Measures That Matter: Simplifying Clinical Quality Misty Roberts, MSN, RN, PMP

Toyosi Morgan, MD, MPH, MBA

12/12/17 1:30-2:45

Session Code: C16

This presenter has nothing to disclose

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Learning Objectives

Show how refining clinical quality measures can increase efficiency, lower costs, reduce burden for physicians, and ultimately improve health outcomes

Walk through specific ways that health care organizations can simplify quality measures

Demonstrate how simplifying clinical quality measures will help physicians in their transition to value-based care

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“Measures” Making Headlines

Industry Paradigm Shift

o Volume-

based

o Emphasizes

sick care

o Incentivizes

quantity

versus quality

o Lack of focus

on

coordinated

care

Traditional Fee for Service

Industry Paradigm Shift

o Outcomes-

based

o Promotes

preventive care

o Focus on

quality versus

quantity

o Highly

coordinated

care

Value-Based Care

Physician Burden

“Each year US physician practices in four common specialties spend, on average, 785

hours per physician and more than $15.4 billion dealing with the reporting of

quality measures.”

Lack of Industry Alignment

Source: Bailit Health Analysis

48 Measure Sets in 25 States and 3 Regions: 1367 Individual Measures 509 Distinct Measures

NOT A SINGLE measure was used by every program

Only 20% of measures

were used by more than

one program

Breast cancer screening most

frequent used (63% of programs)

40% of programs created at least one new measure for use

Show me the Numbers

Centers for Medicare and

Medicaid Services

2189 (by Title)

National Quality Measures

Clearinghouse

2522

National Quality Forum

1101

US Department of Human

Health and Services

2222

Quality

Payment Program

271

Total Measures

2522

What Percentage are Outcome-Based?

*Related health care delivery and population health measures

• Access (21) • Outcome (282) • Patient Experience (418) • Process (1400) • Structure (113) • Other* (288)

11%

Measurement Breakdown

Example diabetes measures…

National Quality Measures Clearinghouse

Diabetes Specific Measures = 351

Health and Human Services

Diabetes Specific Measures = 34

Diabetes

QPP

NQMC

HHS

Quality Payment Program ( MIPS )

Diabetes Specific Measures = 11

National Quality Forum

Diabetes Specific Measures = 66

NQF

Centers for Medicare and Medicaid Services

Diabetes Specific Measures = 58

CMS

Measurement Breakdown

Diabetes Measures

351

What Percentage of Diabetes Measures are Outcome-Based?

*Related health care delivery and population health measures

• Outcome (60) • Patient Experience (10) • Process (220) • Structure (12) • Other* (49)

17%

Common Measures

Of the measures corresponding to

diabetes…

What does this tell us?

…7 were accounted for in all governing entities (NQMC, HHS, CMS, QPP,

NQF)

• Variance • Key measures

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Examining Our Current State

Gathering the Pieces

Multiple data

sources Inconsistencies

Multiple departments

and silos

CMO and sponsor buy-in

Minimal clinical input

Better care, healthier people and

communities, affordable care

NQF-endorsed measures preferred

Data collection and reporting burden

minimal

Overuse and underuse measures included

Patient outcome allow careful and prudent physicians to attain

success.

Limited to a manageable number

Measure patient outcomes, have ability to drive improvement

preferred

Cross-cutting across multiple conditions to

reflect a domain of quality preferred

Meaningful and usable by consumers,

applicable to different patient populations

Reform payment or delivery systems should measure

clinical quality, patient experience, and costs.

Establishing Our Governing Principles

QUALITY MEASURES GOVERNING PRINCIPLES

15 Simplifying Metrics: Our Process

1. Receive Data and Consolidate

2. Pre-Analysis Work

3. Initial Review

4. Filtering and Initial Identification of Key Metrics

5. “Key Metrics” Analysis

6. External Research

7. Gap Analysis and Future State

8. Final Recommendations

ANALYSIS STATE COUNT

Reduce

Refine/ Relate

Reduce

Refine/ Relate

1116

208

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Summarizing Our Results

17 Building Our Future State

Communication Plan and

SharePoint Site One-on-

Ones

Assign Business Owners

Monthly Stakeholder

Meetings

Sustainability Plan

Leadership and

Stakeholder Buy-in

Determine Business Needs

Identify Measure Owners

Clinical Quality Metrics

Alignment Governance

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Creating Sustainability

The Clinical Quality Metrics Alignment (CQMA) Governance Committee

Manage and maintain meaningful measures that matter to consumers Reduce variability in measure selection Reduce collection burden and cost

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Creating Sustainability

• Regularly review current measures and any proposed changes.

• Discuss evidence-based guidelines, metric stewards, metric efficacy, feasibility, reliability, ease of tracking and application.

Review

• Deliver continuity, awareness and collaboration across the enterprise.

Sustain

• Determine the inclusion or retirement of metrics based on review discussions and enterprise/industry priorities.

• Reach consensus on which metrics to maintain, retire, add or revise.

Approve

CQMA Governance

• Maintain standard review criteria and decision-making process based on governing principles and criteria.

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View active and retired metrics

Submit requests

View specific business area metrics

Gain awareness and transparency

And much more!

Developing a CQMA Central Repository A dedicated site to manage all clinical quality metrics

Front page links allow users to:

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The Value: Patient Health & Financial Strength

• Decrease complexity and confusion

• Decrease frustration

• Decrease collection and reporting burden

Improve Physician

Satisfaction

• Influence industry discussions around reducing measures

• Reflect industry best practices

• Collaborate with organizations (CMS, NCQA, AHIP, etc.)

Align/Influence External

Organizations

Reduce Burden & Cost

• Lower costs

through efficiencies and value

• Reduce internal inefficiencies and duplications

• Create a clear method for managing metrics

• Improve consistency

Improve Health

Outcomes

• Use narrow set of impactful measures

• Identify high value metrics

• Reduce hospitalization, readmissions and ED visits

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Our Path to Change

Lack of Alignment Establishing Governing Principles

Creating Sustainability

Overburdened Physicians Multiple data sources

Simplyfying Metrics

Measures that

Matter

Influencing Industry Discussion

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3

Questions?

2

4

Thank you

Misty Roberts, MSN, RN, PMP

mroberts24@humana.com

Toyosi Morgan, MD, MPH, MBA

tmorgan16@humana.com