The Somerdale County Health Care Coalition, an employer coalition committed to value-based purchasing, has collected data on knee replacement surgery for six hospitals in the county, and found the following:

The Somerdale County Health Care Coalition, an employer coalition committed to value-based purchasing, has collected data on knee replacement surgery for six hospitals in the county, and found the following:

Hospital Risk-adjusted health outcomes Average cost per case
A Better than average $ 12,000
B Better than average $ 18,000
C Average $ 18,000
D Average $ 24,000
E Lower than average $ 8,000
F Lower than average $ 15,000

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Assuming the data are valid, what are some of the key strategies you would advise the Coalition to pursue?

2) Great Primary Care Docs of Greater Philadelphia is a large primary care practice site. As part of a quality measurement initiative, they decided to measure provider-specific rates of hypertension control, using measurement specifications adapted from HEDIS. Using the practice’s electronic medical record, they identified all patients with a diagnosis of hypertension. They then stratified the sample by primary care provider, and randomly selected 25 patients for each doctor, for medical record review. From this sample, they excluded anyone who did not have a visit in 2012, and then, for each remaining patient, they determined whether blood pressure was controlled (<140/90) as of the last visit of the year. The findings from a chart review were as follows:

# of charts % of patients
reviewed in control
Dr. Dewars 16 60%
Dr. Daniels 24 80%
Dr. Walker 25 40%

What are some explanations for these findings? What would you do next if you were theDirector of Quality for this practice?

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