Quality Measurement at the Interface of Health Care and Population Health

Size: px
Start display at page:

Download "Quality Measurement at the Interface of Health Care and Population Health"

Transcription

1 1 Institute of Medicine Committee on Quality Measures Healthy People Leading Health Indicators December 10, 2012 Quality Measurement at the Interface of Health Care and Population Health Shari M. Ling, MD CMS Deputy Chief Medical Officer Center for Medicare & Medicaid Services

2 National Quality Strategy BETTER HEALTH Population & Community Health Care Coordination Efficiency & Cost Reduction BETTER CARE LOWER COSTS Clinical Care Safety Person /Caregiver Centered 2

3 Population Health relevant quality measure topics Cardiovascular risk identification & management BP Aspirin Cholesterol Smoking cessation & avoidance of tobacco products Obesity & physical activity High risk populations i.e. diabetes Prevention Vaccination Bone health Cancer screening Mental & Behavioral Health Depression Alcohol 3

4 ABCs: Getting to Goal Intervention Baseline Target Clinical target Aspirin for those at high risk 47% 65% 70% Blood pressure control 46% 65% 70% Cholesterol management 33% 65% 70% Smoking cessation 23% 65% 70% Sodium reduction ~ 3.5 g/day 20% reduction Trans fat reduction ~ 1% of calories 50% reduction 4 Unpublished estimates from Prevention Impacts Simulation Model (PRISM).

5 Alignment of Clinical Quality Measures Million Hearts Clinical Quality Measures Physician Quality Reporting System Meaningful Use PQRS CV Prevention Measures Group Accountable Care Organizations HRSA Uniform Data System National Quality Forum Aspirin Use PQRS #204 S1 opt, S2 core (prop) Yes Yes Yes (2012) NQF #0068 BP Screening PQRS #317 Yes Yes BP Control PQRS #236 S1 opt, S2 core (prop) Yes Yes Yes NQF #0018 Chol Control Pop PQRS #316 S2 core (prop) TBD* Chol Cont DM PQRS #2 S1 opt, S2 opt (prop) Yes Yes NQF #0064 Chol Cont IVD PQRS #241 S1 opt, S2 opt (prop) Yes Yes NQF #0075 Smoking Cessation PQRS #226 S1 core, S2 core (prop) Yes Yes Yes (2011) NQF #0028

6 CMS Quality Programs Hospital Quality Reporting Medicare and Medicaid EHR Incentive Program PPS-Exempt Cancer Hospitals Inpatient Psychiatric Facilities Inpatient Quality Reporting Outpatient Quality Reporting Physician Quality Reporting Medicare and Medicaid EHR Incentive Program PQRS erx quality reporting PAC and Other Settings Inpatient Rehabilitation Facility Nursing Home Compare Measures LTCH Quality Reporting ESRD QIP Hospice Quality Reporting Home Health Quality Reporting Payment Model Reporting Medicare Shared Savings Program Hospital Valuebased Purchasing Physician Feedback/Valuebased Modifier* Population Quality Reporting Medicaid Adult Quality Reporting* CHIPRA Quality Reporting* Health Insurance Exchange Quality Reporting* Medicare Part C* Medicare Part D* Ambulatory Surgical Centers * Denotes that the program did not meet the statutory inclusion criteria for pre-rulemaking, but was included to foster alignment of program measures. 6

7

8 Affordable Care Act Provision with Quality Focus Value based purchasing Hospital value-based purchasing Value-based purchasing for SNF Quality and efficiency measurement Develop a plan to implement VBP for ambulatory surgical centers Pilot testing for pay-for-performance Hospital readmissions Hospital readmissions reduction program Community-based care transitions program Healthcare acquired conditions Payment adjustment for health care-acquired conditions Payment adjustment for conditions acquired in hospitals Accountable care organizations Pediatric accountable care organization demonstration project Medicare Shared Savings Program Dual eligibles Providing federal coverage and payment coordination for dual eligible beneficiaries Preventative services Annual wellness visit providing a personalized plan Removing barriers to preventive services Evidence-based coverage of preventive services Coordination of care State option to provide health homes for enrollees with chronic conditions Demonstration project to evaluate integrated care around a hospitalization Long term care Community first choice option Removal of barriers to providing home and community based services Money follows the person rebalancing demo Protection for recipients of home and community-based services against spousal impoverishment Incentives for states to offer home community based serviced Public reporting Development of outcome measures Improvements to the physician quality reporting system -- also see Provision Public reporting of performance information Quality reporting initiative Adult health quality measures Improvements to the physician quality reporting system Quality Reporting for Long Term Care Hospitals (LTCH), inpatient rehabilitation hospitals, and hospice programs Quality reporting for PPS-exempt cancer hospitals Quality reporting for psychiatric hospitals 8

9 Medicare s Annual Wellness Visit (AWV) Detection of cognitive Impairment Health Risk Assessment Medical & Family History Providers & medications Biometric measurements Preventive service plan (5-10 yrs) Personalized health advice, referrals, Other elements determined appropriate by the Secretary and health education

10 National Alzheimers Project Act For millions of Americans, the heartbreak of watching a loved one struggle with Alzheimer's disease is a pain they know all too well. Alzheimer's disease burdens an increasing number of our Nation's elders and their families, and it is essential that we confront the challenge it poses to our public health. -- President Barack Obama National Alzheimer s Plan Goals Prevent and Effectively Treat Alzheimer's Disease by Optimize Care Quality and Efficiency. Expand Supports for People with Alzheimer's Disease and Their Families. Enhance Public Awareness and Engagement. Track Progress and Drive Improvement. 10

