rated hospital compared to the U.S. hospital average
HealthGrades 8th Annual Hospital Quality in America Study

10. A Look at Hospital Quality By State (HealthGrades 6th Annual Hospital Quality in America Study – 2003)

12. Death in Low Mortality DRGs Failure to Rescue
Comparison of Best Hospitals vs. Worst Hospitals Performance vs. Expected on Three patient Safety Measures
Death in Low Mortality DRGs
Failure to Rescue
Accidental Puncture ..or Laceration
Worst Hospitals Performance Best Hospitals Performance

13. How Is Health Care Quality Measured?

14. Type of Quality Measurement What Does It Measure? Examples
Structure
Are the right structures and tools in place to facilitiate high quality?
Computerized Physician Order Entry (CPOE)
Process
Is the right thing being done at the right time?
Percent of heart attack patients getting aspirin on arrival
Outcome
What was the clinical outcome?
Mortality rates; Complication Rates, e.g., infection rates
Outcome - Patient Safety
Was the patient free from accidental injury due to medical care, or medical errors?
Patient Safety Incident Rates, e.g., foreign body left in patient
Patient Satisfaction
Was the patient satisfied with their care and the outcome of that care?
Patient Satisfaction Scores
Volume
How many cases are done annually?
American College of Cardiology requirement of at least 75 coronary intervention cases/year for maintenance of physician competency

15. Quality Measurement Pyramid

17. How Is Health Care Quality Information Being Used? Consumers
Employers/Payers
Liability Underwriters

18. The New Health Care Consumer
Quality
Cost
Value =
There is no clear answer/consensus on how to measure quality and provide direct incentives to reward quality.
CMS: Financial incentives to hospitals that report process measures for heart attack, heart failure, pneumonia.
Health Plans: Combination of EBM/process measures, chronic disease management, customer satisfaction, investment in technology, cost-containment, etc.
Private market lacks transparency re: what benchmarks are being used – increasing challenges for providers.
Many efforts to make a change:
CMS - $ incentives
Heart Attack
Heart Failure
Pneumonia
Health plans = EBM + Process, etc; starting to drive transparency

19. Perceived Variations in Quality of Health Care
Source: Great-West Healthcare and Harris Interactive

20. The Most Important Factor in Selecting a Hospital
Source: Great-West Healthcare and Harris Interactive

21. Percent of Americans who say they would prefer a…
Information begets the desire for more information. There is no turning back – embrace it!
Source: Kaiser Family Foundation/Agency for Healthcare Research and Quality/Harvard School of Public Health National Survey on Consumers’ Experiences with Patient Safety and Quality Information, November 2004 (Conducted July 7-September 5, 2004).

22. HealthGrades’ Hospital Consumer Ratings - Mortality

23. HealthGrades’ Hospital Consumer Ratings - Complications

25. Pennsylvania Physicians Quality Ratings - Complications
Pennsylvania HCC
Total Hip + Knee replacements by Surgeon
Highlights complications and LOS

28. Product Case Study – Consumer Google Local (Beta Project Example)
LBS, paid search, ecommerce

29. Employers/Payers
Employers and payers are steering employees toward high-quality providers
Poor quality care costs employers $1,900 per employee per year (Midwest Business Group on Health)

31. The State of Health Care

32. Overview of Consumer-Driven Health

33. Source: The New Yorker July 15, 1933

34. Risk Assessment

37. HealthGrades’ Nursing Home Quality Ratings

38. Thank You
Sarah Loughran
(303)