Collaborating, Analyzing, and Improving Care in Boston

07 May 2014
Is it possible to improve health care quality and reduce costs? The Aligning Forces for Quality (AF4Q) initiative in Greater Boston, operated by Massachusetts Health Quality Partners (MHQP), says the answer is yes—and the Alliance has identified a key starting point.
“An important aspect of improving the quality of Massachusetts’s health care system is to reduce unnecessary care, and one way to do that is to better understand unexplained variations,” said Janice Singer, vice president of programs and operations for MHQP.
Studies (e.g., Wennberg and others) about geographic variation in clinician practice patterns have clearly demonstrated wide, unexplained variation in medical and surgical practices that leads to over- and underutilization of services, higher resource use, higher costs, and lower quality.
These studies sparked the idea for MHQP’s Practice Pattern Variation Analysis (PPVA) Collaborative Multi-Stakeholder Project. The Alliance was selected to spearhead the initiative based on its previous successes with collaborative statewide measurement initiatives in Massachusetts. The goal of the project is to implement a statewide evidence-based analysis, reporting, and improvement program to deepen clinicians’ and other stakeholders’ understanding of practice variation that may suggest overuse or underuse of medical services.
PPVA, an approach developed by Howard Beckman and colleagues at Focus Medical Analytics (FMA), has been shown in several markets to effectively move to this next step, engaging and focusing clinical attention and improvement efforts within medical groups and practices. PPVA provides an analytic approach for identifying variation, key drivers of that variation, and insights that can lead to better health outcomes.
“The PPVA has immense potential to positively impact health care because it opens the door for quality improvement measures and reducing costs,” said Deeb N. Salem, MD, physician-in-chief, Sheldon M. Wolff Professor, and chair, Department of Medicine, Tufts University School of Medicine. “It outranks similar local and national initiatives because it takes a comprehensive scientific approach,” he said.
To implement the multi-payer approach to PPVA, MHQP applied for and received permission from the Center for Health Information and Analysis (CHIA) to use the Commonwealth’s all-payer claims databases (APCD) for its analysis. This approach will enable creation of statewide analysis and reports for discussion among providers across Massachusetts.
MHQP has engaged FMA to complete the PPVA analyses, which will provide physician leaders and other stakeholders with clear, succinct, and clinically relevant answers to five very important questions:
  1. What disease conditions account for the highest cost?
  2. What are the key cost drivers within each disease condition?
  3. What variation exists within each key cost driver?
  4. How does one select the right opportunities to reduce costs?
  5. How does one achieve measurable savings while maintaining or improving quality?
The series of reports and analyses generated from the MHQP PPVA project will facilitate discussion with front-line clinicians around opportunities to potentially reduce variation, discussion of community standards for clinical areas with significant unexplained variation
in practice, and peer-to-peer learning sessions to share best practices. They also will promote dialogue between providers and payers and collaborative efforts to reduce unexplainable variation. These reports will be shared with physician leaders and with individual physicians upon request. They will not be made publicly available.
“The PPVA is drawing back the curtain of opportunity for physicians to take the lead,” said Matthew Collins, MD, senior medical director for Medical Affairs at Fallon Health. “We always seem to practice in parallel to one another. This project starts the important conversations and allows us to be the solution to many of our own problems,” he said.
The initiative has broad multi-stakeholder support from the Massachusetts health care community, including six leading health plans (Blue Cross Blue Shield of Massachusetts, Harvard Pilgrim Health Care, Fallon Health, Health New England, Neighborhood Health Plan, and Tufts Associated Health Plan), MassHealth (in anticipation of future inclusion in such analysis), the Massachusetts Medical Society, the Massachusetts Hospital Association, and the MHQP Physician Council (with representation from provider network organizations representing owned and independent practices).
The conversations Alliance’s PPVA initiative will start will lead to changes in behavior through engaging clinicians in variation-focused quality improvement initiatives, developing evidence-based community standards, promoting specialty society discussions, and other activities that will positively impact the cost and quality of care provided to patients.