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1_13_12 LDI/CHIPS Health Policy Seminar-- Building High Value in Health Systems: The Role of Performance Measurement
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1_13_12 LDI/CHIPS Health Policy Seminar-- Building High Value in Health Systems: The Role of Performance Measurement






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  • Bullet 2 - Triple aim may need to be explained: healthy people/communities, better care, more affordable care
  • Wendy to speak to
  • Pre-Rulemaking Process and TimelineNovemberCoordinating Committee (CC) finalized measure selection criteriaCC reviewed MAP workgroup evaluations of core measure sets and gap conceptsDuals Workgroup provided cross-cutting input to other workgroupsDecemberUsing measure selection criteria, core sets, gaps, and input from Duals Workgroup as tools, setting-specific MAP workgroups assess HHS-proposed measures for Federal programs and provide input to CC (December 12, 14, 15)Duals workgroup checks progress of other groups (December 16)JanuaryCC reviews setting-specific recommendations from MAP workgroups and cross-cutting recommendations regarding Duals (January 5-6)CC finalizes input to HHS for February 1report

1_13_12 LDI/CHIPS Health Policy Seminar-- Building High Value in Health Systems: The Role of Performance Measurement 1_13_12 LDI/CHIPS Health Policy Seminar-- Building High Value in Health Systems: The Role of Performance Measurement Presentation Transcript

  • Building High ValueHealth Systems:The Role ofPerformanceMeasurement
  • Presentation at a Glance Role of the National Quality Forum in the Performance Measurement Enterprise National Priorities and Strategies to Achieve Value Measurement Framework and Portfolio Focused on Value Accountability Programs that Encourage and Reward HVHSs 2
  • Role of the National Quality Forum Private, non profit established in 1999 ▫ Non-partisan; Washington, DC based Mission is to improve the performance of the nation’s healthcare system Supported by public dollars, membership dues and private foundations Board and 450 plus members includes varied stakeholders 3
  • Roles of the National Quality Forum Private sector standard setting organization ▫ National Technology Transfer and Advancement Act ▫ Measures, serious reportable events, best practices Neutral convener ▫ National Priorities Partnership (NPP) and Measure Applications Partnership (MAP) ▫ Multi-stakeholder ▫ Public-private sector ▫ Serve in advisory capacity to HHS and others 4
  • Value Agenda Strategy Accreditation Health IT Value-based Public & Certification Incentives Payment Reporting Prioritize Measure Improve Accountability ProgramsNational Quality Standardized & Strategy Measures HVHS Improvement Efforts Infrastructure Support Electronic Data Platform Quality Data Model Measure Authoring Tool 5
  • Presentation at a Glance Role of the National Quality Forum in the Performance Measurement Enterprise National Priorities and Strategies to Achieve Value Measurement Framework and Portfolio Focused on Value Accountability Programs that Encourage and Reward HVHSs 6
  • National Quality StrategyStatutory Authority Health reform legislation, the Affordable Care Act (ACA), requires the Secretary of Health and Human Services to “establish a national strategy to improve the delivery of healthcare services, patient health outcomes, and population health.” ▫ HR 3590 3011, amending the Public Health Service Act (PHSA) by adding 399HH (a)(1) 7
  • ACA: A Framework & Resources forMeasurement-Based Improvement HHS must develop a National Quality Strategy (NQS) to make care safe, effective and affordable NQS to be shaped – and specified – with input from diverse healthcare leaders in the field of health and healthcare Coordination and alignment within the Federal government and across the public and private sectors is key to the ultimate success of the NQS in transforming the US healthcare system 8
  • National Priorities Partnership:Provides Input to HHS Convened by the NQF – viewed as objective, neutral and experienced in building consensus 51 leaders across every key health and healthcare sector ▫ Consumers ▫ Purchasers ▫ Quality alliances ▫ Health professionals/providers ▫ State-based associations ▫ Community collaboratives & regional alliances ▫ Accreditation/certification groups ▫ Health plans ▫ Industry ▫ Federal agencies (AHRQ, CDC, CMS, FDA, HRSA, NIH, OMH, SAMHSA, VA) Co-Chairs ▫ Bernie Rosof, Physician Consortium for Performance Improvement ▫ Helen Darling, National Business Group on Health © National Priorities Partnership 9
  • National Priorities Partnership Responsibilities October 2010: NPP provides input to HHS to inform the development of the NQS March 2011: HHS issues NQS based on the triple aim September 2011: NPP input to HHS helps to make NQS more actionable: ▫ Identification of goals and measures ▫ Recommendation of strategic opportunities ▫ Consensus across key leaders about where they should drive their organizations © National Priorities Partnership 10