11 Overarching Goals 1. Foster health care and public health system changes 2. Maximize the use of proven self-care management and other services 3. Provide better tools and information to health care, public health, and social services workers 4. Facilitate research to fill knowledge gaps

12 Multiple Chronic Conditions account for a Disproportionate Share of Medicare Spending 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Number of chronic conditions Percent of Beneficiaries Percent of Total Costs 12

13 Transformation of Health Care at the Front Line At least six components Quality measurement Aligned payment incentives Comparative effectiveness and evidence available Health information technology Quality improvement collaboratives and learning networks Training of clinicians and multi-disciplinary teams Source: P.H. Conway and Clancy C. Transformation of Health Care at the Front Line. JAMA 2009 Feb 18; 301(7):

14 How Will Change Actually Happen? There is no silver bullet We must apply many incentives We must show successful alternatives We must offer intensive supports Help providers with the painstaking work of improvement We must learn how to scale and spread successful interventions

15 CMS Implementation Levers Fraud & Abuse Enforcement Coverage of services Physician Feedback report Quality Resource Utilization Report Physician Value Modifier Readmissions Target surveys Payment Policy Survey & Cert. Program Integrity CMMI Demos & Research ACOs Community Based Transitions Care Program Dual Eligibles Demonstration Projects Pilots Quality ESRD QIP Hospital VBP Plans for Skilled Nursing Facility and Home Health Agencies, Ambulatory Surgical Centers VBP QIOs EQROs ESRD Networks Q.I. COP Other CMS programs HHS Programs Hospitals, Home Health Agencies, Hospices, ESRD facilities Partnership for Patients Million Hearts National Quality Strategy Data.gov HITECH Hospital Inpatient Quality Reporting Programs

16 16 Rapid Cycle Improvement - How can we improve more quickly? Apply proven interventions reliably across settings and measure results Test the application of new interventions and learn in rapid cycle Partner with providers, communities, and patients Move beyond a traditional government contract with delayed evaluation model Focus efforts where improvement most needed and target interventions

17 Hospitals Role in Population Health: Community Health Needs Assessment New requirements under ACA. To retain tax exempt status, non-profit hospitals must: Conduct a community health needs assessment at least every three years Adopt implementation strategy to meet the community health needs identified through the assessment Penalty: $50,000 tax for each year that a tax exempt hospital fails to satisfy requirement

18 Hospitals Role in Population Health: Community Building IRS-approved activities: Physical improvements and housing Leadership development / training for community Community health improvement advocacy Coalition building Economic development Community support Environmental improvement Workforce development

19 Building Community Capacity, Improving Care Transitions 19

20 Health Outcomes of Interest? More Persuasive Longer life, fewer deaths Fewer distressing symptoms Better function Greater participation Deferred retirement Fewer burdensome tests and treatments E.g Hospitalization, long-term care, etc Less Persuasive Longer life with declining function/participation Improved disease-specific survival without improved overall survival Surrogate test result better Image looks better Doctor feels confident How will we measure this for a population?

21 21 Thank you! Shari M. Ling, M.D. Deputy Chief Medical Officer Centers for Medicare & Medicaid Services

Moving the Dial on Quality

Moving the Dial on Quality Moving the Dial on Quality Washington State Medical Oncology Society November 1, 2013 Nancy L. Fisher, MD, MPH CMO, Region X Centers for Medicare and Medicaid Serving Alaska, Idaho, Oregon, Washington

More information

Reinventing Health Care: Health System Transformation

Reinventing Health Care: Health System Transformation Reinventing Health Care: Health System Transformation Aspen Institute Patrick Conway, M.D., MSc CMS Chief Medical Officer Director, Center for Clinical Standards and Quality Acting Director, Center for

More information

Medicare-Medicaid Payment Incentives and Penalties Summit

Medicare-Medicaid Payment Incentives and Penalties Summit Medicare-Medicaid Payment Incentives and Penalties Summit Patrick Conway, M.D., MSc CMS Chief Medical Officer and Director, Office of Clinical Standards and Quality May 31, 2012 Objectives Outline methods

More information

Health System Transformation. Discussion

Health System Transformation. Discussion Health System Transformation Patrick Conway, M.D., MSc CMS Chief Medical Officer Deputy Administrator for Innovation and Quality Director, Center for Medicare & Medicaid Innovation Director, Center for

More information

CMS Vision for Quality Measurement February 23, 2013

CMS Vision for Quality Measurement February 23, 2013 CMS Vision for Quality Measurement February 23, 2013 Kate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group Centers for Medicare and Medicaid Services DISCLAIMER: The v iews and

More information

Measure Applications Partnership (MAP)

Measure Applications Partnership (MAP) Measure Applications Partnership (MAP) Uniform Data System for Medical Rehabilitation Annual Conference Aisha Pittman, MPH Senior Program Director National Quality Forum August 9, 2012 Overview MAP Background

More information

Quality Measures and Federal Policy: Increasingly Important and A Work in Progress. American Health Quality Association Policy Forum Washington, D.C.

