Where there is valid and reliable literatureevidence regarding “best practice”, use it

•Premier Demo/ Hospital Quality Metrics/ Core Measures

•HCHAPS for hospitals; health plans (STAR ratings)

•Nursing Home Quality metrics/ STAR

CMS Quality Initiatives: they are ALL GOOD

•Every Board meeting 1-2 hours comparing quality metrics• Chief Medical Officer drives decisions based on quality•COMPETITION with other hospitals driven by outcomes metrics. It drives changes with docs nurses, patients.

--ALL GOOD!!--a few slides (from dozens) of last Board meeting

EXAMPLE: Large Hospital Company Driven By Quality Metrics

Hospital Acquired Condition Trend All Payors‐

Consolidated Results

Falls and Other Trauma Rate Per 100,000 Pat Day Women’s Hospital

Readmission Trends by Category 36 months ending Q1

**Published Scores ending Q1 2010

Where are we going?

•Value based purchasing

•Reducing preventable readmissions

•Accountable care organizations

•Bundled payment demonstrations •Clinical effectiveness research