  • HHS’s National Quality Strategy Aimsand Priorities © National Priorities Partnership 11
  • NPP INPUT ON HHS’S NATIONAL PRIORITIES: Prevention and Treatment of Cardiovascular DiseaseGoals:Promote cardiovascular health through: Community interventions (e.g, access to healthy food and recreational facilities Adoption of healthy lifestyle behaviors (e.g., tobacco cessation) Delivery of clinical preventive services (e.g., to achieve blood pressure and cholesterol control)Measure Concepts: Access to healthy foods  Consumption of calories from fats Access to recreational facilities and sugars Tobacco use by adults and  Control of high blood pressure adolescents  Control of high cholesterol 12
  • Measurement Cascade of National Priority 13
  • NPP Report:Three Sets of Strategies One: A national strategy for data collection, measurement and reporting that supports measurement-based improvement so we know “how we are doing” against the NQS Two: Payment and delivery system reform—emphasizing primary care—that rewards value over volume and promotes patient-centered outcomes, efficiency, and appropriate care while reducing waste Three: Community infrastructure (public-private) responsible for improvement efforts, resources for benchmarking and comparing performance; and mechanisms to identify, share and evaluate progress 14
  • Presentation at a Glance Role of the National Quality Forum in the Performance Measurement Enterprise National Priorities and Strategies to Achieve Value Measurement Framework and Portfolio Focused on Value Accountability Programs that Encourage and Reward HVHSs 15
  • Portfolio of NQF-Endorsed Measures  700 Measures in portfolio – all settings, all levels  Evaluation Criteria ▫ Importance ▫ Scientific Acceptability ▫ Usability ▫ Feasibility  Constantly Evolving ▫ Raise the bar ▫ Composite measures ▫ Harmonize across sites  Disparities in all we do 16
  • 2D Framework for Measure Development National Quality Strategy Priorities ▫ Population health, prevention, person/family-centered care, safety, communication/coordination, affordable care Patient Focused Episodes ▫ Top 20 Medicare Conditions ▫ Child Health Conditions 17
  • 2-D Measurement Framework: AMI Episode Post AMI Trajectory 1 (T1) Relatively healthy adult Patient & Family Focus on: Engagement • Secondary prevention • Quality of Life Care Coordination • Functional Status • Advanced care planning Population Health 10 Prevention Post Acute/ Acute Rehabilitation 20 Prevention Phase 20 Prevention Phase (CAD with prior AMI) Post AMI Trajectory 2 (T2) PHASE 2 PHASE 3 PHASE 4 Adult with multiple co-morbidities Focus on: PHASE 1 • Palliative Care • Functional Status Living w/ Illness/Disability (T1) • Advanced Care Planning Staying Healthy Getting Better Coping w/ End of Life (T2) Population Health Overuse Episode begins – onset of Episode ends – 1 symptoms year post AMI Safety 18
  • Quality Measurement in EvolutionPatient-level outcomes (better health) Morbidity and mortality Functional status Health-related quality of life Patient experience of careProcesses of care (better care) Clinical processes tightly linked to outcomes Care coordination and transitions Patient engagement and alignment with patient preferencesProcesses of care (affordable care) Per capita cost Total cost of care Patient out of pocket cost 19
  • Sample Measurement Cascade—Tobacco Use National National Rates of Smoking/Tobacco UseState/Community State Rates of Smoking/Tobacco Use Community Rates of Smoking/Tobacco Use State Pricing Policies on Tobacco Products Health Plan Population Health Plan Population Health Plan Population Health Plan Beneficiary Health Plan of Smokers/Tobacco Users of Smokers/Tobacco Users Offered Smoking of Smokers/Tobacco Quit Rates Incentives for Smoking Cessation Cessation Provider-Level Percentage of Percentage of Smoker Provider Population Rates of Smokers/Tobacco Smoker/Tobacco User Population Offered Provider-Level Quit Rates Referred for Community-Based Users Smoking Cessation Smoking Cessation Clinician/Health Clinician-Level Rates of Patients Who Are Percentage of Patients Who Are Smokers Clinician-Level Quit Percentage of Smokers Referred for Smokers/Tobacco Offered Smoking Rates Community-Based Professional Users Cessation Smoking Cessation Percentage of SmokersPatient/Consumer Who Engage in Behaviors to Stop Smoker/Tobacco User Quit Rates Smoking
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  • Presentation at a Glance Role of the National Quality Forum in the Performance Measurement Enterprise National Priorities and Strategies to Achieve Value Measurement Framework and Portfolio Focused on Value Accountability Programs that Encourage and Reward HVHSs 22
  • Applying Performance Information Accountability Public health/disease Accreditation Performance-Quality improvement surveillance and regulation based payment Improve Quality improvement HIT incentive Consumer Care Certification with benchmarking payments choice Transparency 23
  • Organization and Payment:Selection of Performance Measures
