http://www.qualityforum.org Measure Applications Partnership (MAP) Coordinating Committee In-Person Meeting January 15, 2020
Welcome, Introductions, Disclosures of Interest, and Review of Meeting Objectives 2
Agenda Welcome, Introductions, Disclosures of Interest, and Review of Meeting Objectives CMS Opening Remarks and Meaningful Measures Update MAP Pre-Rulemaking Approach Pre-Rulemaking Recommendations Hospital Programs Clinician Programs PAC/LTC Programs Future Direction of the Pre-Rulemaking Process Closing Remarks and Next Steps Adjourn 3
MAP Coordinating Committee Members Committee Chairs: Bruce Hall, MD, PhD, MBA, FACS; Charles Kahn, III, MPH Organizational Members (voting) Committee Chairs: Bruce Hall, MD, PhD, MBA, FACS; Charles Kahn, III, MPH American College of Physicians National Business Group on Health • Amir Qaseem, MD, PhD, MHA, FACP • Steve Wojcik, MA American HealthCare Association National Committee for Quality Assurance • David Gifford, MD, MPH • Mary Barton, MD, MPP American Hospital Association National Patient Advocate Foundation • To be confirmed • Rebecca Kirch, JD American Medical Association Network for Regional Healthcare Improvement • Scott Ferguson, MD • Chris Queram, MA American Nurses Association Pacific Business Group on Health • Cheryl Peterson, MSN, RN • Emma Hoo America’s Health Insurance Plans Patient & Family Centered Care Partners • Elizabeth Goodman, JD, MSW, DrPH • Libby Hoy Health Care Service Corporation The Joint Commission Esther Morales, MBA David Baker, MD, MPH, FACP • • Humana The Leapfrog Group Misty Roberts, MSN Leah Binder, MA, MGA • • Medicare Rights Center • Frederic Riccardi, MSW 4
MAP Coordinating Committee Members (cont.) Individual Subject Matter Experts (Voting) Harold Pincus, MD Jeff Schiff, MD, MBA Ron Walters, MD, MBA, MHA, MS Federal Government Liaisons (Nonvoting) Agency for Healthcare Research and Quality (AHRQ) Centers for Disease Control and Prevention (CDC) Centers for Medicare & Medicaid Services (CMS) Office of the National Coordinator for Health Information Technology (ONC) 5
NQF Staff Sam Stolpe, Senior Director Kate Buchanan, Senior Project Manager Taroon Amin, Consultant 6
CMS Opening Remarks and Meaningful Measures Update 7
INTRODUCTION TO THE MEANINGFUL MEASURES INITIATIVE
Patients Over Paperwork CMS’s Primary Goal : Remove obstacles that get in the way of the time clinicians spend with their patients • Patients Over Paperwork – Shows CMS’s commitment to patient-centered care and improving beneficiary outcomes – Includes several major tasks aimed at reducing burden for clinicians – Motivates CMS to evaluate its regulations to see what could be improved
CMS Strategic Priorities
A New Approach to Meaningful Outcomes What is the Meaningful Measures Initiative? Launched in 2017, the purpose of the Meaningful Measures initiative is to: Improve outcomes for patients Reduce data reporting burden and costs on clinicians and other health care providers Focus CMS’s quality measurement and improvement efforts to better align with what is most meaningful to patients
Meaningful Measures Objectives Meaningful Measures focus everyone’s efforts on the same quality areas and lend specificity, which can help identify measures that: Address high-impact Are patient-centered Are outcome-based Fulfill requirements measure areas that and meaningful to where possible in programs’ statutes safeguard public health patients, clinicians and providers Minimize level of Identify significant Address measure Align across programs burden for providers opportunity for needs for population and/or with other improvement based payment through payers alternative payment models
