By Barbara Spivak, M.D., President, Mount Auburn Cambridge IPA, and Edward Westrick, M.D., Vice President, Medical Management, UMass Memorial Health Care

With the turmoil surrounding health care issues nationally, it can be easy to forget that, besides taking the lead on expanding access through insurance reform, Massachusetts has been a pioneer in forging consensus around how to measure and report quality data. In fact, this week marks the sixth year that Massachusetts Health Quality Partners (MHQP) has released a report on how medical groups across the state perform on multiple measures of clinical quality.

Once again there’s plenty of good news. Overall, primary care physicians at more than 150 of the state’s medical groups performed better than the national average on 28 of 29 adult and pediatric quality measures reported by MHQP, and above the national 90th percentile on 15 of them.

As Massachusetts turns its attention to addressing the cost and quality of care through delivery system reform, performance measurement promises to play an increasingly important role. Dr. Jack Evjy, MMS Senior Medical Advisor, in a posting on this blog, outlined three essential elements of “patient-centric” system reform: taking an evidence-based approach to care; addressing unnecessary variation, both for under-utilization and over-utilization; and insisting on coordination and collaboration. We couldn’t agree more. Within our own organizations, and as members of MHQP’s Physician Council, we have seen that credible quality data can help drive patient-centered improvements. Here are a few examples of how MHQP’s approach to performance reporting aligns with Dr. Evjy’s criteria for reform.

Focus on evidence-based care
MHQP develops their performance reports through a collaborative, evidence-based process based on national standards for clinical quality that are closely related to patients’ health and well-being. Since MHQP compiles HEDIS^® data from the state’s five major health plans, their reports generally include enough patients to make the data credible and meaningful at the group level. What’s more, MHQP’s only agenda is quality improvement, and they work closely with all of the major stakeholders, including the Massachusetts Medical Society, to make sure their reports reflect that spirit.

Address unnecessary variation in both under-utilization and over-utilization
Even with high levels of performance overall, MHQP still finds that there are significant variations and opportunities for improvement across the state. For instance, one MHQP measure looks at the percent of patients, age 40 and older, who have had a spirometry test to confirm the diagnosis of COPD. The statewide average is 40 percent. While the rate for the best performing group was 64 percent, the lowest rate was only 17 percent, indicating a strong possibility of under-utilization for this simple test.

Similarly, wide variation exists in the over-utilization of imaging studies for adults with low back pain – the best performing group made appropriate use of imaging 97 percent of the time, compared with the lowest-scoring group, at just 52 percent. Improved performance in this measure not only results in safer, better-quality care, but helps reduce unnecessary medical spending.

Encourage coordination and collaboration
It is difficult, if not impossible, to make and sustain measurable improvements in clinical quality  without enhancing teamwork within physician groups. In its press release on their latest clinical quality report, MHQP touches on two examples of how groups have used their performance data to address a major opportunity for improving the treatment of patients with severe depression. In both cases, care coordination and collaboration were key elements of success.

Quality reporting is about to enter a new era as the expanded use of electronic medical records and meaningful use requirements may offer for more refined measures of clinical outcomes than traditional claims data, and MHQP will undoubtedly play an important coordinating role in that transition.  In the meantime, however, the collaborative work done thus far by MHQP has built a strong foundation for delivery system reform – one that is unmatched in most other states.

Filed under: Health, Health Policy, Primary Care