Reimagining Healthcare and Medical Quality Measurements

3962189473d062fdc76ce9a07cbe89fd?s=47 Shahid N. Shah
November 01, 2017
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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

3962189473d062fdc76ce9a07cbe89fd?s=128

Shahid N. Shah

November 01, 2017
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Transcript

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

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

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

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

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

  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