HBI leads the industry in the development and implementation of health care performance assessments as well as providing real-world analyses of cost-effectiveness and overall health outcomes.

In addition to our analytical tools and products, HBI has a team of skilled clinicians, biostatisticians, consultants, and health services researchers who work closely with clients to customize solutions to meet their particular goals and objectives. HBI strives to support its clients by facilitating a transfer of knowledge so that clients and practitioners fully understand the methodologies and processes undertaken in the clinical quality assessment programs. Ensuring the highest level of customer satisfaction is a priority for HBI, demonstrated by our commitment to work with each client step-by-step to ensure a successful execution of any measurement program or research question.

HBI offers a wide variety of products and consulting services aimed at improving overall health care quality, including:

• Physician Clinical Quality Indicators
• Physician Cost of Care Measures
• HBIOnline™ Provider Performance Online Reporting Web Tool

• P4P Program Development and Implementation
• Performance Scoring Methodologies
• High Performance Networks/Provider Tiering Methodologies
• Performance Benchmarking
• Survey Development, Implementation, and Analysis
• ROI Analysis
• Health Services Research & Analysis

HBI Physician Clinical Quality Indicators

Utilizing a set of proven, evidenced-based clinical metrics designed to run cost-effectively on administrative claims data, HBI is able to measures the quality of care delivered by both generalists and specialists. Each indicator is updated annually to assure adherence with the most current clinical guidelines and is rigorously tested in real-world environments to ensure the highest validity and accuracy.

HBI's current inventory of nearly 90 clinical quality indicators covers more than 30 physician specialty areas, and focus on core areas including prevention, early detection, chronic care management, clinical evaluation, ambulatory care follow-up, medication management, and over-utilization.

The Acceptance of HBI's Physician Clinical Quality Indicators in the Real World

HBI's Physician Clinical Quality Indicators have been successfully implemented by a number of managed care organizations and physicians groups. In addition, HBI has worked with several leading managed care clients to develop full scale pay-for-performance programs using physician assessment methodology as the cornerstone. Physicians receive annual awards for demonstrating high-quality care based on clinical indicators, patient surveys, and business operations. These clients have found improvement in many clinical indicator areas since program implementation.

In order to balance the need for cost savings with the goal of improving physician quality, HBI has developed Cost of Care Measures which, when united with our Clinical Quality Indicators, create a more complete measure of overall provider performance.
Drawing upon our in-house expertise and state-of-the-art, evidence-based measurement methodologies, HBI utilizes an episode-based foundation and a robust analytic framework to create the most meaningful measures of true physician cost available using administrative claims data.

HBI's Cost of Care Measurement Approach is Different

• We adjust for identifiable patient risk factors and physician case-mix in a clear, accurate, and data-driven fashion that maximizes the total costs measured
• Using a service-bureau approach, we work with our clients so that measures are transparent, tailored, and supportive to more-effectively drive overall cost-savings within a specific region.
• We evaluate all episodes of care to ensure that factors that may bias final cost profiles are accounted for and minimized.

HBI's Performance Reporting Website is an actionable and cost-effective tool for providers to view their HBI Clinical Quality and Cost measurement data at any time, day or night, via the World Wide Web. In addition to reducing client resource and material costs by potentially eliminating traditional paper-based reports, this portal provides one reliable location for physicians to access their performance reports in a customizable, meaningful environment.

Base Features

By logging on to this secure site, physicians are not only able to view their summary performance results, but are also able to drill down to the details of their scores, including features such as:

• Member level information for all HBI Clinical Quality Indicators for which they scored.
• Episode-specific utilization patterns compared to plan and same-specialty averages.
• Summarized patient demographic information.
• Specific program details such as definitions, client-specific administrative information, and upcoming news.
• Benchmarks for all quality indicators at not only a plan level, but also derived from HBI’s national, longitudinal data warehouse.
• When available, trend data over time, so that providers can track their performance from measurement period to measurement period.

In response to calls for healthcare quality improvement, many health plans have implemented pay-for-performance models that provide incentives to physicians based on the quality of care that is delivered. In these programs, individual physicians as well as physician groups are often ranked and rewarded for the delivery of high quality health services to members. Physicians are compared using evidence-based metrics, like those developed by HBI, to assess their level of quality and efficiency using administrative claims data.

