Core Metrics for Better Care, Lower Costs, and Better Health

Transcription

1 Core Metrics for Better Care, Lower Costs, and Better Health IOM Roundtable on Value & Science-Driven Health Care September 27, 2012 Washington, D.C. Sam Nussbaum, M.D. Executive Vice President, Clinical Health Policy and Chief Medical Officer

2 Challenges in the U.S. Health Care System Variation in quality, safety, outcomes and cost Escalating costs/technology advancements Ranks last or next-to-last on: Quality Access Efficiency Equity Healthy lives* Aging population and increased chronic diseases Lack of information and infrastructure for optimal care Fragmented system: coordination of care; health professional roles *The Commonwealth Fund June

3 Triple Aim and National Priorities Population Health Health Care Cost Promote wide use of best practices to enable healthy living and well-being (National Priority 1) Promote the most effective prevention, treatment, and intervention practices for the leading causes of mortality, starting with cardiovascular disease (National Priority 2) Ensure person- and familycentered care (National Priority 3) Make care safer (National Priority 4) Promote effective communication and care coordination (National Priority 5) Make quality care affordable for people, families, employers, and governments (National Priority 6) Source: IOM Roundtable on Value & Science-Driven Health Care 3

4 IOM Roundtable: Measuring the Triple Aim Population Health Health Care Cost Length of life Quality of life Health behaviors Prevention Community health Effective Patient-Centered Safe Coordination and communication Equitable Efficiency and timeliness Affordability Expenditures Waste Source: IOM Roundtable on Value & Science-Driven Health Care 4

5 CMS Quality Measurement Objectives Align measures with the National Quality Strategy and Six Measure Domains Implement measures that fill critical gaps within the 6 domains Align measures across programs whenever appropriate Leverage opportunities to align with private sector (e.g., NQF MAP) Focus on patient centered measures (patient outcomes and patient experience) Parsimonious sets of measures; core sets of measures Removal of measures that are no longer appropriate (e.g., topped out) Report once and receive credit for multiple programs Focus on EHR and Registry (including those enabled by EHRs) quality reporting 5

6 Avoidable Admission and Readmission Measures for the Care Coordination Readmission measures should be part of a suite of measures to promote a system of patient-centered care coordination All-cause and condition-specific measures of avoidable admissions and readmissions are important Monitoring by program implementers is necessary to mitigate potential unintended consequences Risk adjustment for patient-level severity of illness alone may not address nuances in the complexity of reporting avoidable admissions and readmissions Readmission measures should exclude planned readmissions Source: The National Quality Forum 6

7 Multiple Dimensions of Measurement Current Metric Uses Sources for Metrics Current Metric Gaps Quality Improvement Payment Reporting/Transparency Regulation Funding and purchasing decisions Clinical care data Vital statistics Claims data Population surveys Limited scope Narrow time window Provider-centric focus Narrow focus of accountability measure for teams rather than individual provider Concerns over technical accuracy Need for composite measures Need for actionable measures Source: IOM Roundtable on Value & Science-Driven Health Care 7

8 Payment Innovation: Improving Value and Affordability Old Model New Model Reward unit cost Inadequate focus on care efficiency and patient centeredness Payment for unproven services; limited alignment with quality Reward health outcomes and population health Lower cost while improving patient experience Improve quality, safety and evidence 8

9 Hospital Quality: Q-HIP Hospital Quality Program Q-HIP Hospital Pay-for-Performance rewards quality, safety, outcomes, and patient satisfaction Patient Safety Section (35% of total Q-HIP Score) Computerized Physician Order Entry (CPOE) Adoption (Stage 1 Meaningful Use Criteria) IHI Improvement Map Medication Reconciliation WHO Surgical Safety Checklist NQF Recommended Safe Practices NQF Emergency Care Standards NQF Perinatal Measures Member Satisfaction Section (10% of Total Q-HIP Score) H-CAHPS Survey Results Patient Health Outcomes Section (55% of total Q-HIP Score) PCI Indicators 4 ACC-NCDR/Indicators for Cardiac Catheterization/PCI Joint Commission/CMS Nat l Hospital Quality Measures Acute Myocardial Infarction (AMI) Indicator Heart Failure (HF) Indicator Pneumonia (PN) Indicators Surgical Care Improvement Project (SCIP) Measures NSC Indicators 4 JC/NQF Nursing Sensitive Care Indicators CABG Indicators 4 STS Coronary Artery Bypass Graft (CABG) Measures 9

10 California Patient Safety First Sepsis Deaths VAP Central Line Infection CAUTI Elective Delivery Prior to 39 Weeks -21% -48% -39% -32% -65% 10

11 WellPoint Member Health Index: Improving Population Health and Health Care 4 Domains of health care services Staying Healthy Breast cancer screening Cervical cancer screening Colorectal cancer screening Cholesterol Screening Childhood immunizations Timeliness of Prenatal Care Clinical Outcomes Diabetes Outcomes Emergency Department Visits - Chronic Conditions Hospital Admissions - Chronic Conditions 30-Day All Cause Readmissions Managing Chronic Conditions Diabetes Monitoring Behavioral health follow-up Condition Care Core Engagement Condition Care - Blood Pressure Control Osteoporosis Management Following Fracture Staying Safe Annual Monitoring for Patients on Persistent Medications Use of Imaging Studies for Low Back Pain RHI Medication Safety Alerts 11

12 State Health Index Maternity and Prenatal Care WellPoint State of Health Care Rankings Preventive Care Lifestyle Behavioral Health Morbidity & Mortality 12

13 Measurement: Key Issues Measures for cost/affordability: velocity and expansion Refreshing measures: imaging for breast cancer screening, prostate-specific antigen, U.S. Preventive Services Task Force Alignment of measures across entire system of care: Medicare STARS, accountable care organizations, Comprehensive Primary Care Initiative, exchanges, private health plans Funding for measures development: government, private sector Measure sources: claims, medical records, patient surveys State initiatives: data aggregation, measures How does this all come together: National Health Care Quality Strategy, National Quality Forum, National Priorities Partnerships, Measure Applications Partnership, professional medical organizations, health plans, CMS 13