Quality Improvement in Health Care Today

Presented by Jane Scott at Empower 2016 on May 4, 2016

With the move to a value-based system, quality is at the forefront of health care today. However, the quality landscape is constantly changing and provides challenges for health plans in measures for both quality improvement and health outcomes. Jane discusses quality imperatives and how health plans can improve processes with vulnerable populations including dual eligibles.

Transcript

1. Jane Scott Chief Compliance Officer, Health Integrated Hosted By
2. Quality Care and Our Health Care Future
3. Objectives • Review of CMS Quality Strategy & Initiatives • Relating these initiatives to your world • Take away - weaving CMS strategy into your own organizational strategy 3
4. Changes…Through MACRA • Out of the ACA, the Administration announced a clear timeline for targeting 30 percent of Medicare payments tied to quality or value through alternative payment models by the end of 2016 and 50 percent by the end of 2018. • Using measurable goals to move the Medicare and other programs toward paying providers based on quality, rather than quantity, of care. • The Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act of 2015 (MACRA) supports ongoing transformation of health care delivery by furthering the development of new Medicare payment and delivery models for physicians and other clinicians. • What's the MACRA Quality Payment Program? • The MACRA QPP = paying for value and better care • The Quality Payment Program has two paths: • Merit-Based Incentive Payment System (MIPS) • Alternative Payment Models (APMs) • MIPS and went into effect in 2015 and will go through 2021 and beyond 4
5. Merit-Based Incentive Payment System What’s the Merit-Based Incentive Payment System (MIPS)? The MIPS is a combination of the Physician Quality Reporting System (PQRS), the Value Modifier (VM) and the Medicare Electronic Health Record (EHR) incentive program blended into a single program in which eligible professionals will be measured on: • Quality • Resource use • Clinical practice improvement • Meaningful use of certified EHR technology 5
6. Alternative Payment Models What are Alternative Payment Models (APMs)? APMs are new ways to pay providers for the care given to Medicare beneficiaries. For example: Accountable Care Organizations (ACOs), Patient Centered Medical Homes, and bundled payment models are some examples of APMs. 6
7. The Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act of 2015 - MACRA • MACRA requires that the Secretary of HHS define and post “a draft plan for the development of quality measures” (done in January of 2016) which applies designated provisions related to the new Medicare Merit-based Incentive Payment System (MIPS) and to certain Medicare alternative payment models (APMs). • The “Quality Measurement Development Plan” (MDP) is designed to meet the statute’s intent and to support the MIPS and APMs. • The measures used in the quality category of the MIPs are focused on in the MDP. • The final MDP is to be posted on May 1st 2016. 7
8. What’s the CMS Quality Strategy? Better Care, Smarter Spending and Healthier People Better, smarter, healthier….through: • Using incentives to improve care • Tying payment to value through new payment models (Value Based Programs) • Changing how care is given through: • Better teamwork • Better coordination across health care settings • More attention to population health • Putting the power of health care information to work • Coordinated through six priorities/goals 8
9. What are the CMS Six Priorities? • Make care safer by reducing harm caused in the delivery of care • Ensuring that each person and family is engaged as partners in their own care • Promote effective communication and coordination of care • Promote effective prevention and treatment of chronic disease • Work with communities to help people live healthily • Make care affordable by developing and spreading new health care delivery models These are accomplished through four foundational principles. 9
10. Foundational Principles of Measurement Development Plan (MDP) Eliminate Disparities • Implement stratified reporting of quality measure by race, ethnicity, disability, and primary language. • Educate health care professionals about health disparities and cultural and linguistic competencies as part of a curriculum to promote a culture of safety. • Improve safety and reduce unnecessary and inappropriate care by teaching health care professionals how to better communicate with people of low health literacy and more effectively link health care decisions to person-centered goals. • Promote the use of health care navigators and translation services in the cultivation of a culture of safety. • Implement integrated care across various health care delivery settings, including the development of effective linkages to community resources. 10
11. Foundational Principles Infrastructure and Data Systems • Ensure that standardized race, ethnicity, gender, primary language, geographical (rural/urban), and disability information is collected to identify disparities in health delivery outcomes. • Use health IT (EHR, registries, and health information exchanges) to identify people at risk and improve safety across settings of care. • Implement and test value-based and alternative payment models that link payment incentives to measures of safety and appropriateness. • Link quality measurement to clinical decision support to promote provision of evidence-based care by providers and to reduce inappropriate use of medications, treatments, and diagnostics. • Emphasize use of outcome-based measures of safety over process measures to encourage providers to innovate quality improvement practices to reduce or eliminate harm. 11
