The Health Care Quality and Cost Council (QCC) met this week, focusing on a quality initiative aimed at improving care transitions in the Massachusetts health care system. The initiative, entitled “Reduce Readmissions and Improve Care Transitions,” is part of the State Quality Improvement Initiative (SQII). SQII was launched nationally in 2008 by The Commonwealth Fund and AcademyHealth in order to assist states’ efforts to address quality deficiencies and engage in state-level planning.
Meeting materials are here, and our full, detailed report is below the fold.
Alice Bonner from DPH, Craig Schneider from the Massachusetts Health Data Consortium and Joel Weissman from EOHHS presented a proposal for a strategic plan to reduce readmissions and improve care transitions. They recognized that the barriers to effective care transitions come in structural and procedural forms (i.e. lack of integrated care and ineffective communication), and also in the form of lacking performance measurement and alignment (i.e., underuse of clear measures to indicate optimal transitions).
They stated a vision of interdisciplinary teams delivering safe, effective, and timely care that is culturally and linguistically appropriate in various types of settings. Furthermore, they stated that there must be an alignment of clinical care, public health, and health policy.
The presentation included a comparison of several other models currently utilized across the country. Each of those models is expected to produce significant systemic cost savings through a reduction of the use of hospital facilities. At issue though, is who gets to take advantage of the savings.
Next, the presenters went through a long list of principles around which the plan was created including timely feedback (i.e., cross-continuum teams which can be tasked with creating standardized document for care coordination), communication infrastructure (i.e., creation of a living database which providers can utilize and update as needed), patient and family engagement, accountability of care remaining with the sending set of providers (namely, ensuring that receiving providers are indentified and patients always know who their providers are), standardized process and outcome measures based on nationally endorsed measurements, and finally payment reform.
They noted that once the strategic plan is implemented, including payment reform, health status will be improved (lesser complications, fewer adverse events, and greater patient satisfaction), appropriate utilization of health care resources will occur in the form of fewer ER visits, fewer readmissions, fewer preventable admissions, and a lower incidence of unnecessary care.
During the questions, it became clear that the ultimate benefit of the plan will depend of the hospital market in question. Different localities will receive different degrees of benefits largely due to the level of deficiencies in their systems. Another question concerned studies suggesting that the discharge planning process does not actually account for the nationally disparate rates of readmission. The presenters noted that although the discharge planning process may not necessarily correlate with lower readmission rates, it is the communication and coordination that happens post-discharge which can reduce those rates.
Another question was how the plan accounts for the range of post-discharge services available in different communities (for instance, home-delivered meals). In response, the presenters agreed that because there is such a difference in availability based on the community in which the provider is operating, providers must align with those service providers to ensure that the patients are getting all the care they will need post-discharge. Also the principles in the plan will be prioritized differently in differently communities. For instance, one community may have a strong need for standardization of forms whereas another may need a better communication infrastructure to allow for improved medication tracking for patients.
The Council decided it should have more time to read the proposal before putting it to a vote, and the vote was tabled until the QCC meeting next month.
Next, Marilyn Schlein Kramer gave a presentation on behalf of the Partnership for Health Care Excellence. They found that the economic crisis has pushed other issues (namely, health care) off the radar and people are more likely to name the economy as their top priority. However, although awareness of health issues has generally decreased since April 2008, it has decreased less in the pilot PHCE markets. Further, in pilot markets consumers are slightly more likely to report doing five specific actions than were consumers in other markets (i.e., asking providers if they have washed their hands).
The implications of the Partnership’s findings are ultimately that the economic downturn makes it harder to educate and motivate consumers; there has been an increase in awareness and understanding of key topics in pilot markets; and television ads, which the Partnership can currently not afford, would be extremely beneficial to their campaign to increase awareness and understanding.
Ms. Kramer’s second presentation focused on the Partnership’s broad campaign to raise awareness of the consequences and principle of “moral hazard” and to educate about components and connectedness of the health care system, including messages about utilization of the most appropriate levels of care. The Partnership seeks to engage in various future collaborations. For instance, the Partnership is seeking to align with Blue Cross Blue Shield of Massachusetts and Frameworks to promote a public understanding of quality as distinguished from quantity – more health care does not necessarily mean better. Furthermore, the Partnership is currently engaging in a campaign to educate people about the overuse of antibiotics and inform consumers as to proper use. In one of their studies they found that three out of 10 people believed that antibiotics could treat H1N1 and the flu. They also found that there are large knowledge gaps in this area among lower income, less educated patients.
Next the Council heard updates from the various committees. The Communications Transparency Committee recommended that the Council vote to contract with Medullan, Inc. to create a new version of the Council’s website, “My Health Care Options.” In evaluating Medullan’s proposal, the Committee looked at its integrative approach to product development, the clear milestones it created which were tied to clear deliverables, the staffing mandate, flexibility, process control, pricing, and the fact that Medullan offered a warranty with one year of maintenance included. The Council voted to approve the contract which would ultimately cost approximately $204,000. The new website will include ambulatory data in addition to hospital data (which the website currently provides).