DESIGN A STATEWIDE QUALITY MEASUREMENT STRATEGY AcademyHealth - - PowerPoint PPT Presentation

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DESIGN A STATEWIDE QUALITY MEASUREMENT STRATEGY AcademyHealth - - PowerPoint PPT Presentation

May 24, 2023 272 likes •511 views

ENGAGING SAFETY NET PROVIDERS TO DESIGN A STATEWIDE QUALITY MEASUREMENT STRATEGY AcademyHealth Annual Research Meeting June 25, 2017 1 Medicaid and the District Medicaid Health in the District 1 in 3 District residents 96.2% of

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SLIDE 1

ENGAGING SAFETY NET PROVIDERS TO DESIGN A STATEWIDE QUALITY MEASUREMENT STRATEGY

AcademyHealth Annual Research Meeting June 25, 2017

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SLIDE 2

Medicaid and the District

  • Health in the District

– 96.2% of residents with health insurance (2015) – 12.9% of District adults reported their health was fair or poor (2014 DC BRFSS) – High ED utilization, almost twice the national rate (746:1,000 v. 423:1000) – High readmission rate: (65:1,000 v. 45: 1,000)

  • Medicaid

– 1 in 3 District residents – 7 in 10 District children are covered by Medicaid – FY18 Budget Request: $3.2 billion (96% spent

  • n provider payments)

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SLIDE 3

Guiding Principles to Increase the Value of Health Care in the District

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 Expand Access

  • Ensure appropriate and adequate access to services across all eight (8) wards.
  • Improve patient-centered care coordination for all Medicaid beneficiaries. This includes efforts to

coordinate physical, behavioral, and long-term health care, and support preventive health.

 Improve Quality

  • Enhance hospital quality and outcomes.
  • Promote partnerships between DC hospitals and primary care providers to improve care delivery and
  • utcomes.

 Promote Health Equity

  • Develop programs and services for the District’s high-need populations, particularly those with a

high-burden of chronic illness, and homeless.

  • Need to understand life circumstances better to improve health in the District.

 Enhance Value and Efficiency

  • Pay for value, not for volume of health care services.
  • Promote efficiency, transparency, and flexibility of DHCF’s programs
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SLIDE 4

Steps Towards Managing Population Health and Risk

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No Risk

Full Risk

Payment: FFS Architecture HIE: Use of Certified EHRs and Basic Exchange

Care Coordination: Basic

Financial Reserves

Quality Measurement: Reporting Required HIE: Population Health Management Care Coordination: More Integrated Care

Fee-for- Service Supplemental Payments Pay-for- Performance

Quality Measurement: Payment Tied to Performance HIE: Real-Time Clinical Data

Bundled Payments Care Coordination: Integrated Across Care Continuum Shared Savings Care Coordination: Fully Integrated

Payment: Risk Adjusted Total Cost of Care

Global Payments

FQHC

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SLIDE 5

STEPS TO MEASURE SET DEVELOPMENT

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Measure Set Development Is An Evolving Process

Step 1: Determine who should participate in the process

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 Should the group include those just party to the contract(s)?  How large should the group be?  Is there a mix of clinical, measurement and financial expertise?

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SLIDE 7

Measure Set Development Is An Evolving Process

Step 2: Identify current activities/initiatives

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 Federal agencies

  • HRSA

 Payers

  • Medicaid
  • Medicare
  • Commercial

 Foundations  State and Local Agencies

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SLIDE 8

 Measures

  • Currently in use by contracted providers/payers.
  • Found in national/regional measure sets.
  • Address a priority opportunity for performance improvement.

 Specific populations  Performance domains  Number of measures  Data sources

  • Clinical
  • Claims
  • Survey

Measure Set Development Is An Evolving Process

Step 3: Align priorities, goals, and

  • utcomes

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SLIDE 9

Measure Set Development Is An Evolving Process

Step 4: Identify selection criteria

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 At the individual measure level

  • Has a relevant benchmark
  • Validated
  • Aligned with other measure sets
  • Sufficient denominator size
  • Actionable
  • Transformative potential

 At the measure set level

  • Representative of the diversity of

patients served

  • Parsimonious
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SLIDE 10

Measure Set Development Is An Evolving Process

Step 5: Develop policy & incentive structure

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 To monitor performance with or without financial consequence?  To inform consumers as part of a transparency strategy?  To test new measures for potential future use?

