When Dave Terry started his career in healthcare three decades ago, he noticed something odd and disturbing. The fee-for-service model meant doctors were paid for quantity, not for quality or cost effectiveness. Since then he’s been working to do something about it: for the first twenty years at American Practice Management, then Partners Healthcare and Harborside Healthcare. He made progress, but also learned the limitations of acting against entrenched interests.
For the last decade he’s gotten even more serious, co-founding Remedy Partners in the wake of the Affordable Care Act and then Archway Health, where he is CEO. Archway helps physicians jump into the meaningful risk-based payment models that are finally on offer from the Feds and private carriers.
I compared Dave’s quest to the Thirty Years’ War, but reminded him that there was a Hundred Years’ War, too, so he better gird himself.
Like many healthcare entrepreneurs, Daniel Kivatinos was a tech guy whose bad personal experience with the healthcare system led him to try to make things better. The founding of DrChrono a decade ago coincided with the birth of the iPad and iPhone, and the company has been closely linked to Apple hardware ever since. In fact, Daniel is such a hardcore Apple guy that he recommends buying two Apple watches so you can wear one while the other is charging!
In this edition of the HealthBiz podcast, Daniel charts the history of DrChrono and shares what’s coming next with the Apple Watch, artificial intelligence and more.
Fact: The US spends much more on healthcare than other rich countries but has fewer hospital beds and doctors. That’s hurting us now as we battle COVID-19. In this podcast, Carecentrix CEO John Driscoll and I explain what’s going on and what we can do about it.
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.
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.
For many years Massachusetts Health Quality Partners (MHQP) has collected and published information on the patient experience of care in Massachusetts. The outputs have been revealing and very helpful for physician groups seeking to improve and for patients trying to identify the best places to receive care.
But Medicaid (aka MassHealth) patients have never been included. Considering that Medicaid serves more than one million patients and is the biggest item in the state budget, it’s about time to at least understand what’s going on.
MassHealth has contracted with MHQP to conduct a large-scale patient experience survey of Medicaid patients. It was a big enough deal to merit front page, lead article placement in yesterday’s Boston Globe (edging out stories about the shutdown and the Patriots) so it has people’s attention.
The state government will have access to the full results and promises to make some of the findings public. Frankly I hope they’ll publish everything so the general public, physicians and MassHealth patients can learn as much as possible. The more widely the information is publicized, the more likely it will be to have an impact.
I’m looking forward to reviewing and writing about the results of the first survey, which should be available around the start of next year.