Purchaser Business Group on Health to Sunset Patient Assessment Survey Program
July 23rd, 2024
PBGH will sunset the Patient Assessment Survey (PAS) program, effective July 31, 2024. For more than two decades, the PAS program has been pivotal to advancing high-quality, equitable health care in California. PAS was the statewide source of patient experience data for quality improvement and value-based care.
The Integrated Healthcare Association (IHA) removed patient experience measures based on PAS data from its AMP incentive payment program, beginning in 2025. Without incentives to participate, the business case for providers to report the data is diminished and the PAS program will no longer be sustainable.
PAS was an important source of information on quality and generated the largest patient experience data set in the country. PAS was the only patient experience data set large enough to stratify by race and ethnicity to understand disparities in patient experience. It has provided crucial data for accountability and facilitated public transparency and health equity through its detailed insights into patient experience.
This is a loss for California. Without the PAS program, California stakeholders will lose access to:
- Statewide patient experience results and benchmarks
- Public transparency of patient experience results via OPA Report Cards
- Granularity of performance of provider organizations used by health plans to understand the underlying performance of their contracted medical groups and target improvement for NCQA, Medicare Advantage Stars, DMHC requirements, etc.
- Stratification of patient experience measures for health equity insights
Following completion of the current cycle, PBGH will develop and disseminate a final impact report detailing the program’s history, impact on the industry and innovative patient experience research on disparities, telehealth and behavioral health screening and access.
Former PBGH CEO David Lansky, Ph.D., called for an overhaul of our entire measurement and reporting system in the U.S. to one of patient priorities in a 2022 Health Affairs commentary. He articulated the critical role of data that elevates the patient voice to achieve patient-centered care. Barriers to widespread use of patient experience measurement include outdated and burdensome measurement tools and data collection systems, costs to administer, and lack of incentives to collect and use the results. As noted in our recent request for information response to U.S. Sens. Whitehouse and Cassidy about primary care, “A new, innovative and simplified approach to collect and use patient experience data should be a national priority.”
Despite this setback, PBGH remains dedicated to enhancing health care quality and patient outcomes — including patient experience of care. PBGH will focus on the next generation of patient experience measurement and continue our emphasis on developing long overdue, ground-breaking systems that enable real-time care delivery improvements, benchmarking, transparency and payment incentives through outcomes-oriented data. PBGH and its members will continue its commitment to transforming U.S. health care and redesigning how quality is measured and reported to ensure that patient centered measurement is the basis of a transformed, patient-centered health care system.
Purchaser Business Group on Health Receives Funding to Launch CAA Data Demonstration Project
June 18th, 2024
With newly secured funding, PBGH is now able to launch its Consolidated Appropriations Act (CAA) Data Demonstration Project.
This is a first initiative of its kind, combining CAA hospital and payer datasets with provider quality metrics with specific employer demographic and claims data from five employers in 10 geographic markets.
Key reasons why employers are embarking on this initiative include: 1) informing upcoming carrier and network strategy and selection, 2) carrier performance effectiveness and accountability, 3) incorporating quality measurement into accountability, and 4) fiduciary due diligence.
With this project, PBGH will:
- Create fair-cost commercial benchmarks to help you assess whether what you are paying is fair and appropriate.
- Analyze cost variations so you can you can compare – for the first time – whether it’s the best “deal” by hospital, by network, and by carrier from “actual” price at the service code level (versus self-report aggregated carrier data).
- Correlate price variation data with provider quality data to understand value.
Participating employers will receive the analytics report with findings and recommendations, cost/price benchmarks and recommended application strategies.
The expected timeline for final deliverables is 9-12 months, with potential preliminary insights in six months.
Geographic markets include: Puget Sound, Washington; Oregon; Northern and Southern California; Phoenix, Arizona; Dallas, Texas; Denver, Colorado; Atlanta, Georgia; St. Louis, Missouri; and Northern New Jersey and New York.
All interested PBGH members can participate by contacting Won Andersen.
Supporting Non-Hospital Birthing Options: Employer Strategies to Improve Quality
May 23rd, 2022
Maternal infant health outcomes in the U.S. remain the worst among high-income countries, and Black women in the U.S. are nearly three times more likely to die from pregnancy-related complications than white women are. Additionally, U.S. women of reproductive age are significantly more likely to have problems paying their medical bills or to skip or delay needed care because of costs.
To underscore the high costs disproportionate to the poor maternal health outcomes, the cost of maternity care represents American employers’ second-highest annual health care expenditure – $1 in every $5. Faced with unacceptable results, employers are looking for pathways to improve maternal health care quality, affordability and the overall patient experience.
Improving Quality and Lowering Costs
Consumer surveys have shown that more patients are seeking non-hospital, community-based childbirth options, such as midwives, doulas and birth centers. This is particularly true for birth participants of color who are looking for alternatives to the hospital-physician childbirth experience.
Recent CDC 2020 vital statistics data mirror what we have seen from consumer surveys. Although overall births declined, in 2020 the number of births in birth centers nearly doubled. This is a significant indication that more women want choice in their maternity care team and care location and that more families, when given a choice, are seeking a non-hospital childbirth option.
Non-hospital maternity care options can help to address the problem of high-cost, low-quality care. Evidence shows the use of midwives improves overall maternal and infant health and decreases the cost of maternity care. In fact, research shows that collaborative care led by certified nurse midwives can result in 22% fewer primary C-sections. It also helps address a growing shortage of perinatal health providers. Despite these benefits, however, certified nurse-midwives are vastly underutilized, delivering only 9% of babies nationally.
A birth center is a midwife-led childbirth facility that offers individuals and families a more natural, lower intervention and less medicalized childbirth experience. Birth centers are freestanding facilities and separate from acute obstetric or newborn care where care is provided in the midwifery and wellness model of care. Birth centers typically have relationships with other community health providers and arrangements with other facilities, such as hospitals, for transfers to other levels of care when needed.
The CMS Strong Start program demonstrated that women who received prenatal care in birth centers had better outcomes and lower costs. This included lower rates of:
- Preterm births
- Low birth weight
- C-sections
Additionally, costs were more than $2,000 lower per mother-infant pair during birth and the following year for women who received prenatal care in birth centers.
How Purchasers Can Support Non-Hospital Options
Employers know that improving maternal health outcomes in the U.S. and reducing disparities will require changes to the existing system of care to make it more patient centered. Here are three ways employers can influence the health system and health plan leaders’ perspectives to address the barriers preventing birth center expansion, collaboration between hospitals and birth centers and access to midwives:
- Benefit design: Benefits programs can be designed to expand access to midwives and birth centers. For example, eBay has started covering out-of-network midwives at in-network rates to improve access to community providers.
- Payment and contracting: By paying for care differently and moving towards value-based payment rather than fee-for-service models, employers can greatly improve access to high-value facilities such as birth centers. A simple birth center bundled payment model would allow all prenatal, labor and delivery and postpartum care provided by the birth center to be captured under one claim/invoice. A bundled payment project with Qualcomm produced valuable lessons learned that could benefit other employers pursuing a bundled payment option.
- Quality improvement: In the event of a transfer from a birth center to a hospital, the transfer process is smooth and respectful for the patient and their family. PBGH is leading a project in California to establish a model to inform procedures regarding transfers.
In response to the lack of comprehensive, coordinated care and the overmedicalization of childbirth PBGH has developed several strategies to help employers impact their maternity marketplace.