West Virginia Health Care Authority

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Charleston WV 25311
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Fax 304-558-4776


Meeting 4-20-99

West Virginia Health Care Authority
Quality Utilization Advisory Group Meeting
April 20, 1999 Meeting Notes

Present: See attached list

Welcome and Introduction
Parker Haddix, Chairman of the Health Care Authority and Chairman of the Quality Utilization Advisory Group, called the meeting to order at 10:05 a.m. Mr. Haddix extended his appreciation to those present, and then identified some of the current Health Care Authority activities to include the State Health Plan, Data Advisory Group, and Interagency Long Term Care Panel. Mr. Haddix then introduced the meeting facilitator, Marsha Boggess with Organization Performance Initiatives Corporation. Advisory Group members were then asked to introduce themselves.

Review of Legislation
Parker Haddix reviewed the sections of West Virginia Senate Bill 458 that created the Quality Utilization Advisory Group, and called for this effort to not duplicate the efforts of other agencies and their activities. The purpose of this legislation and proposed mission and goals are as follows:

Legislative Purpose:
Senate Bill 458


§16-29B-23 Utilization review and quality assurance; quality assurance advisory group.

  1. In order to avoid unnecessary or inappropriate utilization of health care services and to ensure high quality health care, the board shall establish a utilization review and quality assurance program. The board shall coordinate this program with utilization review and peer review programs presently established in state agencies, hospital services and health service corporations, hospitals or other organizations.
  2. With the assistance of the above-mentioned entities, and after public hearings, the board shall develop a plan for the review, on a sampling basis, of the necessity of admissions, length of stay and quality of care rendered at said hospitals.

Mission
Avoid unnecessary or inappropriate utilization of health care services and to ensure high quality health care.

Goals

  1. Create a quality advisory group
  2. Establish a Utilization Review and Quality Assurance Program>
  3. Coordinate the project with established utilization and quality programs
  4. Develop a plan for the review of necessity of admissions, length of stay, and quality of care
  5. Monitor identification of program areas
  6. Ensure high quality and appropriate services and utilization through incentives/ sanctions

Discussion on Communication
Mr. Greg Morris, Health Care Authority Executive Director, asked the advisory group members to complete the survey forms, asking for preferences for the manner of ways to communicate with them (e-mail, fax, telephone, and mail). Another means to communicate will involve the Quality Utilization and Advisory Group website. The process used by this advisory group will parallel the activities for the Health Care Authority’s Data Advisory Group, since each has a similar size, contains membership of public/private/consumers, and has had work groups to accomplish the work of the group. Each of the Data Advisory Committee’s four work groups: Access/Privacy; Components of an Integrated Health Information System; Standards, and Public/Private Partnerships, has developed recommendations.

Mr. Morris also indicated travel expenses associated with the Quality Utilization Advisory Group may be reimbursed by the HCA.

Presentation by Dr. Mary Emmett

Dr. Mary Emmett, Director of the CAMCARE Institute Center for Health Services and Outcomes Research, discussed "Quality Measurement: Where Have We Been and Where We Are Going". Dr. Emmett’s presentation provided information to develop a context for discussing the topic of quality by providing an overview of those developments that have and are influencing the approach, method and tools for measurement of the past and future issues of quality of care. (The discussion handout is attached.)

Presentation by Dr. George Pickett

Dr. George Pickett, Medical Director of the West Virginia Medical Institute (WVMI), provided information on the WVMI’s quality activities at the national and state level. The WVMI was created in 1973 as an external peer review organization. It was first named the Professional Standards Review Organization, and reviewed the experiences of physicians and hospitals. This process involved looking for outlyers outside of the normal, bell-shaped curve.

By 1983 this external review and analysis shifted to the concept of quality improvement. While the process still involved identifying and addressing outlyers, it focused on the systems approach by using data and information to analyze and examine hospitalization and professional practices. The process involved using an epidemiological, population-based approach to look for variations and determine possible reasons for their happening. In the context of a systems review, problems are believed to be the result of issues within the system, not the individual professional or hospital. The systemic review has concern for the misappropriation of resources, as well as profiling patterns of care and looking for variations in what is happening and looking for clues as to why this might be happening.

Quality improvement includes a six-step process: topic identification, study group, design, data collection, analysis and feedback. Dr. Pickett indicated that it is very important to have data integrity. He stated that sophisticated analytical tools may be used to develop patterns or to find aberrant patterns and could be a fault of an internal program. Sometimes it takes a third party intervention to determine "Are you doing as well as you want to do?" It becomes a system issue, not individual performance issues. Professionals want to get better and they want information on how to build systems.

Overview of Inventory

Cathy Chadwell, Co-Chair of the Quality Utilization and Assurance Advisory Committee, discussed the quality assurance inventory. She reported that committee members were asked to complete an inventory of their organization’s quality activities. The objective was to increase the awareness of current WV and US quality/utilization activities. Of the 40 QUAG members who received the survey, 26 responded, with 2 determined not to be applicable, and 12 did not respond. The results were distributed at the meeting. No analysis has been attempted at this time since it is considered a work-in-progress document.

