Ohio Health Quality Improvement Plan

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Appendix III — Su r v e y ResultsThe Ohio Health Quality Improvement Plan was presentedto a reconvening of many of those who attended theNovember 2008 Summit, along with others interested in therecommendations. Following the April 27, 2009 meeting,a follow-up survey was sent out to obtain feedback onthe plan. One hundred twenty five (125) individualsresponded from April 30, 2009 – May 11, 2009. Surveyrespondents were asked to respond to questions based onthe Ohio Quality Improvement Draft Plan and were giventhe opportunity to offer general comments. Revisions tothe plan may be made based on the results of and generalcomments from the survey. Following are the resultsobtained through the follow-up survey.OverallRespondents represented a broad group of stakeholdersin both the private and public sectors. The majority ofindividuals responding did not attend the Ohio HealthQuality Improvement Summit in November 2008 (70.9%didn’t attend) or the April 27th follow-up meeting (67.5%didn’t attend). Additional feedback was obtained at theApril 27th meeting as well as through a follow-up survey.All four collaborative transformational strategies alignedwith current work at the respondents’ organizations:Informed and Activated Patients and Individuals had thehighest level of correlation (79.2%) with the existingwork of organizations, followed by Health InformationTechnology (66.4%), Patient Centered Medical Homes(66.4%) and Payment Reform (54.4%).When asked to rank the importance of the collaborativetransformational strategies in helping to achieve the visionfor a Healthy Ohio, 34.7% ranked Informed and Activatedpatients and individuals as the most important strategyand 32.8% ranked Payment reform as the most importantstrategy. Patient Centered Medical Homes was ranked by32.2% as the second most important strategy and HealthInformation Technology was ranked last in the importanceof helping to achieve the vision for a Healthy Ohio.Survey results show that many believe there are substantialbarriers to implementing the strategies. Respondentsindicated that the most challenging barriers to overcomein implementing strategies are funding (68% rated as mostchallenging), access to health insurance (43.8% rated asmost challenging) and culture change (42.5% rated asmost challenging). The following barriers were ranked asmoderately challenging: care coordination across settings(37.8%); physician buy-in (36.2%); access to clinics(34.4%); access to technology (32.3%); and workforcecapacity (30.6%). Lack of information, purchaser buy-in,transportation, access to web services and health disparitiesalso were rated as moderate challenges.Individuals and organizations responding to the surveywere asked in which area/areas their organizations wouldbe able to help achieve the vision for a Healthy Ohio:71.9% said they could help by adopting health informationtechnology (22.8% said it was not applicable to theirorganization); 54.7% believe they could help implementpayment reform strategies that support PCMH (35.8% saidit was not applicable to their organization); 65.2% wouldbe able to help implement patient centered medical homes(25% said it was not applicable to their organization); and82.3% could help engage patients in managing their ownhealth care.Patient-Centered Medical HomesWhen asked to rate the importance of each componentof the definition for Patient Centered Medical Homes(PCMH), as defined in the Ohio Health QualityImprovement Plan, the majority of respondents rated thefollowing components as very important: a continuousrelationship with a physician or other credentialed clinician(63.4%); a multidisciplinary team that is collectivelyresponsible for providing for a patient’s longitudinal healthneeds and making appropriate referrals to other providers(62.1%); coordination and integration with other providers,as well as public health and other community services,supported by health information technology (61.5%); andenhanced access through extended hours, open scheduling,and/or e-mail or phone visits (48.4%). An expanded focuson quality and safety was rated moderately important by41.5% of respondents and very important by 39.8% ofrespondents.Expanding traditional fee for service payments to coveractivities such as coordination of care and care management(48.4% rated as very important, 39.8% rated as moderatelyimportant), and rewarding providers for improving healthoutcomes (44.7% rated very important, 31.7% rated asmoderately important) were rated as key components ofpayment reform to implement the patient centered medicalhome. The majority of respondents rated paying providersfor start-up costs associated with moving to the PCMHapproach as moderately important (37.4%), while somebelieve that this element is very important (33.3%).Survey responses indicate that 56.5 % believe that Ohioshould focus its initial implementation of the PCMH28
