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Health Datapalooza 2013: Employer Use of Healthcare Data and Evidence to Improve Quality and Value - Deborah Greene


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Health Datapalooza IV: June 3rd-4th, 2013
Employer Use of Health Care Data and Evidence to Improve Quality and Value: What Is Working and How Do We Facilitate It

E.J. “Ned” Holland, Jr., Assistant Secretary for Administration, US Department of Health and Human Services (HHS)

Cristie Upshaw Travis, Chief Executive Officer, Memphis Business Group on Health
Lisa Wear-Ellington, President & Chief Executive Officer, South Carolina Business Coalition on Health
William Freeman, Staff Service Fellow, Center for Delivery, Organization, and Markets, Agency for Healthcare Research & Quality (AHRQ)
Keith T. Kanel, Chief Medical Officer (CMO), Pittsburgh Regional Health Initiative
Deborah Greene, Center for Consumer Information and Insurance Oversight, Centers for Medicare and Medicaid Services, Centers for Medicare and Medicaid Services (CMS)
Niall Brennan, Director, Office of Information Products and Data Analytics, Centers for Medicare & Medicaid Services (CMS)
Irene Fraser, Director, Center for Delivery, Organization, & Markets, Agency for Healthcare Research & Quality (AHRQ)

New variations in health care quality and value are a huge priority for employers. Poor quality and unnecessary cost negatively affect the health of employees and their families, the firms’ bottom line, and firm productivity and competitiveness. The panel will review four strategies with existing examples that employers, employer coalitions, and multi-stakeholder groups are using to improve health care quality and value. Discussion will focus on several questions: How can data and tools for each strategy be strengthened? How can the power and utility of data and supporting evidence be increased? How can the alignment and combined power of public and private efforts be maximized?

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Health Datapalooza 2013: Employer Use of Healthcare Data and Evidence to Improve Quality and Value - Deborah Greene

  1. 1. Quality Rating System-Focus on AlignmentDeborah Greene, MPHJune 2013
  2. 2. Statutory Requirements of the Quality RatingSystem• Section 1311(c)(3) directs the Secretary to develop a quality rating ineach benefit level based on quality and price, and to publicly reportinformation to consumers• Section 1311(c)(4) directs the Secretary to develop an enrolleesatisfaction survey and to publicly report information to consumers• In future rulemaking, we intend to establish that:– The Quality Rating System (QRS) will be publically available for thefirst time in 2016• Qualified Health Plan (QHP) issuers will report data for a BetaTest in mid-2015 (on 2014 care), which will be used for testing onlyand not be publicly reported• QHP issuers will report data for rating in mid-2016 (on 2015 care),for Fall 2016 open enrollment (2017 coverage year)2
  3. 3. QRSMeasure Selection Approach
  4. 4. Sources for Measure Scan• The sources for the measures scan included national measuresets as well as a variety of accountability programs in the publicand private sector (e.g. accrediting entities, evalu8)• The national measure sets that were included in the scan wereselected primarily from CMS and include:– Adult Medicaid Core Set– Initial Core Set of Children’s Health Care Quality Measures– Medicare Part C and Part D Reporting Requirements4
  5. 5. Draft QRS Preliminary Measure SetCharacteristics• The draft QRS preliminary measure set includes the followingcharacteristics– Comprised of measures from but not limited to the following sources:• Healthcare Effectiveness and Data Information Set (HEDIS®)• Consumer Assessment of Healthcare Providers and Systems (CAHPS ®) which arebeing incorporated in the QHP Enrollee Satisfaction Survey• Medicare Stars• eValue8– Includes a mix of measure categories that are common across publicreporting programs– Includes mostly NQF-endorsed measures– Is strongly aligned with priority measure sets, EHB requirements, and CMSprograms– Addresses all National Quality Strategy priorities• CMS is considering a phase-in approach for measures in the early years takinginto account continuous enrollment and look-back period considerationsHEDIS is a registered trademark of NCQACAHPS is a registered trademark of AHRQ5
  6. 6. Draft QRS Domain and Summary IndicatorsDraft SummaryIndicatorsDraft Domain Concepts Draft Domain Description Composites (examples)ClinicalQualityManagementClinical Effectiveness(Acute and Chronic)Promoting the most effective treatment practicesCardiovascular CareDiabetes CarePatient SafetyMaking care safer by reducing the harm caused inthe delivery of carePatient SafetyCare CoordinationPromoting effective communication andcoordination of careCoordinated CarePreventionPromote wide use of best practices to enablehealthy living; promote effective preventionpracticesStaying Healthy: Adults andChildChecking for CancerMemberExperienceAccess Evaluating member experience with access to care Getting Needed CareDoctor & CareEvaluating member experience with the networkand providersGlobal Rating of CarePlan Efficiency,Cost ReductionandManagementEfficiency andCost ReductionMaking care more affordable through multipleaims (e.g. resource use, transparency of cost, etc.)Efficient CarePlan ServicesEvaluating aspects of QHP operationalperformance that consumers experienceCustomer ServiceThe Domain “concepts” do not reflect what ultimately will be presented to consumers, but rather thedomain concepts and how the measures will be organized. 6