Frequently Asked Questions

About the Community Health Checkup

Q: What is the Community Health Checkup?
Q: Which health organizations and physician practices are participating in the Community Health Checkup?
Q: Why aren’t all Greater Cleveland’s health systems and doctors’ groups participating?
Q: What clinical factors does the Community Health Checkup measure?
Q: Which patients are included, and how are the measures obtained?
Q: Isn’t the quality of health care already first-rate in Northeast Ohio? What problem is Better Health Greater Cleveland trying to address?
Q: How is this report different from health care rankings?
Q: Is patient privacy protected?
Q: Which practices are best and which are worst?
Q: Why aren’t results shown for individual physicians?
Q: How was the Community Health Checkup developed?
Q: What does the Community Health Checkup show us?
Q: How will a performance report improve quality?
Q: How should I use these reports?
Q: What about hospital information?
Q: What will future Checkups look like?
Q: Are there prohibitions on how health plans, purchasers and health systems may use the Community Health Checkup?
Q: Is Northeast Ohio the only community creating a performance report like this?
Q: What is Better Health Greater Cleveland?
Q: How can I get involved with Better Health Greater Cleveland?

Q. What is the Community Checkup report?
A: The Community Checkup reports performance of Greater Cleveland partner primary care practices on nationally endorsed and locally vetted standards of care for certain chronic conditions. 

The Community Health Checkup measures certain aspects of care provided by doctors’ offices and community health centers that are Better Health Greater Cleveland partners. The Checkup is updated and will expand over time to encourage and support continued improvement.

Q: Which health organizations and physician practices are participating in the Community Checkup?
A: The report shows results for primary care physician practices and health clinics whose organizations are Better Health Greater Cleveland partners and are able to provide data. We anticipate that additional primary care practices will participate in future reports.

We applaud participating practices and clinics for voluntarily sharing their quality scores with the community and leading the region to improve the care and health of Northeast Ohioans. Visit our About Us page to learn more about our participating practices and health organizations.

Q: Why aren’t all Greater Cleveland’s health systems and doctors’ groups participating?
A: Better Health Greater Cleveland is a young organization that began in February 2007, and it will expand both its activities and its partners. We welcome additional partners, but participation is voluntary. Partners that share their data typically have been using electronic medical records or patient registries to measure and improve their care. Many practices in the region do not have these capabilities.  When all practices in the region participate, we will have a more comprehensive understanding of our region’s care and outcomes.

Q: What clinical standards does the Community Checkup measure?
A: Visit the Our Measures page to see details on the standards for Diabetes, Heart Failure and HIgh Blood Pressure.

Q: Isn’t the quality of health care already first-rate in Northeast Ohio? What problem is Better Health Greater Cleveland trying to address?
A: Greater Cleveland is fortunate to have some of the finest doctors and hospitals in the nation. But we all can do better. Wide variations in care and outcomes are well documented in regions throughout the United States, and Greater Cleveland is no exception. Some of this variation may be due to understandable differences in what patients want, or which tests or treatments are available. However, when good evidence from research indicates that certain tests or treatments are more likely to result in better health or reduce complications, we should encourage adoption of these “best practices.” Measuring and reporting our care and outcomes is one step in this direction, motivating our practices and our patients to do better.

In addition to motivating ourselves to do better by measuring and reporting our quality scores, Better Health Greater Cleveland has developed region-wide programs to help practices improve their systems of care, as well as other initiatives designed to improve patients’ involvement in their own care. Nurses and doctors from our clinical practices participate in a Quality Improvement Learning Collaborative to learn and share best practices for solving common problems.

Third is the issue of reducing the staggering costs of care for patients and local businesses. Since 75% of all health care costs in the United States are associated with care for common chronic conditions, better quality of care can also dramatically reduce the costs of health care – now estimated at over $3 trillion annually.

Finally, we seek to shed light on disparities in care, by insurance as well as by race, income and educational attainment. Our reports will highlight these differences in our region, hoping to inform local and national discussion and policy making.

Q: How are these reports different from health care rankings?
A: The Community Checkup offers the first reports in Greater Cleveland on care and outcomes in doctors’ offices and clinics – where most people get most of their care. Because it uses information that comes directly from a patient’s medical record rather than insurance companies’ claims, the Checkup reports care on all eligible patients, whether they have no insurance, commercial insurance through their job, Medicaid or Medicare. Using medical records also allows Checkup to report how patients do on medical tests, in addition to whether a test was done.

Q: Is patient privacy protected?
A: Yes. No personal information that could identify patients or individual physicians is shared outside the doctors’ office that keeps the information.

Q: Which practices are best and which are worst?
A: Our reports show that everyone can improve. We know that our physicians and practices can improve their processes of care; we know that our region’s employers and health plans can do better to promote healthy behavior among their employees and enrollees; and we believe that our patients can have better health outcomes and be more effective partners with physicians in their care.

We highlight “top” practices and hope they will continue to improve since no practice achieves at the 100% level. We also celebrate change in practices' results on our diabetes standards. This permits us to identify health systems, physician practices and physicians who demonstrate exceptional improvement, so that our collaborative can learn and share successful strategies.
 
