CHASE Board Meeting April 24, 2018 Matt Haynes Special Finance - - PowerPoint PPT Presentation

CHASE Board Meeting

April 24, 2018

Matt Haynes—Special Finance Projects Manager Department of Health Care Policy and Financing PCG Project Team

Quality Measure Development

Proposed 2019 Framework

• Framework was approved by the CHASE Board at the

February 27, 2018 meeting

• Focus on the following six areas of measurement:
• Maternal Health and Perinatal Care
• Patient Safety
• Patient Experience (renamed from HCAHPS)
• Behavioral Health
• Substance Use
• Addressing Cost of Care (renamed from Cost of Care)

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HQIP Program Timing

• Two year Cycle
• 2019 Measures = 2019-20 Provider Fee Model Year Payments
• Five primary activities:
• Develop Measures:

Sept – Jan Yr. 1

• Develop Scoring Methodology:

Apr – Aug Yr. 1

• Develop Data Collection Tool:

Aug Yr.1 – Apr. Yr.2

• Collect Data:

May Yr. 2

• Scoring:

June – Sept. Yr. 2

Quality Measure Process

• Environmental scan of measures to identify best practices and review

measure alignment

• Identified potential priority areas for the Department and assess alignment

with other programs.

• Developed a proposed measure framework with subcommittee and received

approval of the framework from the CHASE board

• Develop and review measures that would fit in the framework
• Consulted with quality measure experts, HCPF Chief Medical Officer,

Internal SME, the Colorado Hospital Association, and Public Consulting Group around the appropriateness and feasibility of particular measures.

• The Subcommittee reviewed each measure and the Department removed

some of the proposed measures, modified measures, and proposed replacements where possible.

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Changes to HQIP

• Focused around six priority areas as approved by the

Subcommittee and the CHASE Board

• New areas added: behavioral health and addressing the cost
• f care
• 11 new measures added; eight retired
• Whenever possible outcome measures prioritized, and

Department reported measures used

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Summary

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Measure Group Measure Status Data Goal Perinatal and Maternal Care Breast Feeding Existing Hospital Reported Process C-Section Existing Hospital Reported Outcome Pregnancy related depression New Hospital Reported Process Maternal Emergencies New Hospital Reported Process Family Planning New HCPF/Hospital Report Process Patient Safety C-Diff Existing HCPF/Hospital Report Outcome Adverse Event Existing Hospital Reported Process Falls w/Injury Existing Hospital Reported Outcome CoS Survey Existing Hospital Reported Process Patient Experience HCAHPS New HCPF Outcome Advance Care Plan Existing Hospital Reported Process Behavioral Health Follow-Up after Hospitalization for Mental Illness 7/30 Days New HCPF Outcome ED Utilization for MH New HCPF Outcome ED Utilization SUD New HCPF Outcome Substance Use SUB Composite New Hospital Reported Outcome ALTO and Post-Surg New Hospital Reported Process Addressing Cost of Care Hospital Index New HCPF Outcome

Removed Measures

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Measure Group Measure Status Data Goal RCCO Engagement HTP Hospital Reported Process BHO Engagement HTP Hospital Reported Process CoS Obs Hospital Reported Process Care Transitions HTP Hospital Reported Process TOB 01 03 Obs Hospital Reported Outcome SUB 01 03 Obs Hospital Reported Outcome ED Process HTP Hospital Reported Process 30 day all cause readmit HTP HCPF Outcome Removed Measures

2018 HQIP Measures Removed for Proposed 2019 HQIP

Maternal Health and Perinatal Care

Currently there are 2 areas that are reported and scored at the hospital level and are proposed to continue:

• Breast feeding practices
• Cesarean Section

Proposed new areas:

• Pregnancy Related Depression Screening
• Reproductive Life/Family Planning
• Maternal Emergencies Preparedness (e.g. pre-eclampsia)

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Patient Safety

Patient Safety

• Hospital Acquired Clostridium Difficile Infections
• Adverse Event Reporting
• Falls with Injury
• Culture of Safety Survey