Quality Measures and Federal Policy: Increasingly Important and A Work in Progress. American Health Quality Association Policy Forum Washington, D.C. Quality Measures and Federal Policy: Increasingly Important and A Work in Progress American Health Quality Association Policy Forum Washington, D.C. February 9, 2016 Quality Journey NCQA Develops Health

More information

WELCOME. Kate Gainer, PharmD Executive Vice President and CEO Iowa Pharmacy Association

WELCOME. Kate Gainer, PharmD Executive Vice President and CEO Iowa Pharmacy Association WHAT IS MACRA? WELCOME Kate Gainer, PharmD Executive Vice President and CEO Iowa Pharmacy Association WELCOME Anthony Pudlo, PharmD, MBA, BCACP Vice President of Professional Affairs Iowa Pharmacy Association

More information

Thinking Ahead in Post Acute Care

Thinking Ahead in Post Acute Care Thinking Ahead in Post Acute Care Stella Mandl, RN Technical Advisor Division of Chronic and Post Acute Care Center for Clinical Standards and Quality Center for Medicare & Medicaid Services Stella.mandl@cms.hhs.gov

More information

Future of Patient Safety and Healthcare Quality

Future of Patient Safety and Healthcare Quality Future of Patient Safety and Healthcare Quality Patrick Conway, M.D., MSc CMS Chief Medical Officer Director, Center for Clinical Standards and Quality Acting Director, Center for Medicare and Medicaid

More information

Healthy Aging Recommendations 2015 White House Conference on Aging

Healthy Aging Recommendations 2015 White House Conference on Aging Healthy Aging Recommendations 2015 White House Conference on Aging Chronic diseases are the leading causes of death and disability in the U.S. and account for 75% of the nation s health care spending.

More information

Can Child Mental Health Cross the Quality Chasm? Children s Behavioral Health, Healthcare Reform and the Quality Measurement Industrial Complex

Can Child Mental Health Cross the Quality Chasm? Children s Behavioral Health, Healthcare Reform and the Quality Measurement Industrial Complex Can Child Mental Health Cross the Quality Chasm? Children s Behavioral Health, Healthcare Reform and the Quality Measurement Industrial Complex Harold Alan Pincus, MD Professor and Vice Chair, Department

More information

INTERMACS has a Key Role in Reporting on Quality Metrics

INTERMACS has a Key Role in Reporting on Quality Metrics INTERMACS has a Key Role in Reporting on Quality Metrics Robert L Kormos MD FACS, FAHA FRCS(C) Director Artificial Heart Program University of Pittsburgh Medical Center The Patient Protection and Affordable

More information

Understanding PQRS and the Value-Based Modifier: CMS Plan to Achieve High Value Care through Transforming Payment Systems

Understanding PQRS and the Value-Based Modifier: CMS Plan to Achieve High Value Care through Transforming Payment Systems Understanding PQRS and the Value-Based Modifier: CMS Plan to Achieve High Value Care through Transforming Payment Systems Dr. Ashby Wolfe, Chief Medical Officer Centers for Medicare and Medicaid Services,

More information

Session 1. Measure. Applications Partnership IHA P4P Mini Summit. March 20, Tom Valuck, MD, JD Connie Hwang, MD, MPH

Session 1. Measure. Applications Partnership IHA P4P Mini Summit. March 20, Tom Valuck, MD, JD Connie Hwang, MD, MPH Measure Session 1 Applications Partnership IHA P4P Mini Summit March 20, 2012 Tom Valuck, MD, JD Connie Hwang, MD, MPH Agenda Session 1 Measure Applications Partnership (MAP) Context and Guiding Principles

More information

Patient Protection and Affordable Care Act Selected Prevention Provisions 11/19

Patient Protection and Affordable Care Act Selected Prevention Provisions 11/19 Patient Protection and Affordable Care Act Selected Prevention Provisions 11/19 Coverage of Preventive Health Services (Sec. 2708) Stipulates that a group health plan and a health insurance issuer offering

More information

HEALTH CARE REFORM IN THE U.S.

HEALTH CARE REFORM IN THE U.S. HEALTH CARE REFORM IN THE U.S. A LOOK AT THE PAST, PRESENT AND FUTURE Carolyn Belk January 11, 2016 0 HEALTH CARE REFORM BIRTH OF THE AFFORDABLE CARE ACT Health care reform in the U.S. has been an ongoing

More information

Updates from CMS: Value-Based Purchasing, ACOs, and Other Initiatives The Seventh National Pay for Performance Summit March 20, 2012

Updates from CMS: Value-Based Purchasing, ACOs, and Other Initiatives The Seventh National Pay for Performance Summit March 20, 2012 Updates from CMS: Value-Based Purchasing, ACOs, and Other Initiatives The Seventh National Pay for Performance Summit March 20, 2012 Presenters David Sayen, CMS Regional Administrator Betsy L. Thompson,

More information

Measure Applications Partnership

Measure Applications Partnership Measure Applications Partnership All MAP Member Web Meeting November 13, 2015 Welcome 2 Meeting Overview Creation of the Measures Under Consideration List Debrief of September Coordinating Committee Meeting

More information

The Patient Protection and Affordable Care Act Summary of Key Health Information Technology Provisions June 1, 2010

The Patient Protection and Affordable Care Act Summary of Key Health Information Technology Provisions June 1, 2010 The Patient Protection and Affordable Care Act Summary of Key Health Information Technology Provisions June 1, 2010 This document is a summary of the key health information technology (IT) related provisions

More information

Accountable Care and Governance Challenges Under the Affordable Care Act

Accountable Care and Governance Challenges Under the Affordable Care Act Accountable Care and Governance Challenges Under the Affordable Care Act The First National Congress on Healthcare Clinical Innovations, Quality Improvement and Cost Containment October 26, 2011 Doug Hastings

More information

Person-Centered Accountable Care

Person-Centered Accountable Care Person-Centered Accountable Care Nelly Ganesan, MPH, Senior Director, Avalere s Evidence, Translation and Implementation Practice October 12, 2017 avalere.com @NGanesanAvalere @avalerehealth Despite Potential

More information

Exhibit 1. Medicare Shared Savings Program: Year 1 Performance of Participating Accountable Care Organizations (2013)