We avoid the temptation to identify “worst” practices and discourage others from doing so. We believe it serves little purpose, because these reporting practices may be better than many others that are not currently participating (who knows?), and because, again, all practices can do better.

Q: Why aren’t results shown for individual physicians?
A: The report shows practice-level results and not results for individual physicians. There are statistical reasons for choosing this approach, since we are more confident in performance reporting when there are more patient results to measure, and many physicians simply have too few patients with a reported condition to confidently assess their performance. There also are philosophical reasons for reporting at the practice level, since, in many respects, high quality care and outcomes for chronic conditions requires a team approach, coordinated systems of care, and engaged patients. To attribute high quality outcomes to physicians alone, or to assign blame for outcomes to physicians alone, would miss this important point.

Q: How was the Community Checkup developed?
A: Many doctors and other medical, data and community experts worked to create the report through a collaborative and open process. Physicians, experts in public health and consumer health advocates participated in developing and reporting the standards. 

Q: What does the Community Checkup show us?
A: Doctors and others agree that some basic types of care and national standards of good control of chronic disease should be provided for many patients, such as checking cholesterol and providing treatment so that cholesterol levels are appropriately managed to reduce risk for complications. The Community Checkup shows that even in these areas, variation persists across the region from what we know good care should be. This is a challenge for all of us—doctors, patients, insurers and employers that buy health benefits—and we all share a responsibility to be part of the solution.

Q: How will a performance report improve quality?
A: Research shows that when reports on health care performance are made public, more improvement occurs than if reports are kept private. Public reports are shown to motivate doctors and other health professionals to make changes for improvement, and they help patients better understand what they need to do to improve care. With one regional report that everyone uses to improve care, all players can do their part to align decisions around effective care as defined in national evidence-based guidelines. The reports also identify opportunities for improvement that health plans, employers and policymakers can address.

Better Health Greater Cleveland is working on related health improvement strategies that include physician training in quality improvement methods and development of tools, strategies and community partnerships to help patients and physicians work together to improve outcomes.

Q: How should I use these reports?
A: . Everyone has a part to play:

• Doctors and other health care professionals can learn from each other, look for new approaches to improve the quality of care they provide to their patients and find ways to encourage and partner with their patients for success.
• Health plans should share ideas on how to make and support improvement. Possibilities include: 1) coordinating disease management resources with physicians to optimize the benefit to patients and facilitate doctor-patient partnerships; and 2) ensuring accessibility and affordability of medication, blood glucose test strips, scales and related supplies that patients need to manage their chronic conditions.
• Employers and other purchasers can share the reports with employees and enrollees and ensure that the benefits they purchase cover the basics of effective health care and encourage healthy behavior.
• Patients should talk with their doctors about what they can do for themselves to be healthy — then gather their health care team to help them do it!

Q: What about hospital information?
A: The Checkup will expand in future months to address certain elements in hospital care, particularly hospitalizations that involve patients with chronic conditions. We will focus on on improving patients’ transitions from the hospital to home or another health care setting. That transition is often problematic and leads to anxiety for patients and families as well as re-admissions that could have been avoided.

Q: What will future Checkups look like?
A: The next Checkup report will be available in Winter 2011. We continue to identify trends in care, insurance coverage and gaps in care, so that our community can devise strategies to improve.health in the region on a range of chronic conditions that typically are managed in medical offices and on in-hospital care related to many of the same conditions.

Q: Are there prohibitions on how health plans, purchasers and health systems may use the Community Health Checkup?
A: Yes. Health plans, employers and all others may not use the reports for marketing or business purposes, including establishing networks, designing employee benefit packages or negotiating contracts. These initial Checkup reports are intended to support quality improvement efforts across the community.

Q: Is Northeast Ohio the only community creating a performance report like this?
A: No. Several communities around the country publish reports regarding local health care. Better Health Greater Cleveland is unique in that many stakeholders (physicians, hospitals, employers, consumers, public health officials and health plans) committed from the start to publicly report performance.

Better Health Greater Cleveland is one of 17 communities selected to participate in the Robert Wood Johnson Foundation’s Aligning Forces for Quality program. The Better Health Greater Cleveland alliance works with other coalitions, with help from the Robert Wood Johnson Foundation. By learning from others' experiences, we can adopt proven programs to get results for our region as quickly as possible.

Q: What is Better Health Greater Cleveland?
A: The Alliance is an organization composed of those who provide, pay for and use health care services. Representatives from public health agencies, community organizations, physician practices, employers and health plans comprise a Leadership Team and several working committees.

The Alliance began in February 2007 with support from the Robert Wood Johnson Foundation, the nation’s largest health philanthropy, and continues to grow and expand its activities with continuing support from the Robert Wood Johnson Foundation, the Mt. Sinai Health Care Foundation, The MetroHealth System, Medical Mutual of Ohio, Wellpoint Foundation and other supporters and volunteers from all sectors of health care who contribute their time, expertise and resources. Visit our About Us page to learn more about our alliance and partners.

Q: How can I get involved in Better Health Greater Cleveland?
A: We welcome physician practices, health plans, employers, hospitals, government agencies, nurses and other stakeholders that want to be a part of better health care in our region. Contact us at info@betterhealthcleveland.org.