The Wisconsin Health Information Organization is working with the Centers for Medicare and Medicaid Services to release CMS' Medicare data and add the information to its WHIO Health Analytics Exchange, according to executive director Julie Bartels.
The addition of Medicare claims data to the exchange will enable Wisconsin healthcare providers to get a comprehensive view of the care they give to their patients, she said.
WHIO, a voluntary transparency initiative, comprises healthcare providers, payers, employer groups and public agencies whose mission is to improve the transparency, quality and efficiency of healthcare.
"In our view, there are three keys to transforming the healthcare marketplace into a high-value proposition: transparency, quality measurement and payment reform," Bartels said. "Through the aggregation of commercial and Medicaid - hopefully Medicare soon - claims across payers, health systems and geographic regions we can create a comprehensive picture of a provider's practice pattern."
"This picture can be compared to national quality measures, and to performance of the peer group on a quality process, cost and resource utilization basis," she said. "This information arms provider systems and individual providers with information about where and how highest quality, most efficient care is being delivered."
WHIO's contributing members extract and standardize claims data, which is then aggregated and scrubbed at a single point in WHIO's data mart, which was created by healthcare information and research company Ingenix. "The data mart provides comparative and directional information that helps us to see variation in care delivery and resource utilization," Bartels said. "By sharing and studying this information with providers and other healthcare stakeholders we can begin understand its cause."
Meaningful and sustainable improvements in care delivery can be achieved once root causes are identified and understood. "Today, we literally see variation in care at every level of analysis," she said. "Since variation is the visual representation of opportunity for improvement we are encouraged by what we see."
Bartels noted that variation exists between geographic areas, medical systems within geographic areas, clinics within a system and even among like specialists within the same clinic. "There is no one area, system, specialty, clinic or group of doctors who are best at everything; yet, most are good if not great at some things," she explained. "Shining light on where best practice is in place and then building measurement systems and payment reimbursement programs to support the transition of care delivery to best practice is our business model."
The reports are still in the introductory stage at the clinic level, she said. Thus far, those medical systems that have been focused on the "quality journey" for many years are in the process of reviewing the data and designing best practices in care delivery, which Bartels says will "raise all boats."
Other medical systems and physicians who have been "practicing in a vacuum" are in the early stages of understanding the process of quality improvement, according to Bartels. The Wisconsin Medical Society disperses the reports to its members with the message that this information will help them understand their practice patterns and support quality improvement initiatives.
"The good news is that we have everybody's attention," she said. "They're trying to understand the data and develop new ways of care delivery to improve the overall quality of care."
WHIO has been redesigning a payment system that reimburses behavior change and pays for high-value care using the measuring stick of quality and cost of care and patient experience. The organization has been using its data and other data sources connected to the project and building benchmarks to support the new payment structure. WHIO is also readying a pilot payment program, which will begin in 2011 and run for two to three years - enough time to be able to glean solid results.
Workgroups focusing on acute care (knee-replacement conditions), chronic care (diabetes) and preventive care (screenings) have been tapping into volumes of clinical and administrative data to design payment reform pilot projects. The workgroups are expected to make their program recommendations to WHIO's Board of Directors in mid-December. Pending board approval, these pilot programs will begin implementation in 2011.
WHIO is one of four organizations composing the Wisconsin State Health Information Network (WISHIN), which is the state's governing organization for its statewide HIE. While WHIO is not involved with the HIE efforts of enabling clinical data exchange, as a data collection and measurement organization it is a complementary initiative to HIE and shares WISHIN's and other multi-stakeholders' overall goal, which is to raise the quality of care in an efficient manner while at the same time controlling costs.
With HIEs helping providers become more informed in the clinical setting, the industry should see improvement to overall compliance with national care standards and elimination of unnecessary or redundant treatment, Bartels said. "Fully implemented and regionally connected HIEs should result in more complete and timely care delivery," she said. "Improved care delivery will be reflected in the WHIO database, feeding the Plan Do Study Act (PDSA) quality improvement cycle and constantly raising the bar for future performance."