Exhibit 1. Medicare Shared Savings Program: Year 1 Performance of Participating Accountable Care Organizations (2013) Exhibit 1. Medicare Shared Savings Program: Year 1 Performance of Participating Accountable Care Organizations (2013) 24 percent (52 ACOs) earned shared savings bonus 27 percent (60 ACOs) reduced spending,

More information

5/30/2012

5/30/2012 The Affordable Care Act Background Coverage Long-term Care Home and Community Based Services Payment Delivery Care Transitions Assuring Quality Supreme Court 5/30/2012 www.nasuad.org BACKGROUND Health

More information

Practice Implications for Accountable Care Organizations

Practice Implications for Accountable Care Organizations Practice Implications for Accountable Care Organizations An Overview following the Final Rule Gregory M. Marsh, MPH, PMP December 14, 2011 Why CCME? Effective EHR/HIE Implementation will: Improve patient

More information

Summary of U.S. Senate Finance Committee Health Reform Bill

Summary of U.S. Senate Finance Committee Health Reform Bill Summary of U.S. Senate Finance Committee Health Reform Bill September 2009 The following is a summary of the major hospital and health system provisions included in the Finance Committee bill, the America

More information

The Future of Healthcare Delivery; Are we ready?

The Future of Healthcare Delivery; Are we ready? The Future of Healthcare Delivery; Are we ready? Lisa K. Saladin, PT, PhD, FAPTA Dean and Professor Medical University of South Carolina copyright LisaSaladin 2016 Objectives 1. Discuss 5 of the projected

More information

The Patient Protection and Affordable Care Act (Public Law )

The Patient Protection and Affordable Care Act (Public Law ) Policy Brief No. 2 March 2010 A Summary of the Patient Protection and Affordable Care Act (P.L. 111-148) and Modifications by the On March 23, 2010, President Obama signed into law the Patient Protection

More information

The Affordable Care Act

The Affordable Care Act The Affordable Care Act Medical City, Dallas, TX October 26, 2012 Presented by Cheryl West, MPH Director, Government Affairs, AARC Affordable Care Act (ACA) 2 What I m Not Going to Talk About 3 What I

More information

1. Measures within the program measure set are NQF-endorsed or meet the requirements for expedited review

1. Measures within the program measure set are NQF-endorsed or meet the requirements for expedited review MAP Working Measure Selection Criteria 1. Measures within the program measure set are NQF-endorsed or meet the requirements for expedited review Measures within the program measure set are NQF-endorsed,

More information

Kate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group, CMS

Kate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group, CMS Kate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group, CMS CMS support of Health Care Delivery System Reform (DSR) will result in better care, smarter spending, and healthier

More information

Innovative Coordinated Care Delivery

Innovative Coordinated Care Delivery Innovative Coordinated Care Delivery The Arizona Readmissions Summit 2015, Mesa David W. Saÿen, MBA Regional Administrator Centers for Medicare & Medicaid Services San Francisco February 12, 2015 OUR STRATEGIC

More information

CMS-0044-P; Proposed Rule: Medicare and Medicaid Programs; Electronic Health Record Incentive Program Stage 2

CMS-0044-P; Proposed Rule: Medicare and Medicaid Programs; Electronic Health Record Incentive Program Stage 2 May 7, 2012 Submitted Electronically Ms. Marilyn Tavenner Acting Administrator Centers for Medicare and Medicaid Services Department of Health and Human Services Room 445-G, Hubert H. Humphrey Building

More information

Primary goal of Administration Patients Over Paperwork

Primary goal of Administration Patients Over Paperwork Meaningful Measures Presented by: Maria Durham, Director, Kevin Larsen, MD, Director Continuous Improvement and Strategic Planning, Centers for Medicare & Medicaid Services Discussion Topics Introduction

More information

Improving Quality of Care for Medicare Patients: Accountable Care Organizations

Improving Quality of Care for Medicare Patients: Accountable Care Organizations DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Improving Quality of Care for Medicare Patients: FACT SHEET Overview http://www.cms.gov/sharedsavingsprogram On October

More information

I. Coordinating Quality Strategies Across Managed Care Plans

I. Coordinating Quality Strategies Across Managed Care Plans Jennifer Kent Director California Department of Health Care Services 1501 Capitol Avenue Sacramento, CA 95814 SUBJECT: California Department of Health Care Services Medi-Cal Managed Care Quality Strategy

More information

MEDICARE UPDATES: VBP, SNF QRP, BUNDLING

MEDICARE UPDATES: VBP, SNF QRP, BUNDLING MEDICARE UPDATES: VBP, SNF QRP, BUNDLING PRESENTED BY: ROBIN L. HILLIER, CPA, STNA, LNHA, RAC-MT ROBIN@RLH-CONSULTING.COM (330)807-2850 MEDICARE VALUE BASED PURCHASING 1 PROTECTING ACCESS TO MEDICARE ACT

More information

The Influence of Health Policy on Clinical Practice. Dr. Kim Kuebler, DNP, APRN, ANP-BC Multiple Chronic Conditions Resource Center

The Influence of Health Policy on Clinical Practice. Dr. Kim Kuebler, DNP, APRN, ANP-BC Multiple Chronic Conditions Resource Center The Influence of Health Policy on Clinical Practice Dr. Kim Kuebler, DNP, APRN, ANP-BC Multiple Chronic Conditions Resource Center Disclaimer Director: Multiple Chronic Conditions Resource Center www.multiplechronicconditions.org

More information

2014 Chapter Leadership Workshop

2014 Chapter Leadership Workshop 2014 Chapter Leadership Workshop Saturday, July 26, 2014 2:30 PM 3:00 PM Trust, But Verify: Oncology Nurses Impact on Public Policy Speaker: Alec Stone, MA, MPA Health Policy Director Oncology Nursing

