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

Transcript

1. www.netspective.com
   © 2017 Netspective. All Rights Reserved.
   1
   REIMAGINING QUALITY
   MEASUREMENT
   By Shahid N. Shah, Publisher, Netspective Media
   

   View Slide

2. www.netspective.com
   © 2017 Netspective. All Rights Reserved.
   2
   WACKY IDEAS
   WELCOME FOR
   NEXT HOUR
   

   View Slide

3. www.netspective.com
   © 2017 Netspective. All Rights Reserved.
   3
   WHY ARE WE
   MEASURING
   QUALITY?
   OUTCOMES
   PROCESS
   COMPLIANCE
   COSTS
   

   View Slide

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
   

   View Slide

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
   

   View Slide

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?
   

   View Slide

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.
   

   View Slide

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)
   

   View Slide

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
   

   View Slide

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
    

    View Slide

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
    

    View Slide

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
    

    View Slide

13. www.netspective.com
    © 2017 Netspective. All Rights Reserved.
    14
    

    View Slide

14. www.netspective.com
    © 2017 Netspective. All Rights Reserved.
    15
    

    View Slide

15. www.netspective.com
    © 2017 Netspective. All Rights Reserved.
    16
    

    View Slide

16. www.netspective.com
    © 2017 Netspective. All Rights Reserved.
    17
    

    View Slide

17. www.netspective.com
    © 2017 Netspective. All Rights Reserved.
    18
    

    View Slide

18. www.netspective.com
    © 2017 Netspective. All Rights Reserved.
    19
    Opaque  Transparent
    

    View Slide

19. www.netspective.com
    © 2017 Netspective. All Rights Reserved.
    20
    Reportable  Actionable
    Instant Feedback for
    Immediate Interventions
    

    View Slide

20. www.netspective.com
    © 2017 Netspective. All Rights Reserved.
    21
    Consensus-driven
    Data-driven
    

    View Slide

21. www.netspective.com
    © 2017 Netspective. All Rights Reserved.
    22
    Eminence-driven
    Evidence-driven
    

    View Slide

22. www.netspective.com
    © 2017 Netspective. All Rights Reserved.
    23
    Compliance  Value
    PATIENT SAFETY
    

    View Slide

23. www.netspective.com
    © 2017 Netspective. All Rights Reserved.
    24
    Analog  Digital
    

    View Slide

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
    

    View Slide

25. www.netspective.com
    © 2017 Netspective. All Rights Reserved.
    26
    Discrete  Continuous
    

    View Slide

26. www.netspective.com
    © 2017 Netspective. All Rights Reserved.
    27
    Retrospective reporting
    Interactive telemetry
    EVENT DRIVEN SDKs
    

    View Slide

27. www.netspective.com
    © 2017 Netspective. All Rights Reserved.
    28
    Institution-framed
    Patient-framed
    

    View Slide

28. www.netspective.com
    © 2017 Netspective. All Rights Reserved.
    29
    Population-based
    Personalized
    

    View Slide

29. www.netspective.com
    © 2017 Netspective. All Rights Reserved.
    30
    Sector-specific  Unified
    MU, HEDIS, STARS, MIPS, MACRA, 21st Century Cures, etc.
    

    View Slide

30. www.netspective.com
    © 2017 Netspective. All Rights Reserved.
    31
    Measurement
    Process Improvement
    Care Assurance
    

    View Slide

31. www.netspective.com
    © 2017 Netspective. All Rights Reserved.
    32
    BACK TO
    REALITY
    

    View Slide

32. www.netspective.com
    © 2017 Netspective. All Rights Reserved.
    33
    DOES SIMPLE ACT
    OF MEASUREMENT
    IMPROVE QUALITY?
    

    View Slide

33. www.netspective.com
    © 2017 Netspective. All Rights Reserved.
    34
    DOES INCREASING
    MEASUREMENT
    TRANSPARENCY YIELD
    HIGHER QUALITY?
    

    View Slide

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?
    

    View Slide

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
    

    View Slide

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
    

    View Slide