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Discovering How — and Why — Medical Costs and Outcomes Vary Across Regions

Why do health care quality and cost outcomes vary — in some cases quite widely — from state to state, region to region, and even within the same city? MHQP is collaborating with three other states, the National Bureau of Economic Research, Harvard University, and the Network for Regional Healthcare Improvement in a five- year study that aims to create a national model to help understand the characteristics of delivery systems that contribute to better health care at lower costs.

Measuring the Clinical and Economic Outcomes Associated with Delivery Systems will tap into extensive information — insurance claims, patient-experience data, and other qualitative information — available to MHQP and three other regional health improvement collaboratives (RHICs) to identify which health care delivery systems in a region or state deliver high quality, affordable care and, most importantly, how and why.

The RHICs and states participating in this initiative are:

  • Center for Improving Value in Health Care | Colorado
  • HealthInsight Utah | Utah
  • Massachusetts Health Quality Partners | Massachusetts
  • Oregon Health Care Quality Corporation | Oregon

Understanding how and why variations occur will in turn help inform research and policy decisions at a national level.

In- and across-state comparisons: MHQP and the three other RHICs are analyzing insurance claims data to calculate a common set of quality and cost measures. The RHICs will calculate results at various levels of geographic and organizational granularity. Throughout the five years of the study, the four states will work together to grow their internal quality and cost measure-set and to establish consistency of system and measure definitions.

System characteristics impact: By meeting with local leaders, using information from provider directories, and through knowledge of the marketplace, MHQP will identify factors that impact cost and quality variations in Massachusetts. Some factors to be investigated include: payment models, formal or informal contracting arrangements, political environment, rural versus urban settings, cultural norms, and system integration and consolidation.

Regional collaboration and alignment: This project is building MHQP’s capacity to conduct research across and within Massachusetts, while accommodating and learning from local variation.

The team is currently measuring quality variations across the four states using a common measure set for pediatric, behavioral health, and preventive care. Initial measures included:

  1. Developmental screening for the first 36 months of life
  2. Follow-up care for children prescribed Attention Deficit Hyperactivity Disorder (ADHD) medication
  3. Adolescent well-care visits
  4. Anti-depressant medication management
  5. Hospital admissions for ambulatory-sensitive conditions- acute composite
  6. Hospital admissions for ambulatory-sensitive conditions- chronic composite
  7. Avoidance of antibiotic treatment in adults with acute bronchitis
  8. Chlamydia screening

MHQP will release results specific to Massachusetts in 2017.

This project is supported by grant number U19HS024072 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the political views of the Agency for Healthcare Research and Quality.

For more information about this project, contact: Jim Courtemanche at jcourtemanche @mhqp.org.

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