From Policy to Warehouse to Bedside: Using Public and Private Data to Improve Triple Aim Goals

Transcription

1 From Policy to Warehouse to Bedside: Using Public and Private Data to Improve Triple Aim Goals Helen Burstin, MD, MPH Chief Scientific Officer, NQF HEALTH DATAPALOOZA

2 What is NQF? NQF is an independent, nonprofit, membership organization that brings together all stakeholders working to improve health and healthcare through quality measurement. 2

3 42 year old father presents to an emergency department after falling out at home without any warning Normal EKG; one week follow up Two days later, another episode but did not seek care One week later, he comes in for his primary care visit. 3

4 National Quality Strategy on 4

5 Leveraging the Data Dividend Multitude of new sources of data: registries, EHRs, personal devices, social determinants Great potential to know more Can support better performance measurement and better information to personalize care Challenges Making sense of all these data sources Getting data that is accurate, timely, longitudinal and real time 5

6 Applying data to improve care and measurement Analytics for systems level improvement Feedback on how measures affected care New sources of data and ability to re use data for multiple purposes Use same data sources to support improvement, accountability, and evidence generation 6

7 Patient Focused Episodes Functional Status Quality of Life Shared decision making Clinical outcomes & PROs Costs 7

8 Influence of Healthcare and Patient Factors Outcome due to patient related factors and healthcare factors Healthcare Health status Patient related factors Time 8

9 Potential Patient Related Factors Genetics (e.g., predisposition to conditions) Demographic characteristics (e.g., ethnicity, language) Clinical factors (e.g., diagnoses, conditions, severity) Socioeconomic factors (e.g., poverty, education) Environmental factors (e.g., pollution, walking paths) Health related behaviors (e.g., tobacco, diet) 9

10 Patient Reported Outcomes (PROs) The concept of any report of the status of a patient s health condition that comes directly from the patient, without interpretation of the patient s response. 10

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12 The Pathway from PROs to Performance Measures Symptom: Depression PHQ 9 standardized tool to assess depression Percentage of depressed patients with remission or progress toward remission in PHQ 9 scores at 6 months and at 12 months 12

13 Alternative Payment Framework Models Category 2 FFS with link to quality & value Category 3 APMs built on FFS architecture Category 4 Population based payment Pay for reporting Rewards for performance Rewards & penalties for performance APMs with upside gainsharing APMs with upside gainsharing & downside risk Condition specific population based payment Comprehensive population based payment 13

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15 Data Sources Cited by the NQF Community Based Field Testing Groups

16 Data Sources for Community Focus The ability to measure population health improvement requires access to useful, usable, appropriate data sources Data come from various sources Local, state, federal agencies Administrative claims Electronic and paper medical records, including registries Surveys (patients, community members, providers, others)

17 Data Challenges for Community Focus Small sample sizes of surveys Ability to integrate and share data Coordination, cross linking, aggregation, system interoperability Staff and resources available to perform these functions Timeliness of available data Variation in whether data is collected across regions Gaining access to non medical data to improve population health

18 Health and Well Being: Patient, Provider and Community Health related behaviors 0024: Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents 1348: Children Age 6 17 Years who Engage in Weekly Physical Activity 1349: Child Overweight or Obesity Status Based on Parental Report of BMI 0029: Counseling on physical activity in older adults a. Discussing Physical Activity, b. Advising Physical Activity Community level indicators of health and disease 0728: Asthma Admission Rate (pediatric) (per 100,000 population) 0277: Congestive Heart Failure Admission Rate (PQI 8) (% of county population with admission for CHF) Primary prevention and/or screening 0522: Influenza Immunization Received for Current Flu Season 0680: Percent of Nursing Home Residents Who Were Assessed and Appropriately Given the Seasonal Influenza Vaccine (Short Stay) 1999: Late HIV diagnosis 0046 : Osteoporosis: Screening for Women Aged 65 Years and Older (Assigned to Endocrine Project) 2020: Adult Current Smoking Prevalence 0408: HIV/AIDS: Tuberculosis Screening (Assigned to Infectious Disease Project) Modifiable social, economic, environmental determinants of health 0717: Number of School Days Children Miss Due to Illness 0721: Children Who Attend Schools Perceived as Safe 0723: Children Who Have Inadequate Insurance Coverage For Optimal Health 1346: Children Who Are Exposed To Secondhand Smoke Inside Home 18

19 NQF Measure Incubator: Getting to quality measures that matter Topic Developer Data Funding Novel Measures emeasures Outcome Measures Patient reported Outcome Measures Cost/ Efficiency/ Value Measures Improved Patient Care and Outcomes 19

20 Why a Measure Incubator? Unfulfilled measurement needs Major measurement gaps across healthcare Not consistently achieving measures that matter (outcomes, resource use, patient centered) Growing measurement complexity Methodological challenges Informatics challenges Clinical challenges Patient centered challenges Major barriers to measurement innovation Expensive Time consuming Difficult to access appropriate test beds for innovative measures 20

21 NQF s Measure Incubator: Environment for Innovative Measure Development Facilitation Bring together those with ideas for measures with the resources they need to see concepts turned into specifications Data and test beds Continuous access to robust data throughout the development and testing process Accelerated cycle time Rapid cycle development and testing 21

22 NQF: Lead. Prioritize. Collaborate. Drive measurement that matters to improve quality, safety & affordability 22

23 Quality Imperative The Quality Imperative Not everything that counts can be counted, and not everything that can be counted counts ~Albert Einstein But.. (William Bruce Cameron) You can t improve what you don t measure ~ W. Edwards Deming

24 Uses of Data and Measurement: Improve Healthcare Quality 24

25 Helen Burstin, MD, MPH, 25