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SLIDE 11

Measure Set Development Is An Evolving Process

Step 1: Determine who should participate in the process Step 2: Identify current activities/ initiatives Step 3: Align priorities, goals, and

  • utcomes

Step 4: Identify selection criteria Step 5: Develop policy & incentive structure Step 6: Implement program

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SLIDE 12

THE DISTRICT’S JOURNEY TO A MEASUREMENT STRATEGY

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SLIDE 13

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DC Journey for Safety-Net Providers

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SLIDE 14

Accountability

Period

  • February 2015 to January 2016
  • Monthly and Ad hoc meetings

Stakeholders

  • DHCF, DC Primary Care Association, FQHC Quality Improvement
  • No External Parties

Policy

  • Monitor FQHC performance in DHCF priority areas

Alignment

  • HRSA Uniform Data System (UDS), Medicaid Core Set, Health Home, Medicare PQRS

Measure Domains

  • Asthma, Behavioral Health, Child Health, Cardiovascular, Diabetes, HIV/AIDS,

Prevention, Perinatal/Prenatal

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Accountability Proposed Core Measure Set

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Asthma

Medication Management for People with Asthma

Oral Health

  • Annual Dental Visits
  • Primary Caries Prevention Intervention as

Part of Well/Ill Child Care

Cancer

  • Cervical Cancer Screening
  • Colorectal Cancer Screening
  • Breast Cancer Screening

Care Coordination

  • Plan All-Cause Readmission
  • Low-Acuity Non-Emergent Emergency Visits
  • Care Transition Record Transmitted to Health

Care Professional

  • Prevention Quality Indicators #92: Chronic

Composite

Child Health

  • Appropriate Testing for Children with

Pharyngitis

  • Well-Child Visits

Behavioral Health

  • Initiation and Engagement of Alcohol and

Other Drug Dependence Treatment

  • Anti-depressant Medication Management
  • Screening for Clinical Depression and

Follow-Up Plan

  • Follow-Up After Hospitalization for Mental

Illness

Sexual Health

  • Chlamydia Screening
  • HIV Viral Load Suppression
  • HIV Medical Visit Frequency

Prevention

  • Weight Assessment and

Counseling for Nutrition and Physical Activity for Children/ Adolescents

  • Tobacco Use: Screening and

Cessation Intervention

  • Childhood Immunization Status
  • Adult Body Mass Index (BMI)

Assessment

  • Prevention Quality Indicators

#92: Chronic Composite

Diabetes

  • Comprehensive Diabetes Care: Eye Exam
  • Diabetes: Foot Exam*
  • Comprehensive Diabetes Care: Hemoglobin

A1c testing

  • Comprehensive Diabetes Care: Hemoglobin

A1c (HbA1c) Poor Control (>9.0%)

  • Comprehensive Diabetes Care: Medical

Attention for Nephropathy

Maternal and Infant Health

  • Elective Delivery Prior to 39 Completed

Weeks Gestation (PC-01)

  • Live Births Weighing Less Than 2,500 Grams
  • Frequency of Ongoing Prenatal Care
  • Timeliness of Prenatal Care
  • Postpartum Care

Cardiovascular

  • Ischemic Vascular Disease (IVD): Use of

Aspirin or Another Antithrombotic

  • Controlling High Blood Pressure
  • Persistence of Beta-Blocker Treatment

After a Heart Attack

Future Consideration

  • Substance Use
  • Depression Remission at Twelve

Months

  • Child and Adolescent Major

Depressive Disorder: Suicide Risk Assessment

  • Cesarean Rate for Nulliparous

Singleton Vertex (PC-02)