More information

Health Home Overview 10/1/2013

Health Home Overview 10/1/2013 Health Home Overview Headline Goes Here Presentation Outline What is a Health Home? Health Home Functions Health Home Core Measure Set Eligibility Roles & Responsibilities Frequently Asked Questions 2

More information

Goals & Challenges for Outpatient Quality Directors. Quality HealthCare Consulting, LLC CEO: Jennifer O'Donnell, MHA, PCMH-CCE

Goals & Challenges for Outpatient Quality Directors. Quality HealthCare Consulting, LLC CEO: Jennifer O'Donnell, MHA, PCMH-CCE Goals & Challenges for Outpatient Quality Directors Quality HealthCare Consulting, LLC CEO: Jennifer O'Donnell, MHA, PCMH-CCE Objectives Learn a practical way for Quality Directors to align Quality Measures

More information

Accountable Care and the Laboratory Value Proposition. Les Duncan Director of Operations Highmark Health - Home and Community Services

Accountable Care and the Laboratory Value Proposition. Les Duncan Director of Operations Highmark Health - Home and Community Services Accountable Care and the Laboratory Value Proposition Les Duncan Director of Operations Highmark Health - Home and Community Services Agenda The Goals and Status of Delivery System Reform and Alternative

More information

HHSC Value-Based Purchasing Roadmap Texas Policy Summit

HHSC Value-Based Purchasing Roadmap Texas Policy Summit HHSC Value-Based Purchasing Roadmap Texas Policy Summit Andy Vasquez, Deputy Associate Commissioner MCS, Quality & Program Improvement Section October 19, 2017 1 HHSC Value-Based Purchasing Roadmap Topics

More information

Reimbursement Environment

Reimbursement Environment Reimbursement Environment 1 2017 Medicare Physician Fee Schedule Enhancing Integrative Medicine: CMS adopting additional care management codes in 2017 MPFS. Support patient centered and collaborative strategies.

More information

Medicare Advantage Quality Improvement Project (QIP) & Chronic Care Improvement Program (CCIP)

Medicare Advantage Quality Improvement Project (QIP) & Chronic Care Improvement Program (CCIP) Medicare Advantage Quality Improvement Project (QIP) & Chronic Care Improvement Program (CCIP) Medicare Drug and Health Plan Contract Administration Group Donna Williamson & Brandy Alston December 6, 2016

More information

Value Based Care in LTC: The Quality Connection- Phase 2

Value Based Care in LTC: The Quality Connection- Phase 2 Value Based Care in LTC: The Quality Connection- Phase 2 Joseph J. Tomaino, M.S., R.N., Principal Healthcare Transformation Consulting ChemRx/PharmMerica Geriatric Skilled Nursing Seminar December 7, 2017

More information

Quality Measurement, Population Health and Payment Reform

Quality Measurement, Population Health and Payment Reform Quality Measurement, Population Health and Payment Reform The Move from Volume to Value Dale W. Bratzler, DO, MPH, FACOI, FIDSA Professor, Colleges of Medicine and Public Health Associate Dean, College

More information

Getting Ready for the Maryland Primary Care Program

Getting Ready for the Maryland Primary Care Program Getting Ready for the Maryland Primary Care Program Presentation to Maryland Academy of Nutrition and Dietetics March 19, 2018 Maryland Department of Health All-Payer Model: Performance to Date Performance

More information

Patient Centered Medical Home: Transforming Primary Care in Massachusetts

Patient Centered Medical Home: Transforming Primary Care in Massachusetts Patient Centered Medical Home: Transforming Primary Care in Massachusetts Judith Steinberg, MD, MPH Deputy Chief Medical Officer Commonwealth Medicine UMass Medical School Agenda Overview of Patient Centered

More information

Partner with Health Services Advisory Group

Partner with Health Services Advisory Group Partner with Health Services Advisory Group Bonnie Hollopeter, LPN, CPHQ, CPEHR Health Services Advisory Group (HSAG) Quality Improvement Lead Rosalie McGinnis, MS, RN HSAG Quality Improvement Lead November

More information

RAISING THE BAR: IPRO s Medicare Quality Improvement Report for New York State ( )

RAISING THE BAR: IPRO s Medicare Quality Improvement Report for New York State ( ) RAISING THE BAR: IPRO s Medicare Quality Improvement Report for New York State (2011 2014) The Centers for Medicare & Medicaid Services (CMS) leads a national healthcare quality improvement program, which

More information

CMS in the 21 st Century

CMS in the 21 st Century CMS in the 21 st Century ICE 2013 ANNUAL CONFERENCE David Saÿen, MBA Regional Administrator Centers for Medicare & Medicaid Services San Francisco November 15, 2013 The strategy is to concurrently pursue

More information

Long-Term Care Improvements under the Affordable Care Act (ACA)

Long-Term Care Improvements under the Affordable Care Act (ACA) Long-Term Care Improvements under the Affordable Care Act (ACA) South Carolina Health Care Implementation Coalition September 17, 2010 JoAnn Lamphere, DrPH Director, State Government Relations Health &

More information

Critical Access Hospital Quality

Critical Access Hospital Quality Critical Access Hospital Quality Current Performance and the Development of Relevant Measures Ira Moscovice, PhD Mayo Professor & Head Division of Health Policy & Management School of Public Health, University

