Reimagining Healthcare and Medical Quality Measurements

Lunch Keynote at NCQA HL7 Digital Quality Summit. The video of this deck is available at https://youtu.be/YV5Ih6mVafk

1. www.netspective.com © 2017 Netspective. All Rights Reserved. 1 REIMAGINING QUALITY MEASUREMENT By Shahid N. Shah, Publisher, Netspective Media
2. www.netspective.com © 2017 Netspective. All Rights Reserved. 2 WACKY IDEAS WELCOME FOR NEXT HOUR
3. www.netspective.com © 2017 Netspective. All Rights Reserved. 3 WHY ARE WE MEASURING QUALITY? OUTCOMES PROCESS COMPLIANCE COSTS
4. www.netspective.com © 2017 Netspective. All Rights Reserved. 4 WHO ARE WE MEASURING QUALITY FOR? PATIENTS HEALTH SYSTEMS PAYERS & INSURERS REGULATORS CARE PROFESSIONALS PATIENT’S CAREGIVERS
5. www.netspective.com © 2017 Netspective. All Rights Reserved. 5 Meaningful Use (MU) made us take us our eye off the ball and we ended up with crappy measures
6. www.netspective.com © 2017 Netspective. All Rights Reserved. 6 What would quality measurement look like if MU silliness didn’t make us take our eye off the innovation ball?
7. www.netspective.com © 2017 Netspective. All Rights Reserved. 7 We’d focus on quality improvement (QI) and continuous quality assurance (CQA) not data collection and quality measurement.
8. www.netspective.com © 2017 Netspective. All Rights Reserved. 8 Let’s reimagine QI and CQA for a patient-first, digital-first quality experience (PDQX)
9. www.netspective.com © 2017 Netspective. All Rights Reserved. 9 Let’s reimagine QI and CQA with a zero-based PDQX approach: start from scratch
10. www.netspective.com © 2017 Netspective. All Rights Reserved. 11 Seema Verma Administrator Last week, CMS announced our new initiative “Patients Over Paperwork” to address regulatory burden. This is an effort to go through all of our regulations to reduce burden. Because when burdensome regulations no longer advance the goal of patients first, we must improve or eliminate them. … We’re revising current quality measures across all programs to ensure that measure sets are streamlined, outcomes-based, and meaningful to doctors and patients. This includes a review of the Hospital Star Rating program. And, we’re announcing today our new comprehensive initiative, "Meaningful Measures.” … “Meaningful Measures” takes a new approach to quality measures to reduce the burden of reporting on all providers…Meaningful Measures will involve only assessing those core issues that are the most vital to providing high-quality care and improving patient outcomes. … It’s better to focus on achieving results, as opposed to having CMS try to micromanage and measure processes. This will help two things: • Help address high impact measurement areas that safeguard public health. • Help promote more focused quality measure development towards outcomes that are meaningful to patients, families and their providers. “ ” SPEECH: Remarks by Administrator Seema Verma at the Health Care Payment Learning and Action Network (LAN) Fall Summit (As prepared for delivery - October 30, 2017) https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-10-30.html
11. www.netspective.com © 2017 Netspective. All Rights Reserved. 12 No measure that isn’t understandable by patients or their caregivers would be prioritized for inclusion. MUST be UNDERSTANDABLE by PATIENTS and CAREGIVERS Create a maximum of 10 measures per condition or procedure and then every time we have a great idea for another one, eliminate an older one. EVERY NEW MEASURE MUST ELIMINATE an OLDER MEASURE If a measure isn’t demonstrating outcomes easily understood by patients or loved ones, we’d ignore it. MUST be OUTCOMES FOCUSED, not PROCESS CENTRIC PDQX Measures Reimagine drastically reducing what we measure