Meaningful Measures Framework Promote Effective Communication & Coordination of Care Meaningful Measure Areas: • Medication Management • Admissions and Readmissions to Hospitals • Transfer of Health Information and Interoperability Promote Effective Prevention & Treatment of Chronic Disease Meaningful Measure Areas: • Preventive Care • Management of Chronic Conditions • Prevention, Treatment, and Management of Mental Health • Prevention and Treatment of Opioid and Substance Use Disorders • Risk Adjusted Mortality Work with Communities to Promote Best Practices of Healthy Living Meaningful Measure Areas: • Equity of Care • Community Engagement Make Care Affordable Meaningful Measure Areas: • Appropriate Use of Healthcare • Patient-focused Episode of Care • Risk Adjusted Total Cost of Care Make Care Safer by Reducing Harm Caused in the Delivery of Care Meaningful Measure Areas: • Healthcare-associated Infections • Preventable Healthcare Harm Strengthen Person & Family Engagement as Partners in their Care Meaningful Measure Areas: • Care is Personalized and Aligned with Patient’s Goals • End of Life Care according to Preferences • Patient’s Experience of Care • Functional Outcomes
Promote Effective Prevention & Treatment of Chronic Disease Meaningful Measures Areas: Preventive Care Management Prevention, Prevention & Risk Adjusted of Chronic Treatment, & Treatment of Opioid Mortality Measures Conditions Management & Substance Use Measures Influenza Immunization of Mental Health Disorders Measures Received for Current Hospital 30-Day, Measures Measures Flu Season - HH QRP Osteoporosis All Cause, Risk- Management in Standardized Timeliness of Prenatal Follow-up after Alcohol Use Women Who Had a Mortality Rate Care (PPC) - Medicaid Hospitalization for Screening - IPFQR Fracture - QPP (RSMR) Following & CHIP Mental Illness - Use of Opioids at Heart Failure (HF) IPFQR Hemoglobin A1c Well-Child Visits in the High Dosage - Hospitalization - Test for Pediatric First 15 Months of Life Medicaid & CHIP HVBP Patients (eCQM) - (6 or More Visits) - Medicaid & CHIP Medicaid & CHIP
FUTURE OF THE MEANINGFUL MEASURES INITIATIVE AND NEXT STEPS
Meaningful Measure Development Priorities Patient-reported outcome measures Electronic clinical quality measures (eCQMs) Appropriate use of opioids and avoidance of harm Nursing home infections and safety measures Maternal mortality Sepsis
Considerations for Future Meaningful Measures Developing more APIs for quality measure data submission Prototype the use of the FHIR standard for quality measurement Interoperable electronic registries – incentivizing use Harmonizing measures across registries Timely and actionable feedback to providers Working across CMS on the use of artificial intelligence to predict outcomes
DISCUSSION
Appendix: Meaningful Measure Areas Promote Effective Communication & Coordination Make Care Affordable Meaningful Measure Areas: of Care • Appropriate Use of Healthcare Meaningful Measure Areas: • Patient-focused Episode of Care • Medication Management • Risk Adjusted Total Cost of Care • Admissions and Readmissions to Hospitals • Transfer of Health Information and Interoperability Make Care Safer by Reducing Harm Caused in Promote Effective Prevention & Treatment of the Delivery of Care Chronic Disease Meaningful Measure Areas: • Healthcare-associated Infections Meaningful Measure Areas: • Preventable Healthcare Harm • Preventive Care • Management of Chronic Conditions Strengthen Person & Family Engagement as • Prevention, Treatment, and Management of Mental Health Partners in their Care • Prevention and Treatment of Opioid and Substance Use Disorders Meaningful Measure Areas: • Risk Adjusted Mortality • Care is Personalized and Aligned with Patient’s Goals Work with Communities to Promote Best Practices • End of Life Care according to Preferences of Healthy Living • Patient’s Experience of Care • Functional Outcomes Meaningful Measure Areas: • Equity of Care • Community Engagement
Overview of Pre-Rulemaking Approach 20
Preliminary Analyses 21
Preliminary Analysis of Measures Under Consideration The preliminary analysis is intended to provide MAP members with a succinct profile of each measure and to serve as a starting point for MAP discussions. Staff use an algorithm developed from the MAP Measure Selection Criteria to evaluate each measure in light of MAP’s previous guidance. This algorithm was approved by the MAP Coordinating Committee. 22
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