  • Flu Vaccinations for Adults Ages

18–64

  • Patient Satisfaction
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SLIDE 16

Pay-for-Performance: Care Coordination

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Period

  • January 2016 to July 2016
  • Monthly and Ad hoc meetings

Stakeholders

  • DHCF, DC Primary Care Association, FQHC Quality Improvement, Technical Assistance

Partners

  • Public Comment Period

Policy

  • Monitor FQHC performance in DHCF priority areas + emphasize care coordination

Alignment

HRSA Uniform Data System (UDS), Medicaid Core Set, Health Home, Medicare PQRS

Measure Domains

  • Asthma, Behavioral Health, Child Health, Cardiovascular, Diabetes, HIV/AIDS, Prevention,

Perinatal/Prenatal, Care Coordination

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Pay-for-Performance: Care Coordination Added Barriers

Had to meet the following requirements:  APM selection,  HRSA Quality Improvement Plan,  NCQA PCMH Level 2,  24/7 Access Policy,  Agree to report UDS measures quarterly

 Report UDS measures quarterly  Meet 3% on at least one of the following:

  • Low Acuity Non-Emergent

Emergency Department,

  • 30-day All-Cause Readmissions,
  • Potentially Preventable

Hospitalizations

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Pay-for-Performance: Care Coordination + Access

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Period

  • July 2016 to December 2016
  • Monthly and Ad hoc meetings

Stakeholders

  • DHCF, DC Primary Care Association, FQHC Quality Improvement, FQHC Finance, Medicaid

Managed Care Organizations

  • Public Comment Period

Policy

  • Incentivize care coordination activities while facilitating linkages between providers

Alignment

  • HRSA Uniform Data System (UDS) + Health Home

Measure Domains

  • Access, Transitions of Care, Clinical Outcomes
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SLIDE 19

Pay-for-Performance: Care Coordination + Access

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Patient- Centered Access

Allow DHCF to set expectations that answering service, being open 30- minutes later than normal hours is not

  • sufficient. An opportunity to tie into

Access Monitoring Review Plan. 24/7 Access Policy, Extended Hours, Access to Preventive/Ambulatory Services

Transitions of Care

Model should not solely rely on events

  • utside the control of the FQHC but on

types of care and interventions directly furnished by the FQHC Follow-Up after Hospital Discharge, Follow-Up after Hospital Discharge for Mental Illness, Timely Transmission of Records

Clinical Outcomes

Improve care coordination and ensure beneficiaries are receiving care in the appropriate setting, DHCF plans to hold providers and MCOs to work towards a common goal. LANE, All-Cause 30-day Readmissions, Preventable Hospitalizations

Domain Rationale Measures

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Domain Measures Measure Steward NQF Number FQHC P4P My Health GPS P4P MCO P4P Outcomes Low Acuity Non-Emergency ED Visits DHCF N/A X X X All- Cause 30-day Readmissions NCQA 1768 X X X Potentially Preventable Hospitalizations AHRQ N/A X X X Process Timely Transmission of Discharge Record AMA-PCPI 0648 X X Follow-Up after Discharge MN Community Measurement N/A X Follow-Up after Discharge (Mental Illness) NCQA 0576 X Reconciled Medication List AMA-PCPI 0646 X Access Extended Hours DHCF N/A X 24/7 Access Policy DHCF N/A X Adults’ Access to Preventive/ Ambulatory Health Services NCQA N/A X Efficiency Total Resource Use HealthPartners 1598 X Total Cost of Care HealthPartners 1604 X 20

Aligning Incentive Measures

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Lessons Learned

  • 1. Engage stakeholders early and often.
  • 2. Set clear goals and expectations from the outset.
  • 3. Make sure all who need to be at the table are at it.
  • 4. Keep decision makers in feedback loop.
  • 5. Allow more time.
  • 6. It’s a lot of work.

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Next Up…Deepti Kanneganti and the Buying Value Tool

Contact Information DaShawn Groves, DrPH, MPH dashawn.groves@dc.gov Erin Holve, PhD MPH MPP erin.holve@dc.gov

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