12. www.netspective.com © 2017 Netspective. All Rights Reserved. 13 Patients don’t really have a voice today in quality measures, how will we setup that feedback loop? HOW DO WE KNOW WHAT MATTERS TO PATIENTS and CAREGIVERS? VALIDATED “PROMS” (PATIENT REPORTED OUTCOMES MEASURES) What kind of telemetry and continuous learning can we put into place to know which are useful vs. not? HOW DO WE KNOW IF SOMEONE IS USING AN OLD MEASURE WHEN WE WANT TO DEPRECATE OR ELIMINATE IT? Healthcare outcomes are notoriously difficult to determine, do we not measure process at all? WHO DETERMINES OUTCOMES FOCUSED vs. PROCESS CENTRIC? USE SAME APPROACH AS PROMS DEVELOPERS PDQX Challenges Patient-centric and outcomes-focused easier said than done
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18. www.netspective.com © 2017 Netspective. All Rights Reserved. 19 Opaque  Transparent
19. www.netspective.com © 2017 Netspective. All Rights Reserved. 20 Reportable  Actionable Instant Feedback for Immediate Interventions
20. www.netspective.com © 2017 Netspective. All Rights Reserved. 21 Consensus-driven Data-driven
21. www.netspective.com © 2017 Netspective. All Rights Reserved. 22 Eminence-driven Evidence-driven
22. www.netspective.com © 2017 Netspective. All Rights Reserved. 23 Compliance  Value PATIENT SAFETY
23. www.netspective.com © 2017 Netspective. All Rights Reserved. 24 Analog  Digital
24. www.netspective.com © 2017 Netspective. All Rights Reserved. 25 Manual  System Generated if you have to hand enter it, it’s a crappy measure
25. www.netspective.com © 2017 Netspective. All Rights Reserved. 26 Discrete  Continuous
26. www.netspective.com © 2017 Netspective. All Rights Reserved. 27 Retrospective reporting Interactive telemetry EVENT DRIVEN SDKs
27. www.netspective.com © 2017 Netspective. All Rights Reserved. 28 Institution-framed Patient-framed
28. www.netspective.com © 2017 Netspective. All Rights Reserved. 29 Population-based Personalized
29. www.netspective.com © 2017 Netspective. All Rights Reserved. 30 Sector-specific  Unified MU, HEDIS, STARS, MIPS, MACRA, 21st Century Cures, etc.
30. www.netspective.com © 2017 Netspective. All Rights Reserved. 31 Measurement Process Improvement Care Assurance
31. www.netspective.com © 2017 Netspective. All Rights Reserved. 32 BACK TO REALITY
32. www.netspective.com © 2017 Netspective. All Rights Reserved. 33 DOES SIMPLE ACT OF MEASUREMENT IMPROVE QUALITY?
33. www.netspective.com © 2017 Netspective. All Rights Reserved. 34 DOES INCREASING MEASUREMENT TRANSPARENCY YIELD HIGHER QUALITY?
34. www.netspective.com © 2017 Netspective. All Rights Reserved. 35 How can we help implement CMS’s new “Patients Over Paperwork” and “Meaningful Measures” initiatives?
35. www.netspective.com © 2017 Netspective. All Rights Reserved. 36 No measure that isn’t understandable by patients or their caregivers would be prioritized for inclusion. MUST be UNDERSTANDABLE BY PATIENTS and CAREGIVERS Create a maximum of 10 measures per condition or procedure and then every time we have a great idea for another one, eliminate an older one. EVERY NEW MEASURE MUST ELIMINATE AN OLDER MEASURE If a measure isn’t demonstrating outcomes easily understood by patients or loved ones, we’d ignore it. MUST be OUTCOMES FOCUSED, not PROCESS CENTRIC PDQX Measures Reimagine drastically reducing what we measure
36. www.netspective.com © 2017 Netspective. All Rights Reserved. 37 THANK YOU Shahid N. Shah, Publisher, Netspective Media shahid@shah.org @ShahidNShah REIMAGINING QUALITY MEASUREMENT