A Metric Fatigue Story

November 4, 2015   |  Tags: Blog   |  Tags: Measurement , CCO Metric , Quality Data , Portland
Katie Dobler

As the Chief of Support Services at The Portland Clinic I interact with and see the fatigue caused by measurement every day. This fatigue is what drew the primary care physicians who are part of Portland Coordinated Care Association (PCCA), to focus on this issue. PCCA is similar to an Independant Physicians Association (IPA) and includes seven primary care medical groups in the Portland area, as well as independent specialty practices. PCCA has multiple committees focusing on a variety of topics, two of those committees focus on metrics: one on pediatric measures and one on adults. The goal of the committees is to determine a finite set of measures to focus on measuring and improving.

As a first step in this process, the groups compiled a list of over 150 metrics that are currently being reported to various entities.   After identifying the abundance of measures, the committees worked to identify and focus on a handful of measures that were reported to multiple entities.  All PCCA medical groups have agreed to share provider level data on the metrics being tracked, through a website only the member groups can access.  The provider level data is pulled from the entire clinic population and not focused on one insurance plan.  This data sharing allows for quarterly comparison with peers which has fostered some competition between the groups.

PCCA has found that while the sharing of data does create some competition, the sharing of best practices or new ideas has led to greater gains in improvement.  The medical groups who participate in PCCA vary in size from groups with one clinic site to groups with multiple clinic sites.  This gap in size has meant that some groups have more flexibility to implement new practices and make changes more rapidly than others.  However, this openness and sharing has put pressure on some of the slower moving clinics to improve as well.

One large gap identified by PCCA during this work has been data availability.  There is not a centralized system or warehouse of claims data that PCCA members can access.  This lack of data availability causes headaches in the clinics when payers are calling to find out why a patient has not received a service like a mammogram.  Many times it is determined that the patient changed insurance, so if she did have the services as documented in the chart, the insurance company does not have that information.  Someone has to be dedicated to working on sharing information between insurance companies to make everyone’s records whole.  And, at times, the provider doesn’t have the information but the burden is on them to find it and report it back to the insurance carrier.

PCCA has found that by working together and focusing on a subset of measures, it is possible to improve care, processes and reduce the measurement burden on clinic staff.  Clinics who were once competitors, now collaborate to meet the Triple Aim and it’s working.  There is still a long way to go in order to create alignment and agreement amongst the payers and after an invigorating metrics meeting you go back to work and realize there are still too many measures to track and report on.  You can’t focus on the amount of measures that are out there and the number of measures creates burnout and has created a culture where people can’t figure out what to focus on.  PCCA clinics will continue to work on improving care for those identified measures as well as advocating for a reduced measurement burden.

Katie Dobler has a background is in both retail management and Human Resources.  She started her HR career at Nordstrom and joined The Portland Clinic as HR Director in 2006.  In 2012, she was given the opportunity to work on a collaboration with Northwest Permanente (Kaiser).  This was the first collaboration Kaiser had done nationally.  At this time, she was also promoted to Chief of Support Services and took over Risk Management for the clinic.  In late 2012, the Portland Coordinated Care Association was formed.  She began to work on this exciting project very close to its inception and continues to work on both this and the Kaiser collaboration today.  Most recently, her role has evolved into managing external collaborative relationships, overseeing contracts and recognitions such as Medical Home.