Measures That Matter: Simplifying Clinical Quality
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1 Session Code: C16 This presenter has nothing to disclose 12/12/17 1:30-2:45 Measures That Matter: Simplifying Clinical Quality Misty Roberts, MSN, RN, PMP Toyosi Morgan, MD, MPH, MBA
2 Learning Objectives Show how refining clinical quality measures can increase efficiency, lower costs, reduce burden for physicians, and ultimately improve health outcomes Walk through specific ways that health care organizations can simplify quality measures Demonstrate how simplifying clinical quality measures will help physicians in their transition to value-based care 2
3 Measures Making Headlines 3
4 Industry Paradigm Shift o Volumebased o Emphasizes sick care Traditional Fee for Service o Incentivizes quantity versus quality o Lack of focus on coordinated care
5 Industry Paradigm Shift o Outcomesbased o Promotes preventive care Value-Based Care o Focus on quality versus quantity o Highly coordinated care
6 Physician Burden Each year US physician practices in four common specialties spend, on average, 785 hours per physician and more than $15.4 billion dealing with the reporting of quality measures.
7 Lack of Industry Alignment NOT A SINGLE measure was used by every program 48 Measure Sets in 25 States and 3 Regions: 1367 Individual Measures 509 Distinct Measures 40% of programs created at least one new measure for use Only 20% of measures were used by more than one program Breast cancer screening most frequent used (63% of programs) Source: Bailit Health Analysis
8 Show me the Numbers National Quality Measures Clearinghouse 2522 US Department of Human Health and Services 2222 Centers for Medicare and Medicaid Services 2189 (by Title) Quality Payment Program 271 National Quality Forum 1101
9 Measurement Breakdown What Percentage are Outcome-Based? Total Measures 2522 Access (21) Outcome (282) Patient Experience (418) Process (1400) Structure (113) Other* (288) 11% *Related health care delivery and population health measures
10 Example diabetes measures NQMC National Quality Measures Clearinghouse Diabetes Specific Measures = 351 Diabetes HHS Health and Human Services Diabetes Specific Measures = 34 CMS Centers for Medicare and Medicaid Services Diabetes Specific Measures = 58 QPP Quality Payment Program ( MIPS ) Diabetes Specific Measures = 11 NQF National Quality Forum Diabetes Specific Measures = 66
11 Measurement Breakdown What Percentage of Diabetes Measures are Outcome-Based? Diabetes Measures 351 Outcome (60) Patient Experience (10) Process (220) Structure (12) Other* (49) 17% *Related health care delivery and population health measures
12 Common Measures Of the measures corresponding to diabetes 7 were accounted for in all governing entities (NQMC, HHS, CMS, QPP, NQF) What does this tell us? Variance Key measures
13 Examining Our Current State Multiple departments and silos Minimal clinical input Gathering the Pieces Multiple data sources Inconsistencies CMO and sponsor buy-in 1
14 Establishing Our Governing Principles QUALITY MEASURES GOVERNING PRINCIPLES Better care, healthier people and communities, affordable care NQF-endorsed measures preferred Data collection and reporting burden minimal Overuse and underuse measures included Patient outcome allow careful and prudent physicians to attain success. Limited to a manageable number Measure patient outcomes, have ability to drive improvement preferred Meaningful and usable by consumers, applicable to different patient populations Reform payment or delivery systems should measure clinical quality, patient experience, and costs. Cross-cutting across multiple conditions to reflect a domain of quality preferred
15 Simplifying Metrics: Our Process 15 ANALYSIS STATE 1. Receive Data and Consolidate COUNT Pre-Analysis Work Reduce Refine/ Relate Reduce Refine/ Relate 3. Initial Review 4. Filtering and Initial Identification of Key Metrics 5. Key Metrics Analysis 6. External Research 7. Gap Analysis and Future State 8. Final Recommendations 208
16 Summarizing Our Results 16
17 Building Our Future State Sustainability Plan Communication Plan and SharePoint Site Clinical Quality Metrics Alignment Governance One-on- Ones Leadership and Stakeholder Buy-in 17 Identify Measure Owners Assign Business Owners Monthly Stakeholder Meetings Determine Business Needs
18 Creating Sustainability 18 The Clinical Quality Metrics Alignment (CQMA) Governance Committee Manage and maintain meaningful measures that matter to consumers Reduce variability in measure selection Reduce collection burden and cost
19 Creating Sustainability 19 Review Regularly review current measures and any proposed changes. Discuss evidence-based guidelines, metric stewards, metric efficacy, feasibility, reliability, ease of tracking and application. Sustain Deliver continuity, awareness and collaboration across the enterprise. Maintain standard review criteria and decision-making process based on governing principles and criteria. CQMA Governance Approve Determine the inclusion or retirement of metrics based on review discussions and enterprise/industry priorities. Reach consensus on which metrics to maintain, retire, add or revise.
20 Developing a CQMA Central Repository A dedicated site to manage all clinical quality metrics 20 Front page links allow users to: View active and retired metrics Submit requests View specific business area metrics Gain awareness and transparency And much more!
21 21 The Value: Patient Health & Financial Strength Improve Health Outcomes Reduce Burden & Cost Improve Physician Satisfaction Align/Influence External Organizations Use narrow set of impactful measures Identify high value metrics Reduce hospitalization, readmissions and ED visits Lower costs through efficiencies and value Reduce internal inefficiencies and duplications Create a clear method for managing metrics Improve consistency Decrease complexity and confusion Decrease frustration Decrease collection and reporting burden Influence industry discussions around reducing measures Reflect industry best practices Collaborate with organizations (CMS, NCQA, AHIP, etc.)
22 Our Path to Change 22 Overburdened Physicians Multiple data sources Simplyfying Metrics Influencing Industry Discussion Measures that Matter Lack of Alignment Establishing Governing Principles Creating Sustainability
23 Questions? 2
24 Thank you 2
25 Misty Roberts, MSN, RN, PMP Toyosi Morgan, MD, MPH, MBA
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