P R E S E N T E D T O August 2017
Background & Disclosure Background: President & Chief Strategy Officer of Diameter Health o Diameter Health enables clinical insights through the normalization, cleansing, de-duplication and enrichment of medical data from across the care continuum. This provides a single, unified source of longitudinal structured patient information which can be the basis for improved care and actionable analytics. Technical Advisor to NCQA (National Committee for Quality Assurance) Editor on HL7 C-CDA Standard Published researcher on quality measurement and medical interoperability Disclosure: John D Amore receives salary and equity based compensation from Diameter Health, Inc. He is also adjunct faculty in informatics at Boston University
Quality Programs Value Based Payment Measure Submission Calculation Clinical Data Quality Report Health Information Exchange HEDIS & STAR Clinicians Custom Data Registries Hospitals Quality Report Claims Data Calculation Measure Submission Clearinghouse Value Based Payment Payers IQR ACO & More
Hospitals Clinicians Exchange Payers Advantage Many hospital measures are episodic Clinical data from one system eases calculation Strongest source of longitudinal clinical data Strongest source of longitudinal claims data Challenge Lacks longitudinal data for long-term outcome evaluation Multi-source clinical data normalization Relatively new program Multi-source clinical data normalization Incomplete clinical data and latency of claims data
Messy Clinical Data Platelet count 10E3/UL x10^3 10^3/UL 1000/UL K/uL THOU/mcl 10x3/ul x10e9/l 10^3/mcl x10+3 10-3/MCL 10*9/L k/mm3 {#}/UL Thousand/uL Thousand per microliter (10*3/uL) Discharge Med 97157 atorvastatin 597970 atorvastatin 10 MG 617318 Lipitor 20MG Oral Tablet 597966 atorvastatin 20 MG 63629-3366-1 Lipitor 80, film coated 329299 atorvastatin 80 MG UNK LIPITOR 617312 atorvastatin 10 MG Oral Tablet 42291-143 atorvastatin calcium 10 mg Oral 617311 atorvastatin 40 MG Oral Tablet 259255 atorvastatin 80 MG Oral Tablet 153165 Lipitor 617314 Lipitor 10MG Oral Tablet 617310 atorvastatin 20 MG Oral Tablet 617320 Lipitor 40MG Oral Tablet 262095 Lipitor 80MG Oral Tablet 83366 atorvastatin calcium 1483793 atorvastatin calcium propylene glycol solvate 1297766 atorvastatin calcium trihydrate 63629-3366 Lipitor 80 mg Oral Tablet 597983 atorvastatin 40 MG OTH atorvastatin pill atorvastatin (RxCUI = 83367) HMG CoA Reductase Inhibitor
HEDIS Program Evolution Program Background HEDIS = Health Effectiveness Data & Information Set Used by 90+% of Health Plans with 91 measures Overlap with STARs program affecting Medicare Advantage payments NCQA is national authority over the program Before Meaningful Use Attempts to attach key clinical data to claims Attempts to setup direct information feeds (e.g. HL7 v2) Data Falls into Two Categories Standard Supplemental Data Non-Standard Supplemental Data
Qualified Clinical Data Registry Program Background The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) streamlined a collection of multiple quality programs into a single program system that rewards where clinicians have the opportunity to be rewarded for better care. Centers for Medicare & Medicaid Services (CMS) approved QCDRs to collect clinical data from clinicians (both individual and groups) and submit on their behalf. CMS is national authority over the program Who are QCDRs? ~110 organizations Mix of Vendors, Societies, HIEs Not all do all measures
Principles of Future Quality Measurement 1. A Measure is a Measure Different programs and certifications will be harmonized for future measures definitions to provide so that there is consistency across programs 2. Longitudinal Data Wins HEDIS measure calculation fundamentally assumes complete patient data. While EHRs were an attractive target for quality measurement as part of Meaningful Use, the accuracy of quality measures calculated using only a portion of patient clinical data is compromised 3. Timely Measurement Informs Improvement Systems which are real time electronic and automated - and complete will help clinicians close gaps in care 4. Certification Reduces Audit Burden Systems which are robustly tested and certified for quality measurement will produce data and reporting that can reliably be trusted without intrusive, expensive auditing