More information

Leveraging Wellness Visit with Medicare: Improving Income and Patient Outcomes

Leveraging Wellness Visit with Medicare: Improving Income and Patient Outcomes Leveraging Wellness Visit with Medicare: Improving Income and Patient Outcomes Overview Why Medicare Wellness Exams What are the Medicare Wellness Exams Annual Wellness Exam Components What is covered

More information

Draft Covered California Delivery Reform Contract Provisions Comments Welcome and Encouraged

Draft Covered California Delivery Reform Contract Provisions Comments Welcome and Encouraged TO: FROM: RE: State Based Marketplaces State Medicaid Directors Delivery Reform/Value Promoting Colleagues Peter V. Lee, Executive Director Draft Covered California Delivery Reform Contract Provisions

More information

MAP 2017 Considerations for Implementing Measures in Federal Programs: Hospitals

MAP 2017 Considerations for Implementing Measures in Federal Programs: Hospitals MEASURE APPLICATIONS PARTNERSHIP MAP 2017 Considerations for Implementing Measures in Federal Programs: Hospitals FINAL REPORT FEBRUARY 15, 2017 This report is funded by the Department of Health and Human

More information

A New Vision for the Quality Improvement Organization Program

A New Vision for the Quality Improvement Organization Program A New Vision for the Quality Improvement Organization Program This material was prepared by Masspro, the Medicare Quality Improvement Organization for Massachusetts, under contract with the Centers for

More information

2 nd Annual PPS Quality and Patient Safety Conference

2 nd Annual PPS Quality and Patient Safety Conference 2 nd Annual PPS Quality and Patient Safety Conference Jointly Sponsored by MHA and Stratis Health Welcome and Introduction Jennifer Lundblad, PhD, MBA, President & CEO, Stratis Health Healthcare-Centric

More information

Final Rule Summary. Medicare Skilled Nursing Facility Prospective Payment System Fiscal Year 2016

Final Rule Summary. Medicare Skilled Nursing Facility Prospective Payment System Fiscal Year 2016 Final Rule Summary Medicare Skilled Nursing Facility Prospective Payment System Fiscal Year 2016 August 2015 Table of Contents Overview and Resources... 2 SNF Payment Rates... 2 Effect of Sequestration...

More information

Improving the Continuum of Care: Progress on Selected Provisions of the Affordable Care Act One Year Post-Passage

Improving the Continuum of Care: Progress on Selected Provisions of the Affordable Care Act One Year Post-Passage Improving the Continuum of Care: Progress on Selected Provisions of the Affordable Care Act One Year Post-Passage March 23, 2011 marks the oneyear anniversary of the signing of the Patient Protection and

More information

Protecting Access to Medicare Act of 2014

Protecting Access to Medicare Act of 2014 Protecting Access to Medicare Act of 2014 Protects Current Medicare Beneficiaries Doc Fix : Prevents the 24% cut in reimbursement to doctors who treat Medicare patients on April 1, 2014 and replaces it

More information

Note: Accredited is the highest rating an exchange product can have for 2015.

Note: Accredited is the highest rating an exchange product can have for 2015. Quality Overview Accreditation Exchange Product Accrediting Organization: NCQA HMO (Exchange) Accreditation Status: Accredited Note: Accredited is the highest rating an exchange product can have for 215.

More information

Medicare Quality Improvement Initiatives

Medicare Quality Improvement Initiatives Medicare Quality Improvement Initiatives Participation Opportunities in Minnesota February 2016 Achieve national quality goals in Minnesota. Join Stratis Health in working to achieve the Centers for Medicare

More information

Quality Measurement Approaches of State Medicaid Accountable Care Organization Programs

Quality Measurement Approaches of State Medicaid Accountable Care Organization Programs TECHNICAL ASSISTANCE TOOL September 2014 Quality Measurement Approaches of State Medicaid Accountable Care Organization Programs S tates interested in using an accountable care organization (ACO) model

More information

Medicare & Medicaid EHR Incentive Programs. Stage 2 Final Rule Updates October 2, 2012 Rick Hoover & Andy Finnegan

Medicare & Medicaid EHR Incentive Programs. Stage 2 Final Rule Updates October 2, 2012 Rick Hoover & Andy Finnegan Medicare & Medicaid EHR Incentive Programs Stage 2 Final Rule Updates October 2, 2012 Rick Hoover & Andy Finnegan What is in the Rule Changes to Stage 1 of meaningful use Stage 2 of meaningful use New

More information

=======================================================================

======================================================================= ======================================================================= ----------------------------------------------------------------------- DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of the Secretary

More information

Accountable Care Organizations Under Medicare Shared Savings Program PROPOSED RULE

Accountable Care Organizations Under Medicare Shared Savings Program PROPOSED RULE Accountable Care Organizations Under Medicare Shared Savings Program PROPOSED RULE The information in this document summarizes a proposed rule issued by the Centers for Medicare and Medicaid id Services.

More information

IHA District Meetings February-March, : Iowa Environmental Assessment in Quality and Patient Safety HEN, QIN, TCPI, SIM

IHA District Meetings February-March, : Iowa Environmental Assessment in Quality and Patient Safety HEN, QIN, TCPI, SIM IHA District Meetings February-March, 2015 2015: Iowa Environmental Assessment in Quality and Patient Safety HEN, QIN, TCPI, SIM Looking Back 10 Years Ago IHA, AHA, CMS, IFMC, State of Iowa, JCAHO, AHRQ

More information

Meaningful Use Stage 2

Meaningful Use Stage 2 Meaningful Use Stage 2 Objectives Gain understanding of the changes Focus on Transitions in Care and Patient Engagement Recognize the increasing HIE role Who Are You? What is YOUR Need Today? A. Office

More information

What Have we Learned from the Pioneer ACO Model?