Brainstorming and Sharing Information

Advisory Group members were asked to review the inventory and to determine if other resources could be identified to also include in the inventory. Group discussions identified several groups, including those that collect proprietary information that may not be available for public use. Included in the discussions were JCAHO, NCQA, HEDIS, and payor data sets, University of Maryland Quality Indicator, OASIS-home care, external quality review, employer data, (GE, Steel, Coal accounts). Other resources were identified and includes, epidemiological, health ethics, analytical resources, college of pharmacy (disease management), consumer representatives (are topic specific) NIOSH, physician, community medicine, academic resources, medical society (by specialty) HCFA-OSCAR, CDC, URAC, Picker Patient Satisfaction Surveys, WV Quality Council, American Association of Health Plans, and the Kellogg Foundation Community Voices Project.

Meeting Critique

A critique of the meeting indicated (1) many quality resources are available; (2) these resources could take much time to process; and (3) advisory groups’ activities should follow the mission and goals of the group.

Comments from the group discussions included concerns about short time frames, frustration experienced when information is requested by major funding sources (Medicare/Medicaid), the relationship between this advisory group and the quality issue in the State Health Plan, the availability of the Picker Institute to profile hospital data, the planned roles for the advisory group members, and the difficulties experienced in other states regarding quality activities. A comment was made that this could be viewed as an opportunity to accomplish what other states have not been able to do, because of the size of the state.

To accomplish the goals for the advisory group, three subgroups will be established. Each subgroup will develop recommendations for an approach to developing a plan for reviewing the necessity of admissions, length of stay and quality of care. Advisory Group members were asked to complete a questionnaire to rank in order their preferences for participating on the subgroups. Each subcommittee will have an organizational meeting by May 25, 1999.

Committee members found the meeting to be helpful, provided great speakers, was well organized, provided an opportunity to see and meet others. Other members expressed concern for the timetable and ambitions, the need for clearer guidelines, the perceived lack of understanding of the legislative intent creating the group, the hope that the group will not experience a blue ribbon syndrome and the need for process agreements for the group.

Follow up activities:

Notes from sub-teams will be distributed to other sub-teams.

HCA staff will contact members to let people know of the subgroup they will participate in and the meeting details.

Information will be posted on the website and by other means of communication.

Subcommittee meetings by May 25, 1999 (HCA staff and MB).

Closing Comments

Parker Haddix indicated that he was encouraged by the participation and understanding of quality issues of the advisory group members, affirmed that the mission of the Health Care Authority is to protect the people of West Virginia, indicated the West Virginia legislature will be apprised of the findings and activities of the advisory group, and requested members to provide information of interest to the group. Mr. Haddix stated that there will be no attempt to obtain proprietary information. He asked for the members to not be discouraged by some of the information discussed that identified some barriers and obstacles, but instead to focus on what can be accomplished by a group of committed members to move forward to protect the people of the State of West Virginia.

Meeting adjourned at 2:50 p.m.

Meeting handouts:

Membership List

Quality Assurance Inventory

Communication Preferences Survey

Dr. Emmett’s discussion outline

Other Sources of Quality Programs and Information

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NCQP
URAL
JCAHO
Corporate Medical Director
WV Quality Assurance Professionals
National Consumer Groups
Kellogg Grant Community Voices
American Society of Consultant Pharmacists
Veterans Hospitals
Hospital
WV Health Right
Personal Care Homes (AL)
Nursing Homes
National Hospice Organization
ADA
AARP
Families USA
Mental Health National Association
Senator Rockefeller Office Search
Maryland Quality Indicator Project
Support Groups (Cancer society, MS Society, Diabetes Association)
American Association Health Plans
State/County Health Department
Healthy People 2000/2010 - WV
Educators - Nursing Schools
Durable Medical Equipment Companies
Pharmaceutical Companies
Home Health
Weight Watchers
Physical Therapy
Dental
Chiropractor
Infection Control
Environmental Health
Air Pollution Control Commission
Architects/Engineers
Bureau of Vital Statistics


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JCAHO
NCQA
Payor Data ($PMPM, Diag/DRG)
HEDIS
Aspect of care/Disease Management
UM - data log, days/1000 admits/1000
Oasis/HH
External Quality Review (WVMI/DELMARVA)
Employer Data


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Epidemiologist
Council of Churchs
Senators/Delegates
Economists
BMS - Health Prom/Dis.Prev.
Department of Statistics
College of Pharmacy - National Parc. Council
Ethical - Dr. Glover
Consumer Rep - topic specific


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Marshall - AQIP - Diabetes studies
NIOSH - Occupational Safety/Health
WVU Department Community Medicine
QA Staff - Hospitals
Phy. Representatives - College of Phy. (National QA Activities)


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NCQA - HEDIS
URAQ
Oscar HCFA
Maryland Quality Indicator Project
CDC
Picker Patient Satisfaction
WV Quality Council
American Health Council
JCAHO
AAHP
Network - National Q! for renal