12. Foundational Principles Enable Local Innovations • Support the collection of data locally to identify and target issues of harm and inappropriately delivered care within a community or practice location. • Support multi-stakeholder meetings that include local frontline providers, individuals, and families to identify innovative solutions to reduce harm in all settings. 12
13. Foundational Principles Foster Learning Organizations • Support health worker education about reducing inappropriate and unnecessary care, promoting dialogue between practitioners and patients. • Encourage multidisciplinary, cross-sector learning communities bringing together clinicians, other licensed providers, persons and families community health workers, and other community stakeholders to disseminate best practices and learn from high performers. 13
14. Attributes of the Quality Measure Development Plan Multi-Payer Applicability: • Incorporates measures used by private payers and integrated delivery systems within Medicare quality reporting programs. • Creating measures across payers can lessen provider burden and contribute to improved health outcomes by reducing data capture and measure variation. • CMS is leveraging a strategic approach through partnerships and other stakeholders to identify creative solutions for the use of measures across multiple payers and delivery systems, both public and private. Coordination/Sharing Across Measure Developers: • Measure developers are required to coordinate across CMS programs, as well as with initiatives in other public programs and in the private sector. • CMS will eliminate inefficiencies in the measure development process, implement new ways to foster communication and knowledge sharing, and will coordinate measure development across federal agencies. 14
15. Quality Measure Development Plan Clinical Practice Guidelines: • MDP to take into account how clinical practice guidelines and best practices can be used in the development of quality measures • CMS requires measure developers to conduct a thorough review and evaluation of clinical practice guidelines and promote alignment between the clinical guideline update process and measure maintenance • Any measure selected for inclusion in MIPS that is not endorsed by a consensus- based entity must have a focus that is evidence-based Quality Domains : • CMS will collaborate with specialty groups and associations to develop measures that are important to both patients and providers; representing important performance gaps in the targeted quality domains. • CMS will prioritize outcomes, person and caregiver experience, communication and care coordination, and appropriate resource use. • Five Quality Domains: clinical care, safety, care coordination, patient/caregiver experience, pop health and prevention 15
16. Quality Measure Development Plan • MACRA requires the MDP to be applicable across healthcare settings when developing the measures for MIPS and APMs. This includes measures that are applicable across settings of care and different types of clinicians. • CMS will evaluate clinical practice improvement activities to identify innovative approaches to new measure development at the national level to address gaps in measurement and clinical care • Measures developed from electronic data sources such as: EHRs and qualified clinical data registries (QCDRs), align rich clinical data and reduce data collection and reporting burden while supporting more timely performance feedback to providers than traditional claims- or paper processes used today. 16
18. Quality Measure Development Plan Challenges: • Engaging patients in the measure development process • Reducing provider burden • Shortening the period for measure development • Streamlining data acquisition for measure testing • Developing meaningful outcome measures • Developing patient-reported outcome measures (PROMs) and appropriate use measures • Developing measures that promote shared accountability across settings and providers 18
21. How Will CMS Address the Challenges? • Integrating the “voice” of the patients, families, and caregivers in the measure development process • Deriving measures constructed from primary assessment of clinical workflow • Prioritization of measures based on data from EHRs • Adopting process improvements which shall reduce waste throughout the measure development process • Forums for feedback in the measure development process • Forming a “National Testing Collaborative” for measure testing • Outcomes measures will be given priority • Support the development of health information exchange-which in turn will facilitate development of more care coordination and shared accountability measures. 21
22. The Vision of the Quality Measure Development Plan • Design a patient-centered measure portfolio which address measure gaps • Facilitates alignment across federal, state and private programs • Promotes efficient data collection • Design of measures which will hold individual providers and group practices accountable for care and promote shared accountability across multiple payers 22
23. MDP Will Evolve Over Time to: • Follow the patient across the continuum of care for patient populations with one or more chronic conditions. • Emphasize outcomes, including global outcome measures and population-based measures, balanced with process measures that are proximal to outcomes. • Address patient experience, care coordination, and appropriate use (e.g., overuse and underuse). • Promote multiple levels of accountability (e.g., individual clinicians, group practices ,system level, population level). • Apply to multiple types of providers, including clinical specialists, non-physician professionals, and non-patient-facing professionals. 23
24. MDP Timeline 24
25. To learn more, contact Jane Scott at jscott@healthintegrated.com 25
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