Health plans must also consider many other facets of any performance profiling initiative, in addition to the quality metrics. Because we bring almost 15 years of experience and expertise in this arena, HBI can support clients in a variety of other strategic and operational elements of a program including the following:

• Strategic planning and implementation
• Marketing and communication
• Provider enrollment strategies
• Program metrics that go beyond clinical quality and efficiency to include member satisfaction, business operations, etc.
• Compensation model development
• Scorecard development and reporting
• High performance networks development
• Performance benchmarking
• Survey Development, implementation, and analysis
• ROI analysis

With years of experience with, and as, medical providers, HBI understands the importance of provider scorecard design as crucial step in a successful measurement program. To ensure that our clients provide the most useful information in a succinct, meaningful manner, HBI will assist our clients by either developing and mass-producing provider scorecards, or guiding the proper development of scorecards within our clients'own corporation.

Of course, due to the intensive nature of generating and distributing paper based scorecards, HBI recommends that clients consider utilizing the Provider Performance Reporting Web-Tool as a means of disseminating physician performance results.

Increasingly, health plans and employer coalitions are developing tiered provider networks in an attempt to rein in the rising costs of health care. High-value providers are recognized and assigned to different tiers based on whether or not they meet certain standards of utilization and quality, and patients are offered price differentials such as different co-payments and benefit/premium differentials for visiting doctors in these high-performing tiers.

The emerging tiered-networks model extends to the provider network some of the principles developed years ago for pharmacy benefit coverage, where the member’s share of the costs is linked to the pharmacy tier chosen. However, while it is relatively simple to identify cost-effective alternative prescription drugs, it is much more difficult to sort physicians based on similar characteristics.

In combination, HBI's cost of care measures and clinical quality indicators form the necessary foundation for identifying cost-effective providers or medical care to support plan’s in developing their performance tiers.

Given the constant evolution of US healthcare, absolute performance is often meaningless without a comparative benchmark. Recognizing this, HBI leverages its data warehouse of more than 20 million unique members to generate national benchmarks of clinical quality, cost, and other performance marks. By bringing the same expertise to bear in the development of benchmarks as we do in developing our clinical quality and cost measurement methods, HBI strives to ensure that these data are not only useful for the physician measured, but are also valuable in client research and decision-making.

The data repository integrates data from numerous sources including:

• Inpatient claims
• Outpatient claims
• Employer data
• Pharmacy claims
• Membership and demographic data
• Carve-out vendor data (e.g. mental health)
• Financial data
• Laboratory values
• Survey data

HBI has extensive experience in developing both consumer and physician based surveys for managed care and life sciences companies. HBI's well trained team of consultants and health services researchers can devise surveys to reach almost any target audience and gather information on a wide variety of topics. Each survey is developed with the client¡¯s need in mind and can be custom tailored to meet specific goals and objectives.

HBI has the capability to implement client surveys using traditional paper-based methodologies, interactive voice response systems, and/or secured web-enabled applications. HBI can assist clients in devising a cost-effective survey distribution strategy that facilitates data collection and maximizes survey response rates different. If required, HBI can also arrange to have surveys translated into languages to increase survey accessibility. HBI's team of Ph.D.-level biostatisticians and health services researchers can also transform raw survey data into meaningful and actionable recommendations to bring about positive change in our client organizations.

Physician assessment and pay-for-performance programs offer several opportunities to demonstrate ROI:
Direct:

• Direct savings related to specific indicators (e.g. antibiotics)
• Support for High Performance Network selections

• Long term benefits from improved quality of care
• Support measurement requirements (NCQA, HEDIS, state department of health)
• Meet employer-based guarantees
• Improve overall claims quality
• Provide unique competitive advantage
• Improve physician satisfaction and retention

With a strong, reputable track record, HBI’s health services researchers are skilled at applying scientific rigor to address our clients’ research objectives. HBI experience in health services research has been validated by an extensive peer-reviewed publication record. HBI’s team of expert analysts has the training and industry experience to ask the right questions and answer them with valid, state-of-the-art techniques.

Please see a list of our products and services within health services research and analysis:

• Prospective Patient Registries: real-world studies for collecting prospective patient- and provider-reported data.
• Retrospective Database Studies: studies designed to assess unique differences in health outcomes or level of resource utilization between groups of interest.
• Dissemination strategy: targeted effort to highlight results to key audiences including presentations at leading academic conferences and publications in peer-reviewed literature.