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Patient Experience

HCAHPS Survey Composites

• Communication about Medicines
• Discharge Information
• Care Transitions

Advance Care Planning

• Current HQIP measure based on NQF#0326

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Behavioral Health

• Follow-up appointments within 7 days after hospital discharge

for a mental health condition

• Follow-up appointments within 30 days after hospital

discharge for a mental health condition

• Emergency Department Utilization for mental health condition
• Emergency Department Utilization for substance use condition

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Substance Use

• Using Alternatives to Opioids (ALTOs) in Hospital Emergency

Departments

• Post-surgical Opioid Prescribing
• Tobacco and Substance Use Screening and Intervention

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Addressing Cost of Care

• Hospital Index - PROMETHEUS – composite
• The Prometheus tool is an episode of care grouper that allows us to measure risk in ways
• utside of the traditional utilization and unit cost metrics.
• Prometheus splits episode service costs into Typical and Potentially Avoidable Complications

(PAC) from which we are able to calculate PAC rates.

• Episodes have been defined and refined by expert clinicians assembled in Clinical Working

Groups

• Tool is transparent without added expense to hospitals; definitions are available on Altarum's

website and methodology is described in detail

• Study period consists of claims incurred in SFY14, SFY15, and SFY16 time periods (36

months), and this will be used as benchmark data moving forward

• SFY17 and SFY18 data will be used for additional trending and as the measurement period
• Lower hospital index indicates lower PAC cost relative to the total episode cost; lower score

can be interpreted as better quality and cost effectiveness

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Addressing Cost of Care

Hospital Index – Methodology

• Weighted average of PAC % with episode weights across all episodes generates the

Hospital Index

• The methodology normalizes for credibility, accounting for low utilization in specific

episodes for each hospital

• Hospitals can be compared to themselves over time by tracking their Hospital Index

through successive years to measure improvement and can be compared to benchmark targets

Hospital Index – A Valuable Tool for Hospitals

• The detail behind the Hospital Index allows facilities to drill down into their episode-

specific performance

• Detailed summaries will be provided to each hospital allowing for deeper dives into the
• utput
• Hospital Index will identify intervention targets as well as areas that are currently
• perating at an above average level of cost effectiveness
• Hospitals will be able to review output to better understand inner operations at the

physician level and evaluate drivers of PAC levels

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Summary of Proposed Measures

Measure Group Measure Status Data Goal Perinatal and Maternal Care Breast Feeding Existing Hospital Reported Process C-Section Existing Hospital Reported Outcome Pregnancy related depression New Hospital Reported Process Maternal Emergencies New Hospital Reported Process Family Planning New HCPF/Hospital Report Process Patient Safety C-Diff Existing HCPF/Hospital Report Outcome Adverse Event Existing Hospital Reported Process Falls w/Injury Existing Hospital Reported Outcome CoS Survey Existing Hospital Reported Process Patient Experience HCAHPS New HCPF Outcome Advance Care Plan Existing Hospital Reported Process Behavioral Health Follow-Up after Hospitalization for Mental Illness 7/30 Days New HCPF Outcome ED Utilization for MH New HCPF Outcome ED Utilization SUD New HCPF Outcome Substance Use SUB Composite New Hospital Reported Outcome ALTO and Post-Surg New Hospital Reported Process Addressing Cost of Care Hospital Index New HCPF Outcome

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HQIP Subcommittee Members

Contact Name Organization

David Solawetz Middle Park Medical Center Thomas Mackenzie Denver Health Medical Center Lindy Garvin Health One Cynthia Parson Littleton Adventist Hospital Ann Marie Stein Valley View Katherine Bilys Health One Dorma Eastman Banner Western Division John Savage Colorado Hospital Association Janet Mclntyre Colorado Hospital Association Stephanie Marziano Gunnison Valley Health Shari Aman Parker Adventist Hospital Jaclyn Vaught Parkview Medical Center Glenn Sommerfeld Yampa Valley Medical Center Jennifferr Baird San Luis Valley Health Regional Medical Center Wendy DeHerrera San Luis Valley Health Regional Medical Center Melinda Sandgren Gunnison Valley Health

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Next Steps

• Finalize measure specifications
• Determine point assignment by measure and total points
• Determine # of required measures
• Determine tiering and payment methodology
• Actual scoring “buckets” for any measures that are based
• n ranking are determined once we the data is collected

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