1. A PRESENTATION TO THE ADVISORY COUNCIL OF THE DIRIGO HEALTH AGENCY’S MAINE QUALITY FORUM MAY 11, 2012 Patient Experience Matters

2. Goals for Today Learn about why patient experience matters Discuss plans in Maine to collect patient experience survey data Seek the support and participation of Advisory Council member

3. IOM’s 6 Aims for Improvement Equity Efficiency Timeliness Patient-Centeredness Effectiveness Safety Institute of Medicine. Crossing the Quality Chasm. Washington, DC: National Academy Press: 2001.

4. Patient-Centered Care: A Definition “Health care that establishes a partnership among practitioners, patients, and their families…to ensure that decisions respect patients’ wants, needs, and preferences and that patients have the education and support they need to make decisions and participate in their own care.” Institute of Medicine. Envisioning the National Health Care Quality Report. Washington, DC: National Academy Press: 2001.

5. The Clinical Benefits of a Good Experience of Care Good patient experience is correlated with more activated and engaged patients who are more adherent to advice and treatment plans. Better care experiences lead to better outcomes. Measuring patient experience is first step to practice level and system-wide improvements Positive correlation between patient experience and preventive/disease management processes.

6. Good Patient Experience has Financial Benefits, also! Better patient experience lowers likelihood of lawsuit. Measuring and improving patient experience enhances culture which lowers staff turnover and increases employee satisfaction. Better experience leads to patient loyalty – good for practices and good for patient care. Payers planning future tie financial incentives to patient experience.

7. Why Survey Patients on their Experience of care? Surveying patients helps engage patients in the delivery of their care It places the patient at center of healthcare encounter and re-emphasizes the focus of the provider to that center. It results in improved communication between patients and providers.

8. Why Survey Patients on their Experience of care? (con’t) Through public reporting, survey results provide basis for standards and comparison points to improve quality. Provides patient experience data to payers and consumers.

9. Why is DHA-MQF interested in collecting Patient Experience Data? Law directs the Maine Quality Forum to evaluate and compare health care quality and provider performance. DHA-MQF is a convener together with MHMC and Maine Quality Counts for the Patient Centered Medical Home pilot, Medicare’s MAPCP demonstration as well as for Aligned Forces for Quality in Maine. As such, Patient Experience surveying is a natural progression

10. Maine’s Plan Patient Experience Matters Project Convenors Target population Survey Instrument Sampling Survey Vendor Subsidies Data Submission Public reporting

11. Partners DHA/Maine Quality Forum, Lead  Maine Quality Counts  Maine Health Management Coalition  Maine’s Aligning Forces for Quality Adviser  Dale, Shaller, Principal, Shaller Consulting, Inc. Staff support  Muskie School of Public Service

12. Statewide Survey Design Voluntary Target population/practice sites:  Adult patients of primary care and specialty care practice sites  Parents of children served by pediatric practice sites Survey conducted at practice-site level

13. Use of CAHPS Survey Instruments Endorsed by the National Quality Forum Growing use of CAHPS as nationally accepted instrument for assessing patient experience (e.g., Medicare Compare, ACOs, Medical home demos) Availability of regional and national benchmarks

14. Selected CAHPS Instruments Primary Care Adult: Adult PCMH 12-month Survey, version 2.0 Primary Care Child: Child PCMH 12-month Survey, version 2.0 Specialist Adult: Core questions from CG-CAHPS 12-month survey, version 2.0 with subset of PCMH items to be determined with stakeholder input

15. CG-CAHPS PCMH Survey Instrument CG-CAHPS Core Composites Access to care Communication Office staff Global rating PCMH Composites Comprehensiveness Self Mgmt support Shared decision making Coordination of care Information on care and appointments Access to ca re

16. CG-CAHPS PCMH Survey Item Count Adult PrimaryAdult Specialist*Pediatric Survey CG-CAHPS Core34 55 PCMH Item Set181011 CG-CAHPS +PCMH Items524466 * Estimated; final selection subject to advice of Stakeholder Group

17. Modes of Survey Administration* Mail only Mixed mode of mail with telephone follow-up Mixed mode of e-mail with mail follow-up Mixed mode of e-mail with telephone follow-up

18. Sample Frame Sample will be based on patients seen by a practice site over the prior 12-month period. Size of random sample based on number of providers per practice site and expected response rate. Number of required completed surveys per practice site based on guidelines developed by AHRQ.