What Have we Learned from the Pioneer ACO Model? What Have we Learned from the Pioneer ACO Model? Sherly Binu, CMMI December 7, 2016 Disclaimers 2 This presentation was prepared as a tool to assist providers and is not intended to grant rights or impose

More information

Healthcare Transformation and the Affordable Care Act David Nilasena, MD, MSPH, MS Chief Medical Officer, CMS Region VI

Healthcare Transformation and the Affordable Care Act David Nilasena, MD, MSPH, MS Chief Medical Officer, CMS Region VI National Readmission Prevention Collaborative Dallas, TX October 22, 2015 Healthcare Transformation and the Affordable Care Act David Nilasena, MD, MSPH, MS Chief Medical Officer, CMS Region VI Disclaimers

More information

Examples of Measure Selection Criteria From Six Different Programs

Examples of Measure Selection Criteria From Six Different Programs Examples of Measure Selection Criteria From Six Different Programs NQF Criteria to Assess Measures for Endorsement 1. Important to measure and report to keep focus on priority areas, where the evidence

More information

Division C: Increasing Choice, Access, and Quality in Health Care for Americans TITLE XV: Provisions Relating to Medicare Part A

Division C: Increasing Choice, Access, and Quality in Health Care for Americans TITLE XV: Provisions Relating to Medicare Part A Division C: Increasing Choice, Access, and Quality in Health Care for Americans TITLE XV: Provisions Relating to Medicare Part A Sec. 15001. Development of Medicare study for HCPCS versions of MS-DRG codes

More information

Using population health management tools to improve quality

Using population health management tools to improve quality Using population health management tools to improve quality Jessica Diamond, MPA, CPHQ Chief Population Health Officer CHCANYS Statewide Conference and Clinical Forum Sunday, October 18, 2015 Introduction

More information

Medicare & Medicaid EHR Incentive Programs. Stage 2 Final Rule Travis Broome AMIA

Medicare & Medicaid EHR Incentive Programs. Stage 2 Final Rule Travis Broome AMIA Medicare & Medicaid EHR Incentive Programs Stage 2 Final Rule Travis Broome AMIA 9-20-2012 What is in the Rule Changes to Stage 1 of meaningful use Stage 2 of meaningful use New clinical quality measures

More information

Health Care Systems - A National Perspective Erica Preston-Roedder, MSPH PhD

Health Care Systems - A National Perspective Erica Preston-Roedder, MSPH PhD Health Care Systems - A National Perspective Erica Preston-Roedder, MSPH PhD Outline Quality Overview Overview and discussion of CMS programs Increasing transparency Move from P4R to P4P Expanding beyond

More information

CareMore Special Needs Plans Model of Care. Annual Evaluation 2015 Performance

CareMore Special Needs Plans Model of Care. Annual Evaluation 2015 Performance CareMore Special Needs Plans Model of Care Annual Evaluation 2015 Performance The Special Needs Plans (SNPs) Medicare SNPs are a type of Medicare Advantage Plan (like an HMO or PPO). Medicare SNPs limit

More information

For audio, dial: ; Meeting/Event Number:

For audio, dial: ; Meeting/Event Number: November 7, 2011 For audio, dial: 1-877-668-4490; Meeting/Event Number: 710 239 432 The Integrated Care Resource Center, a joint initiative of the Centers for Medicare & Medicaid Services Medicare-Medicaid

More information

7/7/17. Value and Quality in Health Care. Kevin Shah, MD MBA. Overview of Quality. Define. Measure. Improve

7/7/17. Value and Quality in Health Care. Kevin Shah, MD MBA. Overview of Quality. Define. Measure. Improve Value and Quality in Health Care Kevin Shah, MD MBA 1 Overview of Quality Define Measure 2 1 Define Health care reform is transitioning financing from volume to value based reimbursement Today Fee for

More information

FirstHealth Moore Regional Hospital. Implementation Plan

FirstHealth Moore Regional Hospital. Implementation Plan FirstHealth Moore Regional Hospital Implementation Plan FirstHealth Moore Regional Hospital Implementation Plan For 2016 Community Health Needs Assessment Summary of Community Health Needs Assessment Results

More information

A Place at the Table: Behavioral Health and CMS Physician Quality Reporting System

A Place at the Table: Behavioral Health and CMS Physician Quality Reporting System : Behavioral Health and CMS Physician Quality Reporting System Table of Contents Introduction... 1 CMS Quality Strategy and Behavioral Health... 2 Overview of the Physician Quality Reporting System...

More information

CCHS: Quality and Patient Safety. J Michael Henderson, MD Guido Bergomi

CCHS: Quality and Patient Safety. J Michael Henderson, MD Guido Bergomi CCHS: Quality and Patient Safety J Michael Henderson, MD Guido Bergomi Outline Integrated Quality & Safety structure Quality Goals and Performance Improvement Quality data sources Quality Reporting The

More information

A Systems Approach to Achieve the Triple Aim

A Systems Approach to Achieve the Triple Aim 12/5/2012 A Systems Approach to Achieve the Triple Aim George Isham, MD, MS Senior Advisor HealthPartners Institute of Medicine: Workshop on Core Metrics for Better Care, Lower Costs & Better Health Ants

More information

Medicare & Medicaid EHR Incentive Programs. Stage 2 Final Rule Pennsylvania ehealth Initiative All Committee Meeting November 14, 2012

Medicare & Medicaid EHR Incentive Programs. Stage 2 Final Rule Pennsylvania ehealth Initiative All Committee Meeting November 14, 2012 Medicare & Medicaid EHR Incentive Programs Stage 2 Final Rule Pennsylvania ehealth Initiative All Committee Meeting November 14, 2012 What is in the Rule Changes to Stage 1 of meaningful use Stage 2 of