  • Measure Applications PartnershipStatutory Authority Health reform legislation, the Affordable Care Act (ACA), requires HHS to contract with the consensus-based entity (i.e., NQF) to “convene multi-stakeholder groups to provide input on the selection of quality measures” for public reporting, payment, and other programs. ▫ HR 3590 3014, amending the Social Security Act (PHSA) by adding 1890(b)(7) 25
  • Measure Applications Partnership MAP Coordinating Committee Membership AARP George Isham, MD, MS chairs Co- Academy of Managed Care Pharmacy AdvaMed Elizabeth McGlynn, PhD, MPP AFL-CIO Richard Antonelli, MD, MS Subject Matter America’s Health Insurance Plans Bobbie Berkowitz, PhD, RN, CNAA, FAAN Experts American College of Physicians Joseph Betancourt, MD, MPHOrganizational Members American College of Surgeons Ira Moscovice, PhD American Hospital Association Harold Pincus, MD American Medical Association Carol Raphael, MPA American Medical Group Association Agency for Healthcare Research and Quality Federal Government American Nurses Association Centers for Disease Control and Prevention Centers for Medicare & Medicaid Services Members Catalyst for Payment Reform Consumers Union Health Services and Resources Administration Federation of American Hospitals LeadingAge Office of Personnel Management/FEHBP Maine Health Management Coalition Office of the National Coordinator for HIT National Association of Medicaid Directors Certification Accreditatio American Board of Medical Specialties National Partnership for Women and Families Liaisons National Committee for Quality Assurance Pacific Business Group on Health n/ The Joint Commission 26
  • MAP Pre-Rulemaking Input to HHSRecommendations in three sections: Vision for harmonized performance measurement Measure selection ▫ Criteria ▫ Measure-by-measure analysis Core measures sets 27
  • MAP Measure Selection Criteria1. Measures meet NQF endorsement criteria2. Measure set adequately addresses the National Quality Strategy priorities3. Measure set adequately addresses high-impact conditions relevant to the program’s intended population(s) (e.g., children, adult non-Medicare, older adults, dual eligible beneficiaries)4. Measure set promotes alignment with specific program attributes (i.e., intended setting(s), level(s) of analysis, and population(s) 28
  • MAP Measure Selection Criteria5. Measure set includes appropriate mix of measure types (i.e., outcome, process, experience of care, cost, structure)6. Measure set enables measurement across the patient- focused episode of care7. Measure set includes considerations for healthcare disparities8. Measure set promotes parsimony 29
  • Pre-Rulemaking Guidance: Process and Timeline Clinician List of Measures Workgroup from HHS for Pre- Meeting Public Rulemaking Dec 12 Comment Analysis PAC/LTC Workgroup Meeting Dec 14 Coordinating Coordinating All MAP Coordinating Committee Committee Hospital Workgroups Committee Workgroup Pre-Rulemaking Nov 1-2 Meeting Dec 8 January 5-6 Analysis Dec 15 In-Person In-Person Web Meeting Meeting Final Report Meeting Duals February 1 Workgroup Meeting Dec 16 30
  • MAP Pre-Rulemaking Approach Vision • National Quality Strategy • Coordinated and accountable care delivery models • Measurement Tactics • Cascading measure sets focused on value • Harmonized measures across settings and populations Clinician Hospital PAC/LTC Core = Available Measures + Core = Available Measures + Core = Available Measures + Gap Concepts Gap Concepts Gap Concepts MAP Input on HHS Proposed Program Measure Sets Outpatient ESRD Hospital Quality Long-Term PQRS Quality Hospice EHR Incentive Program VBP Incentive Care Reporting Care Program Hospitals Program Inpatient Inpatient Skilled Programs Listed for Quality Cancer Psychiatric Rehab Home Nursing Hospitals Hospitals Illustrative Purposes Reporting Facilities Health Care Facilities Program Coordinated Delivery Programs (ACOs) 31
  • Aligning Accountability Programs with Value: The Performance Measurement Enterprise Electronic Alignment of Evaluation Priorities and Standardized Data Environmental and Strategies Measures Platform Drivers FeedbackNational Quality NQF Endorsement Quality Data Model Measures Applications Measure Use Strategy Process Partnership Measure Authoring Impact on National Tool Quality Positioning Health, Health Priorities System Care, and Cost Partnership High Impact Conditions 32
  • In summary, we all must align efforts todrive change…focus on the same set of priorities and goals laid out in the NQS…withpublic and private sectors rowing in the same direction, at the same time,for shared and important gains in improving health.…recognize that the key to health and well-being begins long before anindividual enters the healthcare system and collaborate within communitiesto accelerate progress on healthy behaviors and social determinants ascontributors to health.…use the same data platforms, measures, and public reporting ofperformance .…send unified signals to the market about incentives and rewards.…take great strides to find places where both public and private sectors canmake gains individually and in partnership removing unnecessary andburdensome fragmentation and complexity. 33