19. Practice/ Group Site/Clinic A Provider A Provider B Site/Clinic B Provider C Practice Site Sample 19

20. Estimated Sample Size # Providers at Practice Site* Required # of Completed Surveys per Practice Site** Estimated Sample Size per Practice Site*** 150143 2100286 3150429 4-9175500 10-13200571 14-19250714 20+300857 * Providers include physicians, nurse practitioners and physician assistants who independently manage a patient caseload. **Based on AHRQ guidelines for practice site sampling *** Based on an estimated 35% response rate

21. Survey Administration Approaches Designated vendors Subsidy Registration

22. Survey Administration Health systems/practice sites with existing survey vendor relationships  Existing vendor apply to be designated vendor  Leverage existing efforts by replacing or supplementing current survey with common instrument for limited period. Practice sites without existing survey vendor  Select from DHA list of designated vendors

23. Designated Vendors DHA to issue RFP for designated vendors :  Agree to meet DHA Survey Guidelines  Complete online registration of participating practice sites  Submit survey results to CAHPS Benchmarking Database  Work with practice sites to obtain release for DHA access to survey results for public reporting at practice site level  Balance bill practices after survey administration Designated vendor must be NCQA certified or approved by CMS for H-CAHPS or Medicare Advantage Only designated vendors will be eligible for subsidy.

24. Subsidy Available to designated vendors that:  Use selected CG-CAHPS PCMH instruments  Administer survey at the practice site level between Sept- Nov 2012  Follow specifications of DHA Survey Guidelines  Submit practice site level results to CAHPS Database  Obtain Data Use Agreement from practice sites allowing access to survey results for public reporting by DHA

25. Subsidy Levels Based on best bid from RFP DHA currently estimates that subsidy would cover 60- 90% of survey costs. Practice sites responsible for balance of all survey costs

26. Estimated Subsidy Levels Number of Providers per Practice Site Required # Completed Surveys Estimated Total Survey Costs* Estimated DHA Practice-Site Subsidy** Estimated Balance to be Paid by Practice Site 150$600$540$60 2100$1200$1080$120 3150$1800$1620$180 4-9175$2100$1890$210 10-13200$2400$2160$240 14-19250$3000$2700$300 20 +300$3600$3240$360 *Estimate based on $12 per completed survey ** Assumes 90% DHA contribution

27. Data Collection and Reporting DHA Survey Guidelines CAHPS Database for Benchmarking Public Reporting on DHA Website

28. DHA Participation Guidelines Online manual of specifications related to:  Survey instrument  Target population  Sampling procedure  Modes of survey administration  Designated Vendors  Timeline  Survey administration  Submission of survey results to CAHPS database  Subsidy determination and payment  Public reporting at practice site level <

29. CAHPS Database National repository of data for selected CAHPS surveys Two major applications  Benchmarking  Benchmarking to evaluate health system performance and support quality improvement  Research  Research on consumer assessments of quality Funded by AHRQ and administered by Westat through the CAHPS User Network

30. CAHPS Online Reporting System Public portal available to everyone  Ability to view summary-level data only Password-protected portal accessible only to participants who contribute data  Ability to view your own results compared to selected benchmarks 30

31. Maine’s Use of CAHPS Database DHA plans to use the CAHPS Database to analyze and aggregate comparative practice site-level results and national benchmarks for state-level reporting. Benefits –  Minimizes costs of analyzing and aggregating survey data  Streamlines data submission  Allows practice sites to view their own practice site data against national/regional benchmarks  Composite measures available through CAHPS database for public reporting

32. How It Will Work Signed agreement between practice site and DHA to authorize DHA to have access to site-level information for statewide reporting. Designated vendors will submit survey results to the CAHPS Benchmarking Database following submission guidelines.

33. DHA Public Reporting Practice sites must agree to have practice site-level survey results publicly reported as a condition of subsidy. Practice site level survey data will be publicly reported on the DHA website. Design a DHA public reporting website will be developed with input from Maine Quality Forum Advisory Council and stakeholders.

34. Estimated Timeline Apr’12 May’12Jun’12Ju’12lAug’12Sep’12Oct’12Nov’12Dec’12Jan/Feb 2113 Mar/Apr 2013 May/Jun 2013 Survey Monkey DHA Survey Guidelines Vendor RFP Designated Vendor Proces Public Awareness Campaign Survey Administration Data Submission to CAHPS Database Preliminary Findings Public Reporting

35. Next Steps Specialist Survey Sub-Committee Purpose: Recommend supplemental items for Specialist survey Commitment: one-time 2-hour meeting When: May 2012 Public Reporting Sub-Committee Purpose: Advise DHA on content/format of public reports on patient experience survey results Commitment: up to four 6-hour meetings When: August 2012 – March 2013