Health Coalition Uses Data to Create High-Performance Provider Network

Despite the considerable challenges that must be addressed in order to define and deliver value-based health care, some organizations are paving the way. The Delaware Valley Health Care Coalition (DVHCC)—a voluntary association of union health-and-welfare and pension funds representing occupations ranging from plumbers and pipefitters to teachers and municipal workers—is doing just that.

The Coalition was founded primarily to maximize the purchasing power of its member funds, many of whom are smaller groups who might otherwise have to commit significant resources to educate themselves about health care options and then negotiate by themselves to meet their members’ insurance coverage needs. Two million members and their families are represented by the Coalition, most of whom live and work in Philadelphia or its surrounding counties.

The DVHCC provides its member fund-plans with more than just enhanced group bargaining leverage. It is currently developing a “High-Performance, Best Practices Program,” designed to improve the quality of health care services delivered to its members. Under the program, each DVHCC member fund can structure a benefit plan to meet its particular members’ needs.

To develop the High-Performance, Best Practices Program, the DVHCC first convened a “Quality Advisory Committee” comprising experts from a variety of fields and organizations. The Committee determined the appropriate metrics, data sources and methodological approaches for identifying health care providers that have consistently delivered high-quality services to patients.

The Committee identified quality criteria encompassing structure, process and outcomes utilizing 32 global quality measures along with 200 separate criteria to evaluate 17 clinical domains, ranging from obstetrics to oncology, and more than 40 procedure and treatment groups that included stroke, heart attack, pneumonia, chronic obstructive pulmonary disease, and cardiac surgery.

As part of their quality assessment, the DVHCC utilized two years of patient-level inpatient discharge data representing 1.3 million records, as well as outcome measures such as mortality, readmission for complication or infection, and length of stay from the Pennsylvania Health Care Cost Containment Council (PHC4).

The DVHCC has taken what it learned from the process and has begun establishing a High-Performance, Best Practices Program consisting of providers and services for a variety of specialties and disease categories. It is launching the pilot program in the Philadelphia metropolitan area, with additional programs to be developed throughout Pennsylvania.

“We not only do the homework for our members,” said Matt Kearney, president of the Coalition, “but we help them understand how the results could help shape each fund’s benefit design.”

In addition to doing the substantive research, the DVHCC program will also be communicating the results to its member funds and providing specific training on how they can “custom fit” this information to their particular members’ medical needs. Given the diversity of occupations and groups represented in the Coalition, funds can ensure that they have the highest quality providers in their plan design for the disease categories their members find most relevant. As part of its program, the DVHCC will regularly receive updated data from PHC4 in order to keep the information current for its members.

“PHC4’s data and expertise has been indispensable to helping us develop a high-performance network of providers. We will continue to rely on it to ensure that our members get the highest-quality health care available,” said Kearney.

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Read about how other clients use PHC4 data.