Jeff Susman, MD

This Progress Report provides an update on our region's physician outcomes measurement and public reporting initiative. I thank Dr. Jeff Susman for providing this report.

- Craig Brammer, Director, Cincinnati AF4Q

Improving health care quality in our community requires better information about the performance of doctors and hospitals.

Most people agree that performance measurement is part of the changing expectations in health care. Physicians in our region want to provide the best possible care for our patients, and we need information about the quality of care we provide if we are going to improve it. Patients also need information about the quality of care that doctors and hospitals provide if they are going to make informed choices about their own care, and purchasers need information about the value they are getting for their health care dollars.

But it's the "how" and "who" of measurement and public reporting that gets debated — nationally and in local markets. How will it be done, and who will gather the data and make it available to the public?

Here in Greater Cincinnati, we've been on an exciting journey over the last two years as health care providers, payers and employers have come together through the Health Improvement Collaborative's Aligning Forces for Quality initiative to create a measurement and public reporting system that is local, physician-driven, fair and meaningful.

This work represents our region’s largest and most comprehensive public reporting initiative for diabetes outpatient data, and other chronic conditions will be added and measured in the future. We aim to collect data from half of Greater Cincinnati’s primary care practices by summer 2010.

Progress to Date

Physicians, employers and health care insurers in our community have worked together to standardize quality measurements of care for patients with diabetes. Unlike other efforts that use billing or claims information, the measures we use are based on clinical data that have real meaning for the care of chronic illness. Inherent in the design of the program is the ability for a practice to both track its performance over time and compare its performance to peers — powerful insight that can have a significant impact on improving quality of care.

The methodology that AF4Q has deployed is consistent with one used in Minnesota which has enjoyed great success among physicians in that region. (Read Wall Street Journal article about Minnesota's successful efforts.)

Here's how it works: Practices submit patient data once annually. It is analyzed, and physician ratings are assigned based on an agreed-upon methodology. Participating physicians get immediate access to the data so they can begin to use it for quality improvement purposes. The public will have access to the annual ratings through a new, consumer-friendly website, where they will also find information regarding the patient's role in achieving quality care. The design of this state-of-the-art site is led by an impressive team that includes experts from P&G, Bridge Worldwide, InterBrand and others.

A pilot was conducted in 2009 to test the process of data submission, measuring and reporting. Approximately 258 physicians (approximately 50 practices) took part. These practices covered a broad spectrum: medium-sized unaffiliated practices, affiliated practices, safety net providers and federally qualified health centers.

Every practice that participated in the pilot plans to continue its involvement in 2010. I think this is a testament to the value they have experienced thus far.

Focus groups with physicians have been held to continue to gain insight into how to sustain this work locally in a manner which will improve the overall quality of care in our community. The overall approach that AF4Q is taking was generally accepted and viewed by the physicians as a credible approach to public measurement and reporting, which they regard as part of the changing expectations of medical practice.

A consistent theme expressed by physicians is the belief that providers should be rewarded for providing higher quality care. That is why AF4Q is equally committed to its Patient-Centered Medical Home Pilot, where local insurers and employers have agreed to use the data submitted by physician groups to reimburse participating practices by an agreed-upon, performance-based formula.

What's Next?

Currently, medical practices representing about a third of all primary care physicians (PCPs) in Greater Cincinnati have agreed to be part of this effort to track how they are performing against selected evidence-based diabetes measures. (See current list of participating practices.)

The Cincinnati Academy of Medicine has endorsed the Collaborative's measurement work and encourages full participation by area primary care physicians. Our goal is to have half of Greater Cincinnati's primary care practices on board by summer 2010, and to eventually have all primary care physicians in the region participate.

In the first quarter of 2010, AF4Q will be assisting participating practices with their once-annual data submission. Reports will be shared with these groups for quality improvement purposes in the spring, and results will be available to the public via the website in summer 2010.

AF4Q is doing what it was designed to do: bringing all stakeholders to the table to achieve gains in health outcomes and quality of care...in this case, to design a public reporting system that is local, physician-driven, fair and meaningful. For this to be a success, I believe local physicians must support and take ownership of maintaining this initiative.

Ultimately, the Collaborative is providing the community with an invaluable tool to assist all types of practices that want to know where they stand so they can continue to improve care. After all, we can't improve what we can't measure.