Beyond the Numbers

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Making progress on a key health measure for Care Compass Network, Executive Director Mark Ropiecki reports there was a 22% reduction in potentially preventable hospitalizations among adults (PQI #90) from 2015 to 2018, and a 49% reduction among pediatrics (PDI #90) over the same period. Ropiecki shared these figures and more during the annual Care Compass Network Stakeholders meeting in December 2018 as he spoke about the progress that the network – including our 150 partners – is seeing in health outcomes in our region.

What is a health measure?

Performance, or health, measures are maintained by the National Committee for Quality Assurance (NCQA) and are used to track patient health outcomes. The NCQA maintains quality standards for health care, including health care institutions, health plans, clinicians, and other health care organizations. Tracking health measures helps entities highlight potential areas for improvement, track changes/ trends over time, and also helps identify key areas in need of further research.

How are they measured?

Metrics are developed using medical claims data, and are measured as either a percentage or a rate. Metrics that are measured as a percentage, capture the percent of people who meet certain criteria (eligibility) or the percent of encounters.

Metrics that are measured as a rate capture the frequency of certain types of encounters per 100 individuals or per 100,000 individuals.

Impacting the Metrics

Since the inception of the Delivery System Reform Incentive Payment (DSIRP) program, Care Compass Network and partner organizations throughout the Southern Tier have been implementing new programs that are resulting in improved health outcomes in our communities. Two of note, are the potentially preventable hospitalizations in adults and pediatrics.

However, there is more to the reduced rate in potentially preventable hospitalizations than the numbers themselves. The rate is a compiled score made up of a subset of information that is examined collectively to arrive at the percentage for both adults and pediatrics. “It is not 22% fewer people, it’s a rate that’s calculated by taking into consideration particular events, diagnoses, and specific conditions,” says Rachel Francis, Population Health Analyst for Care Compass Network.

It is important to understand that the compiled score is based on potentially preventable hospitalizations for particular diagnoses that have been identified as Prevention Quality Indicators (PQI) or Pediatric Quality Indicators (PDI). The list is comprise of several different conditions that, if treated early and appropriately with outpatient care or medication adherence, could be controlled.

“These are things that, if a patient is not following their prescribed method of treatment, they are more likely to re-present later,” Francis says.

The rate of reduction also takes into account other metrics such a patients that are readmitted for a condition for which they were previously hospitalized.

The numerator, or number that the data is being compared against, is the total number of admissions during the reporting period with a primary diagnosis code falling in the PQI measures for Medicaid members ages 18 or older at the time of admission for adults, and the PDI measures for ages 3 months to 17 years old for children.

The reduced rate of potentially preventable hospitalizations is higher for pediatrics due to a few factors: Children are hospitalized less often so there are not as many children to account for; and also, there are only four indicators for pediatrics compared to 11 for adults. In addition, there are different age considerations for pediatric patients and their diagnoses. For example, asthma includes patients aged 2-17 years whereas diabetes measures ages 6 through 17 years.

Moving Forward
A continual focus on the health outcomes for the Southern Tier is a top priority for Care Compass Network and its partner organizations. The development of new programs–made possible through the Innovation Fund program and the implementation of new and enhanced Electronic Medical Records and/or Electronic Health Records, along with the adoption of Care Management and Population Health platforms–will further support the regions efforts to improve the health of those in need across our nine-county region.