Appendix III — Su r v e y Resultsapproach on populations with multiple chronic conditions,32.3% believe that initial implementation should focuson children, 28.2% believe that all populations shouldbe focused on in the implementation, 27.4% believe thefocus should be on children with special health care needs,18.5% believe focus should be on populations with a singlechronic condition, and 10.5% offer an alternative response(rural access, uninsured, low income, Medicaid, andpatients with disabilities).Health Information TechnologyThe majority of respondents (71.2%) said they wouldtrust a non-profit with broad board participation to run astate wide health exchange. Approximately forty eightpercent (48.4%) prefer that the non-profit facilitate an EMRpurchasing collaborative and 36.9% prefer the non-profit toprovide an EMR as a service. Over forty-one percent(41.9 %) said they would pay a nominal fee toelectronically access patient data to which they do notcurrently have electronic access, 24.2% indicated theywould not pay a nominal fee and 33.9% didn’t feel they hadsufficient information to answer the question.Payment ReformRespondents overwhelmingly responded that the followingpayment reform strategies should be the same forgovernment programs and private health plans: expandingtraditional fee for service payments to cover activitiessuch as coordination of care and care management(86.7%); rewarding providers for improving healthoutcomes (87.5%); and paying providers for start up costsassociated with moving to the PCMH approach (72.9%).Approximately fifty nine percent (58.9%) believe thatpayment reform strategies should be implemented throughmandatory requirements, while 38.4% believe paymentreform strategies should be implemented through voluntarycompliance. When asked which payment reform strategyshould be implemented first, 40.2% agreed that strategiesto support medical homes should be implemented first;followed by strategies to support health informationtechnology (41.5%); and lastly, strategies to eliminateduplication, waste and errors in the delivery of care(38.7%).Informed and Activated Patients andIndividualsWhen asked to rank the order of importance of areas inwhich individuals often need help to effectively managetheir health and health care, 46.6% ranked assistance withmaking healthy lifestyle choices as the most important area.Assistance with making health care treatment decisions wasranked as the second most important area (41.3%) followedby assistance with making health care coverage decisions.Respondents ranked assistance with making end-of-lifedecisions as the least important area in helping patients toeffectively manage their health and health care.The following populations that often need support toeffectively manage their health and health care wereranked based on their potential for immediate impact(listed in order of most immediate to longest time forimpact): individuals with chronic illness (most immediate),uninsured individuals, individuals with public healthcare coverage, all Ohioans under 65 years of age, andindividuals with employer-sponsored health coverage(longest time for impact).When surveyed, the majority of respondents indicatedthat web-based information, community activities, andmarketing campaigns are neutral to moderately ineffectivein helping individuals to become more engaged intheir health and health care. Respondents indicated thatencouragement or information from providers as well asfinancial incentives are the most effective ways of engagingindividuals in their health and health care. The majorityof respondents indicated that providers are moderatelyto very effective in informing and educating individualsabout their care. Respondents indicated that individuals aremoderately effective in educating themselves about theircare. Schools, communities, employers and health plans/insurers are moderately to neutrally effective in educatingindividuals about their care.29
Page 1 and 2: Ohio Health QualityImprovement Plan
Page 3 and 4: Introduc tionIn November 2008, more
Page 5 and 6: In t r o d u c t io nimplementation
Page 7 and 8: Oh io He a l t h Qu a l it y Im p r
Page 9 and 10: Pa t ie n t Centered Me d ic a l Ho
Page 11 and 12: Pa t ie n t Centered Me d ic a l Ho
Page 13 and 14: He a l t h In f o r m a t io n Te c
Page 15 and 16: Pa y m e n t Re f o r m◦◦◦◦
Page 17 and 18: In f o r m e d a n d ActivatedPa t
Page 23 and 24: Me a s u r in g Su c c e s sPropose
Page 25 and 26: Ne x t StepsOhio Health Care Covera
Page 27: Appendix II — Response to Questio
Page 31 and 32: Appendix IV — Co m m e n t s f r
Page 45: CORE PLANNING TEAMAmy Rohling McGee

Ohio Health Quality Improvement Plan

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