Washington Delivers Higher Medical Quality Care
Premera Blue Cross 2006 Quality Score Card – A Five Year Milestone
December 8, 2006
MOUNTLAKE TERRACE, WA – Medical quality in Washington state has improved significantly since 2002.
That's a key finding of the fifth annual Quality Score Card, a joint effort by leading medical groups throughout Washington and Premera Blue Cross. Premera and participating medical groups announced 2006 results at community briefings in Seattle and Spokane, Washington.
The 2006 Quality Score Card is published online at www.premera.com/qsc.
"Learning how to measure the important things, publishing our scores, and learning from each other have helped us all improve and raise the bar for everyone." said William Gotthold, M.D., medical director at Wenatchee Valley Medical Center, one of the pioneering medical groups.
"The beneficiary of all this is the patient," Dr. Gotthold said.
Quality Score Card participating medical groups, who reach more than 300,000 Premera members in Washington state, include: Columbia Medical Associates; The Everett Clinic; Lakeshore Clinic; Madrona Medical Group; Minor & James Medical; MultiCare Health System; Pacific Medical Centers; Pediatric Associates; Physicians Clinic of Spokane; The Polyclinic; Puget Sound Family Physicians; Rockwood Clinic, P.S.; Virginia Mason Medical Center; Swedish Physicians; UW Medicine Neighborhood Clinics; and Wenatchee Valley Medical Center
On average, an estimated 72.2 percent of medical care delivered by the medical groups met evidence-based standards of quality last year for a representative range of preventive, acute, and chronic care.
That represents an 8 percent improvement in quality since 2002, when the first Premera Quality Score Card estimated the same array of medical care met national standards 66.8 percent of the time in Washington state.
"That improvement is real--and it tells a remarkable story," said Mark Sollek, MD, Premera's medical director in charge of the Quality Score Card initiative. "Areas of medical care for which medical quality in Washington were initially quite low have improved by as much as 50 percent over the past five years. Other areas of already high medical quality tended to stay high, but with nominal improvement.
"It's significant that over the past five years, health care quality in Washington has improved in nearly every area we measured," said Dr. Sollek.
The Premera Quality Score Card also estimates the overall quality of medical care delivered statewide. Results are extracted from millions of Premera medical care claims reflecting treatment by thousands of Washington health-care professionals beyond the participating medical groups.
Overall, medical groups participating in the Quality Score Card posted scores slightly higher than the statewide average: 71 percent of other Washington clinics met evidence-based standards of quality last year, up from 64 percent in 2002.
Those 2002 Quality Score Card results were similar to those of the 2003 Rand Health study, "The Quality of Care Delivered to Adults in the United States." The Rand study found that 59 percent of medical care in the Seattle area and 55 percent of medical care nationwide met recognized quality standards.
The Quality Score Card also measured other areas -- from patient satisfaction to use of generic drugs. In 2002, generics were prescribed about 42 percent of the time both by Quality Score Card participating clinics and by other clinics statewide. The 2006 Quality Score Card shows that participating clinics prescribed generics 58 percent of the time -- a 38 percent improvement. Other clinics statewide prescribed generics 54 percent of the time in 2006.
The Quality Score Card tracks not just how often recommended care is delivered, but also how often health improves. For instance, among participating medical groups, the number of diabetics with well controlled blood sugar rose by 91 percent since 2004; those with well controlled LDL cholesterol rose by 81 percent; and those with well controlled blood pressure grew by 61 percent.
Extending Quality initiatives to Smaller Clinics and Practices
Building on this five year collaboration, Premera today announced that a customized Quality Index report will be available to more than 150 smaller clinics and practices throughout Washington state. The report indexes each clinic's performance to statewide benchmarks in four categories: chronic care, preventive care, acute care, and overall quality and efficiency.
"The pioneering work by our Quality Score Card participating clinics enables smaller clinics throughout Washington to benefit from their knowledge and experience," said John Castiglia, MD, Premera's chief medical officer. "We're now prepared to support results of smaller clinics with quality information tested for half a decade by leading Washington medical groups. This means more patients will benefit."
At November 1 and 2 community receptions, Premera will honor the participating medical groups and 27 smaller clinics and practices across Washington for their medical-quality leadership.
Next, Premera medical directors are preparing to share this information with other interested physicians at up to 156 smaller practices and clinics.
"We're sharing these results for one reason: supporting clinics' efforts to improve medical quality," noted Dr. Castiglia.
"More than five years ago, Premera reached out to physicians and clinics and asked them to help us create a quality program that would benefit their patients. Beginning with the original six clinics, this five year collaboration has been built on mutual trust by working together to create the measures," Dr. Castiglia said. "In this first reporting year for the smaller clinics, their data is not being published but only shared confidentially with each clinic – just as we did initially with the Quality Score Card medical groups."
Premera is also working with Washington State Medical Association and the Puget Sound Health Alliance as they prepare to launch similar efforts in 2007.
The Cost/Quality Connection
The 2006 Quality Index gives clinics information about the relative cost-efficiency of the care they deliver compared to statewide benchmarks.
The 2006 Quality Index also revealed an important finding: efficiency and quality are not mutually exclusive goals. This finding resulted by comparing an overall quality score of 156 clinics to the medical costs managed by the clinics as they treat their patients.
"On the whole, clinics are not sacrificing quality to achieve efficiency," said Dr. Sollek. "In fact, the reverse was true: On the average, clinics with higher Quality Index scores tended to have slightly higher Efficiency Index scores overall. You don't have to sacrifice quality for efficiency. In Washington state, it appears that efficiency and quality are being achieved together."
Next step: delivering patient-specific, actionable information
"The medical groups participating in the Quality Score Card initiative have been asking us for quality feedback they can carry into the examination room. That's our focus forward," said Dr. Castiglia.
Last month, Premera began delivering specific quality information to interested medical groups about their patients. The company plans to expand efforts in 2007.
"To say, 'Here's your quality score --' that's an important data point for making improvement," said Premera's Dr. Sollek. "To say, 'Here are the names of your patients who have and haven't had recommended tests and treatment' -- we're being told that's an extraordinarily valuable piece of information that allows the clinician to raise the quality level of their practice."
Premera is providing to the Pacific Medical Center and Virginia Mason Medical Center a registry of its members being treated by each clinic for diabetes and coronary artery disease. This registry includes lists of each clinic's patients missing recommended tests such as HemaglobinA1c tests (measuring blood sugar control) for diabetics and cholesterol checks for patients with heart disease.
"It's really a two-way street," Dr. Sollek said. "Large sophisticated medical groups like these have their own electronic medical record systems. They can use our data as a double-check -- and can also help us improve the quality of information we supply to smaller clinics that don't have the medical-quality systems and infrastructure available to larger medical groups."
About Premera Blue Cross
Our mission is to provide peace of mind to our members about their health-care coverage. We provide health insurance and related services to more than 1.3 million people. Premera Blue Cross has operated in Washington since 1933, and Alaska since 1957. Premera Blue Cross is an independent licensee of the Blue Cross Blue Shield Association.
Premera Blue Cross is a member of a family of companies based in Mountlake Terrace, Washington, that provide health, life, vision, dental, and long-term care insurance, and other related services.
