Quality

WISCONSIN Ahead of the Pack

By Richard Haugh

In Wisconsin, the issue isn’t about whether to report quality and cost information, it’s how quickly can the information be made public

Wisconsin is emerging as a national model for private-sector initiatives to meet demands for information on health care costs and quality. That’s crucial as consumer-driven health plans catch fire and the public demands more information to make purchasing decisions, say health leaders in the state.

“People need good data to make good decisions,” says Joseph Neidenbach, executive vice president and administrator of St. Vincent Hospital, Green Bay. “We’ve set the tone for a lot of national thinking on this. We’ve been willing to put it out there.”

And outside experts are taking note. Paul Ginsberg, president of the Center for Studying Health System Change, Washington, D.C., says Wisconsin’s health care and business leaders are out in front on a lot of quality and transparency issues, adding that they aren’t “bucking the trends, they are running with the trends.”

Hospitals, physicians, insurers and employers in Wisconsin are joining to form coalitions promoting and improving the transparency of health care information. The state also is developing a regional health information organization, called the Wisconsin Health Information Exchange, to tie it all together. The package could serve as a model for other quality improvement and cost reporting efforts around the country.

“There’s been a shift over the last couple of years to recognize, if not embrace, the transparency movement,” says Chris Queram, CEO of the Employer Health Care Alliance Cooperative, Madison. “It isn’t about whether we should be reporting. It’s about what and how quickly we can wrap up and expand the number of measures that are reported.”

The move for transparency is driven in part by the fact that Wisconsin has some of the most expensive health care in the country. A study by the Government Accountability Office, requested by Wisconsin Rep. Paul Ryan, a Republican, found that eight of the 10 U.S. metropolitan areas with the highest physician prices were in Wisconsin, and except for Fond du Lac, every metropolitan area in the state ranked in the top 16 most expensive cities. No other state came close to having that many ranked cities.

Hospitals fared better in the GAO report, with only Milwaukee and LaCrosse breaking into the top 10 list. The GAO pinned the blame for the pricier cities on less competition among providers and less market clout for managed care companies.

In March, the Greater Milwaukee Business Foundation on Health released a study it funded on the cost efficiency of health care in the Milwaukee area. It found Milwaukee’s cost for medical services after provider-negotiated discounts was 27 percent higher in 2003 than other Midwest metropolitan areas. The foundation joined a growing chorus of organizations calling for the creation of a central repository of standardized health care information that can be used to gauge medical outcomes and quality measures.

“This is the first ever report in Wisconsin that compares hospitals and their systems side by side based on allowed or negotiated fees rather than on charges,” Jim Wrocklage, the foundation’s executive director, said in releasing the report. “It’s essential that we have timely and standardized data available.”

Years of Experience

Some reporting initiatives have been in place for a number of years. Wisconsin’s Department of Health & Family Services hosts a Web site providing information on the state’s managed care plans, based mostly on HEDIS data, and their performance in providing high quality care and customer service to members. The National Committee for Quality Assurance also ranks health plans in its annual “State of Health Care Quality Report.” This year the NCQA placed six Wisconsin HMOs among the top 50 health plans it ranked. And health insurers offer information on provider price and quality to support consumer decision-making, with the idea of reducing cost by motivating consumers to choose lower cost or higher quality providers to reduce overall utilization.

Probably the most ambitious cost reporting initiative, though, was undertaken by the Wisconsin Hospital Association, Madison, when in February it introduced a Web-based program called PricePoint to allow consumers to compare costs at different hospitals. The state has long compiled and disclosed information about hospital charges on its Web site, but before the hospital association took over data collection for the state, the information was too technical for most consumers to understand. The WHA decided to decipher the data and provide average discounts that hospitals allow for various inpatient procedures.

