Community Quality Collaboratives: Accomplishments, Challenges and

Opportunities

Gary J. Young, J.D., Ph.D.Director and Professor

Center for Health Policy and Healthcare Research

Northeastern University, Boston MA

September 20, 2011

Financial support from the Agency for Healthcare Research and Quality

Overview of Presentation Study purpose and goals

Methods

Key Findings– Activities and Accomplishments

Improving quality Building trust among stakeholders Integrating within local health community

– Future Challenges and Sustainability Securing financial resources Maintaining cohesion among stakeholders Adapting to health reform

Conclusion

•

Study Purpose and Goals

Focus on multi-stakeholder community collaboratives

Select study sample from AHRQ Chartered Value Exchanges and affiliated collaboratives

Investigate accomplishments, challenges, and opportunities

Study Methods

Selection of sample

Data collection– Key informant interviews– Documents and Archival Records

Analysis

Quality Collaboratives

Massachusetts Health Quality Partners Oregon Health Care Quality Corporation Integrated Healthcare Association (California) Puget Sound Health Alliance (Washington

State) Health Improvement Collaborative of Greater

Cincinnati (Ohio) MN Community Measurement (Minnesota) Wisconsin Collaborative for Healthcare Quality Indiana Health Information Exchange

Key Findings: Activities and

Accomplishments

Improving Quality

– Activities Public provider reports

– Develop first community-based, consolidated quality report for physician organizations

– Expand reports to include patient experience and efficiency measures

Best practice dissemination

Payment innovations

Guideline adherence

–

Key Findings: Activities and

Accomplishments

Evidence of improvements

Upward trends in quality measures (Chlamydia screening > 15 percentage points)

Reduced variation among providers

Accounts of provider investments and practice change

Key Findings: Activities and

Accomplishments

Building Trust among Stakeholders

– Rules for collaborating and competing

– Inclusive and transparent decision making

– Emphasis in the culture and operating practices on gradual change

Key Findings: Activities and

Accomplishments

– Early on we recognized the need to lay out clearly defined rules about how quality data could be used… These rules have been used to keep stakeholders aligned and focused on the bigger picture of what is best for our community. Getting these kinds of issues on the table early on was really essential.

– …trust is something I earn one day at a time in each and every decision I make. You really need to demonstrate complete credibility and you do this by being sincere and completely transparent as to how decisions are made.

Key Findings: Activities and Accomplishments

Integrating into Local Health Community

–Partnerships with local private and public organizations

Key Findings: Future Challenges and Sustainability

Securing Financial Resources

– Threats to existing funds

– Opportunities for future funding

Key Findings: Future Challenges and Sustainability

– …putting out these public reports is a pretty big event. In fact, each [reporting cycle] is incredibly intense in the need to oversee so many procedures and details and deal with internal politics. I do think some people now see these reports as a routine thing; sort of like our state’s report on vital statistics. But a big difference is that there is no national or state funding to support what we do. So, I feel intense pressure to identify new quality improvement opportunities that will attract attention and financial support.

Key Findings: Future Challenges and Sustainability

Maintaining Cohesion among Stakeholders

– Tensions from collaborating and competing

– Contentious issues over future directionAddition of efficiency measures to public

reports

Inclusion of physician-level scores

Key Findings: Future Challenges and

Sustainability

Adapting to Health Reform

– Opportunities Developing performance measures Reducing patient readmissions

– ChallengesNational data collection initiatives Internal decision making processes (e.g.,

consensus on clinically meaningful measures)

Conclusion

Important contributions to quality improvement

Viability of current governance and management practices

Strong leadership as a key attribute