More information

IT Enabled Quality Measurement IOM Dec 2012

IT Enabled Quality Measurement IOM Dec 2012 IT Enabled Quality Measurement IOM Dec 2012 Kevin Larsen MD, FACP Medical Director of Meaningful Use, ONC December 6, 2012 Our National Quality Strategy Aims Better Health for the Population Better Care

More information

South Dakota Health Homes Care Coordination Innovation

South Dakota Health Homes Care Coordination Innovation South Dakota Health Homes Care Coordination Innovation Senator Deb Soholt NCSL Health Innovation Task Force December 6, 2016 South Dakota Health Homes Health Homes (HH)- provide enhanced health care services

More information

Colorado Choice Health Plans

Colorado Choice Health Plans Quality Overview Health Plans Accreditation Exchange Product Accrediting Organization: Accreditation Status: URAC Health Plan Accreditation (Marketplace ) Full Full: Organization demonstrates full compliance

More information

Special Needs Plan Model of Care Chinese Community Health Plan

Special Needs Plan Model of Care Chinese Community Health Plan Special Needs Plan Model of Care 2017 2017 Chinese Community Health Plan Elements of CCHP SNP Model of Care Special Needs Plan (SNP) Goals CCHP Dual Eligible SNP Enrollment & Eligibility Vulnerable Beneficiaries

More information

Overview of Six Texas Demonstrations

Overview of Six Texas Demonstrations Texas Case Study: Document 2 Overview of Six Texas Demonstrations The chart below provides an overview of six Texas demonstrations. Where possible, the chart indicates the purpose of the demonstration,

More information

Submission #1. Short Description: Medicare Payment to HOPDs, Section 603 of BiBA 2015

Submission #1. Short Description: Medicare Payment to HOPDs, Section 603 of BiBA 2015 Submission #1 Medicare Payment to HOPDs, Section 603 of BiBA 2015 Within the span of a week, Section 603 of the Bipartisan Budget Act of 2015 was enacted. It included a significant policy/payment change

More information

Medicare & Medicaid EHR Incentive Programs. Stage 2 Final Rule Jason McNamara Technical Director for Health IT HIMSS Meeting April 25, 2013

Medicare & Medicaid EHR Incentive Programs. Stage 2 Final Rule Jason McNamara Technical Director for Health IT HIMSS Meeting April 25, 2013 Medicare & Medicaid EHR Incentive Programs Stage 2 Final Rule Jason McNamara Technical Director for Health IT HIMSS Meeting April 25, 2013 What is in the Rule Changes to Stage 1 of meaningful use Stage

More information

The Inpatient Rehabilitation Facility Quality Reporting Program. Overview. Legislative Mandate. Anne Deutsch, RN, PhD, CRRN

The Inpatient Rehabilitation Facility Quality Reporting Program. Overview. Legislative Mandate. Anne Deutsch, RN, PhD, CRRN The Inpatient Rehabilitation Facility Quality Reporting Program Anne Deutsch, RN, PhD, CRRN UDSMR Annual Conference August 8, 2013 is a trade name of Research Triangle Institute. UDSMR is a trademark of

More information

Calendar Year 2014 Medicare Physician Fee Schedule Final Rule

Calendar Year 2014 Medicare Physician Fee Schedule Final Rule Calendar Year 2014 Medicare Physician Fee Schedule Final Rule Non-Facility Cap After receiving many negative comments on this issue from physician groups, along with the House GOP Doctors Caucus letter

More information

Person Centered Agenda

Person Centered Agenda 1 Person Centered Agenda Initial Confusion Overwhelmed by Statistics and Acronyms Dramatic Engagement of Issue Extreme Interest and Curiosity Deep Sense of Relief SAMHSA S STRATEGIC INITIATIVES Leading

More information

Evolving Roles of Pharmacists: Integrating Medication Management Services

Evolving Roles of Pharmacists: Integrating Medication Management Services Evolving Roles of Pharmacists: Integrating Management Services Marie Smith, PharmD, FNAP Palmer Professor and Assistant Dean, Practice and Policy Partnerships UCONN School of Pharmacy (marie.smith@uconn.edu)

More information

United Medical ACO Participation Criteria

United Medical ACO Participation Criteria United Medical ACO Participation Criteria Items Requiring Practice Reporting 1) Submission of Reports: Practices must report A,B, and C to UMACO A. Thirty-four ACO Quality Measures -See Appendix A B. Average

More information

Leading Change: Using Quality Improvement Strategies, Data, and Culture to Drive Practice Transformation: The Power of Learning Networks

Leading Change: Using Quality Improvement Strategies, Data, and Culture to Drive Practice Transformation: The Power of Learning Networks Leading Change: Using Quality Improvement Strategies, Data, and Culture to Drive Practice Transformation: The Power of Learning Networks Annual Summer Institute hosted by Arizona State University July

More information

FIDA. Care Management for ALL

FIDA. Care Management for ALL Care Management for ALL In 2011, Governor Andrew M. Cuomo established a Medicaid Redesign Team (MRT), which initiated significant reforms to the state s Medicaid program. This included a critical initiative

More information

Small Rural Hospital Transitions (SRHT) Project. Rural Relevant Measures: Next Steps for the Future

Small Rural Hospital Transitions (SRHT) Project. Rural Relevant Measures: Next Steps for the Future Small Rural Hospital Transitions (SRHT) Project Rural Relevant Measures: Next Steps for the Future Paul Moore, DPh Senior Health Policy Advisor Federal Office of Rural Health Policy, Health Resources &

More information