Category: Research

Experiencing Patient Experience results from MHQP

published date
January 28th, 2019 by

For the past 14 years, Massachusetts Health Quality Partners (MHQP) has published results of its primary care patient experience survey. The information is useful to the practices themselves as they seek to improve, and to health plans looking to evaluate their networks, improve member service, and pay bonuses to the best practices.

This year MHQP added an analysis of free text feedback to its analysis, to give practices more color on the scores.

The consumer-facing site, Healthcare Compass lets users view ratings for individual practices and compare up to three at a time. Users can click on the individual categories to learn what each one means, what patients can do, what doctors can do, and where to find additional resources. For example, the “what you can do” tab in the communications section includes suggestions to speak up if you want your doctor to make eye contact and to ask the doctor to repeat back what you just said.

I used the site to compare three practices I am familiar with and the results match up well with my perceptions.

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Comparing MD offices
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Click on the Harvey ball to see the underlying data

There is a lot to like about MHQP’s patient experience reporting including:

  • It provides validated information on key elements of practices, for both adult and pediatric
  • The site is easy to navigate. The information is communicated in plain English and with simple, intuitive graphics. For even more detail, you can click on the Harvey balls (I didn’t realize this at first) to get the detail behind the score.
  • Providers have responded to the feedback by improving performance in key areas over the years, including communications and care coordination
  • The bottom line “willingness to recommend” percentage provides a useful benchmark for comparing practices
  • For the first time this year, MHQP issued awards for the highest performing practices for adults and pediatrics and for each domain of care. You have to go to the MHQP site itself to see it, but you can bet the doctors know it’s there!

MHQP has built trust with providers and payers by working collaboratively with them and taking their sensitivities into account when publishing the performance data. Here’s how public reporting of survey results could expand, subject to the consent of providers and payers and additional funding:

  • Provide more prominence to the actual scores for the measures, rather than just a three-level Harvey ball (full, half full, empty) showing relative performance. The current approach obscures the fact that median scores for certain categories are much higher than others. For example, the mean score for pediatric practices on patient-provider communications is 97.3% compared with 50.3% for empowering patient self care. While we’re at it, it might also be nice to see the range of scores. Does everyone cluster around 50% for self care or do some practices get into the 70s or 80s?
  • Provide reporting at the level of the individual MD for measures where that’s relevant, e.g., “how well doctors communicate with their patients” and “how well doctors know their patients,” while keeping practice-level reporting for measures such as, “getting timely appointments, care, and information.” The challenge here is that it would require a much bigger budget to reach the needed sample size
  • Provide a synthesis of the qualitative comments
  • Provide ratings of specialists as well as primary care

The pushback will be that there are valid reasons to present the information as it is and that expanding will be cost prohibitive, but on the other hand it would make this reliable and validated information more likely to be used.

Congratulations to MHQP for its continued success in shining a light on patient experience and making useful information available to all the stakeholders in the Massachusetts healthcare system.


By healthcare business consultant David E. Williams, president of Health Business Group.

 

Food for health

published date
January 22nd, 2018 by

Fatty, high calorie foods are relatively inexpensive in the US, while fresh fruits and vegetables are expensive, especially in cold weather states but even in agricultural centers. That’s one reason why lower income families often have unhealthy diets.

The SNAP program (aka food stamps) tries to encourage healthy eating on a budget through its SNAP-Ed Connection, but provides few incentives for the purchase of healthy foods or disincentives for the unhealthy stuff.

So I was pleased to see a Kaiser Health News article (When Food Stamps Pass As Tickets To Better Health) on a US Department of Agriculture pilot program called Mas Fresco, which provides funding to induce food stamp recipients to purchase fruits and vegetables.

In theory, the program will encourage healthier eating, which will lead to better health, a reduction in chronic disease, lower healthcare costs, higher productivity and income. It could reduce quality of life and economic disparities. There’s no guarantee that the program will achieve these results, but it strikes me as a good use of federal dollars to give it a try.


By healthcare business consultant David E. Williams, president of Health Business Group.

 

Clinical registry solution market heads toward $2 billion

published date
September 20th, 2017 by

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Specialty medical societies such as the American College of Cardiology and American College of Surgeons sponsor clinical registries that collect observational data on patients with specific conditions or procedures, such as heart failure or joint replacement. This “real world” evidence helps hospitals improve quality of care, meet state and federal reporting requirements, and achieve pay-for-performance bonuses.

