Program Questions
Policy Issues
Please provide guidance on how to protect COAP information and how it can be shared appropriately.
Documents in two formats are available for your information and use in discussions of this important topic. Denise Dominik, RN, Douglas Stewart, MD, and Lois Catts, RN have developed a PowerPoint presentation; please credit the authors when you use this presentation. In addition, the information in the slides has been summarized as a Word doc and an Adobe PDF document. These documents, and the PowerPoint presentation, are available on the COAP web site.
How did COAP originate?
COAP officially began in 1993 when the Washington State Health Care Authority, in an effort to promote quality while reducing costs, released a Request for Information aimed at selective contracting for CABG services. Based on the uniformly negative response from the provider community, the HCA chose to pursue a more collaborative approach to working with the medical community with the goal of quality improvement. A pilot project was conducted in 1995 and 1996, which demonstrated that a collaborative relationship between the state and medical community was feasible and that important information could be gained through such an effort. Based on the success of this pilot program, COAP has been launched as a physician-led program, in partnership with other stakeholders, designed to promote data driven quality improvement activities across Washington.
What is the relationship between COAP and the State of Washington?
State agencies across the nation are increasingly requiring the collection of outcomes data, especially in cardiac care, and using the data to generate public report cards. Washington State has elected to pursue a different approach. The central premise of COAP is that quality of care can best be enhanced through collaborative, not punitive, mechanisms. Based on the well-organized leadership demonstrated by the cardiac physicians in this state, the Health Care Authority has delegated the responsibility of this quality improvement program to a physicianled management committee. Under the terms of COAP’s contract with the state, no state agency will be authorized to review patient-, physician- or hospital-identified data without appropriate consent from the respective party. Instead, the COAP Management Committee will share with the State blinded data reports demonstrating general trends in cardiac care, and will outline how it has responded to any concerns about quality of care. The HCA continues to provide strong support to COAP by requiring that health plans contract with hospitals that participate in COAP and by contributing to program planning and development in an advisory role.
Who is paying for this program?
Funding for this program is multifaceted. Support of the “start-up” phase was provided by several sources: the Health Care Authority (on behalf of its contracted health plans) contracted with COAP to organize and facilitate a secure and confidential statewide quality improvement program for cardiac revascularization services; the Foundation for Health Care Quality, under whose auspices COAP operates, has been generous in providing essential infrastructure and development costs. With the ending of the HCA’s direct financial support as of January 2001, ongoing funding is provided by annual user fees and per-case fees. Efforts to secure grants and contracts will continue.
What happens if an institution chooses not to participate?
Participation in COAP is a QI/QA requirement defined in the contracts between the Health Care Authority and the health plans. Should an institution choose not to participate, the initial response would be an effort by COAP to meet the needs of the institution through cooperative measures, and thereby facilitate participation. Beyond that, the consequences of non-participation would be based on contractual mechanisms between the Health Care Authority, the Health Plan(s), and the nonparticipating cardiac program(s)—possibly jeopardizing access to state-funded patients. An important goal of COAP is to avoid such coercive measures and create an atmosphere of collaboration and partnership in an effort to better serve patients in this state.
In its Quality Improvement Plan, the Management Committee provides additional definition of “participation” in COAP; please see the Plan for further detail. A list of hospitals that are “full participants” in COAP is posted on this web site and will be updated to reflect any future changes in status. The Management Committee makes any changes in participation status.