PricePoint is unique among similar Web sites in that it provides aggregated discount information for each hospital for three major kinds of health coverage—private insurance, Medicare and Medicaid, says Joe Kachelski, vice president of the WHA Information Center. Spending totals for uncompensated care are provided as well. The site’s data also is more current than other reporting initiatives, such as those that rely on Medicare data. PricePoint displays the four most recently reported quarters of data from hospitals and includes information about all hospitalizations in the state.

Kachelski says the Web site will prove particularly valuable as consumer-directed health plans become more prevalent. “As the health insurance market evolves, hospital charges will be increasingly relevant to consumers, and this will be a helpful tool for them,” he says.

The Web site does have some limitations—it lists costs only for inpatient procedures, not outpatient procedures or primary care visits to physicians, which together make up the bulk of health care costs. Outpatient charges are next on

WHA plans for the site. The association also would like to have insurers contribute charge information.

Checking on Quality

The other side of the reporting coin is quality, and a partnership between the Wisconsin Collaborative for Healthcare Quality and the WHA, launched in May, puts detailed quality information on the Web. Called Healthclick Wisconsin, the site links quality initiatives sponsored by the two organizations on one site: the WHA’s CheckPoint and the WCHQ’s Performance and Progress Report.

The WHA says CheckPoint is the first voluntary quality reporting initiative in the country, and preceded the Centers for Medicare & Medicaid Services’ Web site, Hospital Compare, by more than a year. Consumers can check hospital performance by visiting the CheckPoint Web site to see how virtually every hospital compares with others in the state and with national and state benchmarks on select measures of health care quality. The WHA site reports data from 126 hospitals, covering 99 percent of admitted patients. Medical services data on the site is updated every three months, and error prevention data is updated every six months.

The WCHQ’s Performance and Progress Report compares the quality of outpatient and inpatient care in 21 major markets in the state. It uses 45 measures of quality to gauge the performance of 14 multispecialty medical groups, 19 hospitals and seven health plans.

Shared Vision

While Wisconsin is out front in reporting efforts, what’s truly unusual is the shared collaborative encompassing not just health care organizations, but the business community as well, says Queram (who is moving from the Employer Health Care Alliance Cooperative to assume the reins at the WCHQ). That collaboration stems from a recognition that to make meaningful progress on these fronts, a group of committed stakeholders need to come together and work toward common goals.

“What’s different about this is there is a desire on the part of the members to do both public reporting and quality improvements, combining the elements of both into one organizational platform,” he says. “There is a business case for focusing on quality, and by publishing information we’re seeing performance improve.”

Efforts in that area will be aided by another recent development in Wisconsin: the launch of a regional health information organization. Building on the data repository concept called for in the Greater Milwaukee Business Foundation on Health study on costs, the RHIO will link three existing networks: an emergency medical services network that displays the diversion status of emergency departments in nine southeast Wisconsin hospitals, a Wisconsin Department of Health and Family Services registry of immunization information, and the Wisconsin Public Health Information Network.

The goal many see for the various initiatives is a cohesive view of health care in the state, anchored by an electronic medical record and shared through the RHIO. St. Vincent’s Neidenbach sees an added side benefit: better understanding of how the various components interact, and how they impact care in any given setting. “We have enough trouble understanding this and we live in it every day,” he says. “It’s not an easy challenge, but that’s not an excuse to not put good information out there.”

All these efforts are moves in the right direction, says Patrick Remington, M.D. But what hasn’t happened yet is asking how the quality improvement and cost reporting efforts can provide not just better care, but less care overall, says Remington, director of the Public Health and Health Policy Institute at the University of Wisconsin, Madison. While hospitals and health organizations are moving in that direction, they’re mired in the business realities of purchasing high quality, low cost health care.

“These initiatives don’t really help us in the long run if there are no financial or market incentives to keep people healthy and out of care,” he says. “Otherwise, it will be just like the HMO movement and managed care—we’ll just end up squeezing what we can out of this transparency initiative and eventually there will be more people with more health problems.”

This article 1st appeared in the November 2005 issue of HHN Magazine.

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