Q-Centrix, which provides technology and services that enable hospitals to participate in registries, commissioned Health Business Group to conduct a market sizing and growth study. We found that the market will reach almost $2 billion over the next five years. Q-Centrix is offering a complimentary download of the findings.

Clinical registries have been around for decades, but in recent years they have become central to achieving quality in healthcare delivery. Registries have proved their superiority over other approaches such as electronic medical records and traditional clinical trials, and are being embraced by accrediting organizations, commercial health plans and federal agencies such as FDA and CDC.

Hospitals continue to gain experience with registries and are deriving more and more value from them over time. However, in a digital, automated world, participating in registries is still a remarkably manual and time consuming process. Each patient record for the registry must be “abstracted” according to the specific requirements of that registry and then submitted securely and accurately. Some registries provide software tools to help, but even then the tool is only useful for a specific registry. That’s cumbersome for hospitals that participate in multiple registries, a big issue since hospitals often participate in 10 or more.

Hospitals have rationalized other manual, labor intensive administrative processes by outsourcing. Medical transcription is a good example, where the use of outsourcing and automation are now the norm.  The same approach is being taken in the registry world, which is why companies such as Q-Centrix are thriving.

At Health Business Group, we were excited to conduct research into this dynamic and growing market, especially since there was very little information published about the topic. To formulate our projections we reviewed secondary data sources, leveraged the Health Business Group knowledge base, and conducted interviews with dozens of hospitals, specialty societies, market experts, and industry participants. We also fielded an online survey of hospitals to develop a detailed understanding of industry trends and their root causes.

Health Business Group specializes in the assessment of healthcare markets and development of growth and M&A strategies for healthcare companies and investors. To learn more, contact us or visit our website.


By healthcare business consultant David E. Williams, president of Health Business Group.

 

USPSTF adopts my reasoning on PSA screening for prostate cancer

published date
April 13th, 2017 by
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Which way on PSA?

I oppose over-testing and over-treatment, so I really had to think hard five years ago when I turned 45 and my doctor offered PSA screening for prostate caner. The US Preventive Services Task Force (USPSTF) had just come out against PSA screening, concluding that the harms outweighed the benefits.

Nonetheless (Why I decided to get a PSA screening test for prostate cancer), I did go forward. As I wrote:

I know that PSA is a very imperfect indicator. I definitely want to avoid the stress and possible discomfort of having a biopsy. I’m worried about false positive and false negative biopsy results. And I don’t relish the significant potential for incontinence, impotence, or bowel problems from treatment.

But at this stage of my life I am willing to accept a significant risk of morbidity in exchange for a small reduction in mortality risk, which is my impression of what my choice to have the PSA test means. In 10 or 20 years I probably won’t feel that way. And I hope there will be better detection, follow-up and treatment options by then.

I’m also confident in my ability to make informed choices with my physicians along the way. The PSA test itself was done as part of routine blood work and there was no additional risk from that. My doctor and I agreed that if the PSA is elevated we’ll discuss what to do next. At that stage I’ll also have the chance to do more research and get more opinions if necessary. I’m not automatically going to get into a cascade of follow-up and treatment.

Now the USPSTF appears to be coming around to my way of thinking. In particular, they note that more men are choosing “active surveillance,” i.e., keeping a close watch rather than jumping straight to aggressive treatment.

The choice about whether to undergo PSA testing and what to do once results are in is a great opportunity for shared decision making. And this is what should be encourage.

By healthcare business consultant David E. Williams, president of Health Business Group.

Just a granule of sugar makes the medicine go down (and out)

published date
December 15th, 2016 by
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What Would Mary Do?

Many drugs fail in development due to safety problems. A study indicates that impurities in the non-active ingredients may sometimes be to blame. According to lead researcher Daniel Weinbuch from Leiden University:

“We found that sugar excipients themselves contain nanometer-sized particles, which can damage proteins and make drugs unsafe. These nanoparticle impurities in sugar could even trigger the immune system itself.”

Obviously, drug companies need to learn about this problem and find sugar manufacturers who can make pure products.

It’s unfortunate that this problem exists, but it also holds out the possibility that some drugs that were previously thought to be unsafe could actually be safe. If so, it would be time to restart the development process.

The academic paper (Nanoparticle Impurities in Pharmaceutical-Grade Sugars and their Interference with Light Scattering-Based Analysis of Protein Formulations) was published in Pharmaceutical Research.

By healthcare business consultant David E. Williams, president of Health Business Group.