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Reimagining Healthcare and Medical Quality Measurements

Shahid N. Shah
November 01, 2017
120

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

Shahid N. Shah

November 01, 2017
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  1. www.netspective.com
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    1
    REIMAGINING QUALITY
    MEASUREMENT
    By Shahid N. Shah, Publisher, Netspective Media

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    WACKY IDEAS
    WELCOME FOR
    NEXT HOUR

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    WHY ARE WE
    MEASURING
    QUALITY?
    OUTCOMES
    PROCESS
    COMPLIANCE
    COSTS

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    WHO ARE WE
    MEASURING
    QUALITY FOR?
    PATIENTS
    HEALTH
    SYSTEMS
    PAYERS &
    INSURERS
    REGULATORS
    CARE
    PROFESSIONALS
    PATIENT’S
    CAREGIVERS

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    Meaningful Use (MU)
    made us take us our eye
    off the ball and we ended
    up with crappy measures

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    What would quality
    measurement look like if
    MU silliness didn’t make
    us take our eye off the
    innovation ball?

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    We’d focus on quality
    improvement (QI) and continuous
    quality assurance (CQA) not
    data collection and quality
    measurement.

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    Let’s reimagine QI and
    CQA for a patient-first,
    digital-first quality
    experience (PDQX)

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    Let’s reimagine QI and
    CQA with a zero-based
    PDQX approach:
    start from scratch

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    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

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    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

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    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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    Opaque  Transparent

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    Reportable  Actionable
    Instant Feedback for
    Immediate Interventions

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    Consensus-driven
    Data-driven

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    Eminence-driven
    Evidence-driven

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    Compliance  Value
    PATIENT SAFETY

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    Analog  Digital

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    Manual  System Generated
    if you have to hand enter it, it’s a crappy measure

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    Discrete  Continuous

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    Retrospective reporting
    Interactive telemetry
    EVENT DRIVEN SDKs

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    Institution-framed
    Patient-framed

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    Population-based
    Personalized

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    Sector-specific  Unified
    MU, HEDIS, STARS, MIPS, MACRA, 21st Century Cures, etc.

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    Measurement
    Process Improvement
    Care Assurance

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    BACK TO
    REALITY

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    DOES SIMPLE ACT
    OF MEASUREMENT
    IMPROVE QUALITY?

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    DOES INCREASING
    MEASUREMENT
    TRANSPARENCY YIELD
    HIGHER QUALITY?

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    How can we help
    implement CMS’s new
    “Patients Over Paperwork”
    and “Meaningful Measures”
    initiatives?

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    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

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    THANK YOU
    Shahid N. Shah, Publisher, Netspective Media
    [email protected] @ShahidNShah
    REIMAGINING QUALITY
    MEASUREMENT

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