AHRQ Research Agenda: Incentives & Value-based Care

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1 AHRQ Research Agenda: Incentives & Value-based Care Richard Kronick, Ph.D. Director Agency for Healthcare Research and Quality American Board of Medical Specialties 2015 National Policy Forum Washington, DC April 22, 2015

2 Agenda Research on Paying for Value Understanding How and Why Change Occurs Using Incentives To Catalyze Quality Improvement Q & A

3 AHRQ s Mission To produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable, and to work within HHS and with other partners to make sure that the evidence is understood and used.

4 WHEN IS IT APPROPRIATE AND WHEN IS IT NOT APPROPRIATE TO USE STRONG FINANCIAL INCENTIVES?

5 Delivery System Reform Initiative HHS Departmental Initiative Goal: Better Care, Smarter Spending, Healthier People Focus: Improving the way providers are paid Improving and innovating in care delivery Sharing information more broadly to providers, consumers, and others to support better decisions while maintaining privacy Learning and Action Network

6 Goals: Sustainable Growth Rate (SGR) Repeal Permanent fix of the SGR funding formula Transition Medicare toward valuebased payments Improved care coordination New focus on quality, data transparency and coordination of health care teams

7 Strong Versus Weak Incentives In Health Care

8 AHRQ Paying for Value Project Focus on developing research agenda to answer: When are strong incentives appropriate in medical care? What should be done in areas where strong incentives are not appropriate? Commission papers that: Frame the issues Suggest a research agenda to produce evidence about how to pay for value in ways that will improve the quality and efficiency of health care delivery

9 Selected Measured Attributes Selected Unmeasured Attributes What Is The Difference In QALYs Between The Highest- and Lowest- Performing Systems in the U.S.? High Performing System in the United States Readmission Rates HbA1c Control Immunization Rates HEDIS CAHPS CLABSI CAUTI PSI 90 Accurate Diagnoses Good Judgment on Therapeutic Options Strong Internal Communication Effective Use of Health IT Patient Engagement Performance H I G H Low Performing System in the United States Readmission Rates HbA1c Control Immunization Rates HEDIS CAHPS CLABSI CAUTI PSI 90 Accurate Diagnoses Good Judgment on Therapeutic Options Strong Internal Communication Effective Use of Health IT Patient Engagement Performance L O W

10 What Is The Difference In QALYs Between Highand Low-Performing Systems With Average Performance on Unmeasured Attributes Selected Measured Attributes Selected Unmeasured Attributes High Performing System in the United States Readmission Rates HbA1c Control Immunization Rates HEDIS CAHPS CLABSI CAUTI PSI 90 Accurate Diagnoses Good Judgment on Therapeutic Options Strong Internal Communication Effective Use of Health IT Patient Engagement Performance H I G H A V E R A G E Low Performing System in the United States Readmission Rates HbA1c Control Immunization Rates HEDIS CAHPS CLABSI CAUTI PSI 90 Accurate Diagnoses Good Judgment on Therapeutic Options Strong Internal Communication Effective Use of Health IT Patient Engagement Performance L O W A V E R A G E

11 Contributions To Quality Improvement and Cost Savings In 2011, HHS launched the Partnership for Patients program, a national public-private sector initiative to share best practices among hospitals to reduce preventable patient harm. Today, over 3,700 hospitals representing over 80% of the population are participating. Data shows

12 IDENTIFYING A THEORY OF CHANGE

13 On A Variety of Dimensions, Quality Has Been Improving Slowly Quality of health care improved generally through 2012, but the pace of improvement varied by measure Number and percentage of all quality measures that are improving, not changing, or worsening through 2012, overall and by NQS priority. AHRQ 2014 National Healthcare Quality and Disparities Report

14 How and Why Change Occurs Three Theories About How Change and Improvement Happen in Health Care Licensure and Accreditation Response to new information about what does or does not work Competition that spurs improvement

15 Supporting Transformation and Patient-Centered Practice The Practice Facilitation Handbook Designed to assist in training of new practice facilitators 20 training modules organized in four parts o Introduction to practice facilitation o Core competencies o Common tasks o Working with practices that are implementing the Care Model or transforming into patient-centered medical homes Expanded curriculum in development

16 Accelerating Adoption of PCOR: Focusing on ABCS Accelerating Adoption of PCOR: Focusing on ABCS Grants for dissemination of patient-centered outcomes research to small- and medium-size primary care practices Focus: Million Hearts ABCS (aspirin use among people with heart disease, blood pressure control, high blood cholesterol control and smoking cessation advice and support) campaign to prevent heart attacks and strokes

17 Comparative Health System Performance in Accelerating PCOR Dissemination AHRQ Centers of Excellence Coordinating Center Data Core Data Core Data Core Study Topics Study Topics Study Topics

18 FIGURING OUT HOW FINANCIAL INCENTIVES CAN BE USED TO CATALYZE IMPROVEMENT

19 Where To From Here Continue evolving from the good old days of payment without measurement or understanding of what we re paying for Create an environment in which incentives to figure out how many and what kinds of resources are needed to produce outcomes that patients care about Figure out how to generate improvements in a way that capitalizes on the intrinsic motivation to do a good job

20 Thank You