1. Measuring the Value of Community-Based Services Jane Brock, MD, MSPH Telligen QIO National Coordinating Center

2. 2 “If you cannot measure it you cannot improve it” Lord Kelvin – before 1900 In reality, if you can’t prove you improved it, you cannot participate

3. 3 Value-Based Payment in Medical Services Quality/Efficiency and XX COMPARE Physicians and Resource Utilization (2015) Readmissions a key –MSPB (http://www.medicare.gov/hospitalcompare/Data/spending-per-hospital-patient.html?) –Post acute bundled payment demonstration Total resource use: –ACOs –Other bundled payment models –Maryland hospital payment demonstration Quality – from clinical information Efficiency/Resource Use – from claims data

4. 4 The Limitations for CBOs The current/frequent state: Clinical data – unintegrated and therefore unaccounted for Claims - ?? The goal is to not have as many But we do really good work…

5. 5 Better Health for the Populatio n Better Care for Individuals Lower Cost Through Improve ment Better Health for the Population ‘The Future’ which is now The Present

6. 6 The 3 huge opportunities that community services have.. Better Health for the Population *10% of health is medical You are in the secondary prevention business Measure health, or at least function #1 Medical utilization is not a ‘patient centered’ outcome But being at home is Measure what matters to people #2 #3 Neighborhood matters Target/Measure impact among those living in challenging environments

7. 7 Health, function and quality of life – all part of Healthy People 2020 Community Tenure –Being tracked by QIO program –? Experiment with small areas in association with medical- community programs Neighborhood matters –Residence in a deprived neighborhood –Annals of Internal Medicine –file:///C:/Users/jbp/Downloads/HIPxChange.org.html

8. 8 Interventions/Program Hospital 30-day readmission rate # Served Ensuring a quality product

9. 9 Latest Greatest Idea for Improvement ‘Uptake’ ‘Penetration’ ‘Dissemination’ (But in the real world will people/can people do it?) (but it may not be solving the real problem.. Research is one thing and reality is entirely another..) Impact of this intervention on the targeted driver of readmissions (is it working?? What makes me think it will affect readmissions? What can I know now ?) ‘Spot- check’ utilization measure Readmission data from CMS Ensuring a quality product

10. 10 Intervention = CTI How often did it happen? Process measure = number of times intervention occurred; e.g. # of patients coached/month Interim outcome measure = Number of times the intervention did what it was intended to do; e.g. improvement in PAM scores Proximal Utilization Outcome measure = Utilization among those receiving the intervention; e.g. # readmissions among those with improved PAM scores vs. those without improved scores Is the intervention working? Are we getting the expected outcome? Final Utilization measure = readmission rate in the entire target population Is it enough to make a difference? EXAMPLE

11. 11 ‘One’ piece of advice For the work you do now.. –Ask partners (and QIOs) to share outcomes data –Identify measures of interim progress/product that you can capture  Test capturing – can spot check –Ask medical partners if you can help them spot check measures of progress (you are in the home..) For the business you are in –Develop partnerships in public health and housing –Become familiar with potential hospital partners’ MSPBs –Experiment with adjusting your outcomes by neighborhood