[PPT] - POQC Discussion Jennifer J. Griggs, MD, MPH, FACP, FASCO Program PowerPoint Presentation

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POQC Discussion

Jennifer J. Griggs, MD, MPH, FACP, FASCO Program Director

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Objectives

What is the relationship between Blue Cross Blue

Shield of Michigan and MOQC?

How does Blue Cross Blue Shield of Michigan benefit

from MOQC’s work?

What is ASCO?
What is QOPI?
How do we collect data? Which data do we collect?
What do we do with the data?
What value does MOQC provide to practices?

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BCBSM, MOQC, and the CQI’s

The Michigan Oncology Quality Consortium (MOQC)

is one of 17 Collaborative Quality Initiatives (CQI’s).

The CQI’s are part of the Blue Cross/Blue Shield of

Michigan’s (BCBSM) Value Partnerships, a collection

f patient safety, clinical quality, and care process

efforts.

Hospitals and physicians share data to develop best

practices around areas of care with high c gh costs and high v gh variation.

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(All those acronyms)

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How BCBSM relates to the CQI’s

Hospital & physician performance not judged
Blue Cross never sees individual hospital or physician

data

The data are used only to identify areas of opportunity

for improvement. Other Ways in Which BCBSM Relates to the CQI’s

BCBSM funds the CQIs
Approves our budget
Approves our Statement of Work (SOW)

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So what does BCBSM get out of the CQI’s?

Value Partnerships initiatives have saved more than $1.4 billion in health care expenses.

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There are currently 17 CQIs

Michigan Cardiovascular Consortium
Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative
Michigan Bariatric Surgery Consortium
Michigan Surgical Quality Collaborative
Michigan Anticoagulation Quality Improvement Initiative
Michigan O

Onc ncology Q Qua uality C Conso sortium

Hospital Medicine Safety Consortium
Michigan Trauma Quality Improvement Project
Michigan Urological Surgery Improvement Collaborative
Michigan Radiation Oncology Quality Consortium
Michigan Arthroplasty Registry Collaborative for Quality Improvement
Michigan Spine Surgery Improvement Collaborative
Michigan Value Collaborative
Anesthesiology Performance Improvement and Reporting Exchange
Michigan Pharmacists Transforming Care and Quality Consortium
Michigan Emergency Department Improvement Collaborative
Integrated Michigan Patient-Centered Alliance on Care Transitions

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American Society of Clinical Oncology (ASCO)

International organization with over 40,000 oncology providers
Represent oncologists and allied health professionals & their patients
Activities include scientific dissemination, advocacy, quality

advancement, and more

Core values are Evidence, Care, Impact
Quality measurement & certification “arm” of ASCO
Includes 177 validated measures in adult oncology
Branching into pediatrics & into hematology
Certifies practices across the country & internationally
Committee in ASCO works to keep QOPI up-to-date
Measures group in ASCO keep quality measures up-to-date
All committees are volunteer-based & include patients

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MOQC Coordinating Center

MOQC’s Structure

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MOQC Steering Committee

Patient and Caregiver Oncology Quality Council (POQC)

Practices

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Committees that Report to the Steering Committee

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Steering Committee Research & Publication Committee Measures Committee Advanced Imaging Workgroup

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How do we collect data?

Practices identify patient charts that meet criteria
Criteria differ by measure
Professional abstractors go through patient records
All abstractors are trained in protecting confidentiality
Paper charts (unusual)
Electronic records (more common)
Combination of paper charts and electronic records
Abstractors may work for practices or be MOQC

abstractors

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MOQC Measures

Selected by the MOQC Measures Committee
Chosen with patient and caregiver input
Committee meets annually to revisit measures
Approved by Steering Committee
Measures need to
Be meaningful
Demonstrate some gap in care
Be feasible to measure
Be addressable through practice system(s)

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Subset of QOPI Measures

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VBR

Measure Module

Name of QOPI Measure

MOQC

Performance

QOPI

Performance

Core

Pain addressed appropriately

81% 82%

X

Core* Pain addressed appropriately by second office visit and during most recent office visits

74% 75%

Core* Antineoplastic treatment administered to patients with metastatic solid tumor with

performance status of 3, 4, or undocumented (Lower Score Better)

23% 21%

Core

Oral antineoplastic/chemotherapy treatment monitored on visit/contact following start of therapy: medication adherence assessed

72% 66%

Core

Signed patient consent for antineoplastic treatment

76% 79%

X

Core

Tobacco cessation counseling administered or patient referred in past year

42% 35%

Core* Smoking/tobacco use cessation administered appropriately in past year

86% 89%

Sympto m

Aprepitant/fosaprepitant or netupitant prescribed with low or moderate risk emetic antineoplastic/chemotherapy treatment (Lower Score Better)

18% 9%

Sympto m

Infertility risks discussed prior to antineoplastic treatment with patients of reproductive age

38% 37%

X

EOL*

Pain addressed appropriately

77% 80%

EOL*

Dyspnea addressed appropriately

77% 77%

EOL

Hospice enrollment within 3 days of death (Lower Score Better)

18% 16%

X

EOL** Hospice enrollment, palliative care referral/services, or documented discussion

66% 76%

Breast PET, CT, or radionuclide bone scan ordered by practice within 60 days after diagnosis to stage

I, IIA, or IIB breast cancer (Lower Score Better)

42% 22%

Breast

Serum tumor marker surveillance ordered by practice between 30 days and 365 days after diagnosis of breast cancer in patients who received treatment with curative intent (Lower Score Better)

96% 87%

Colorect al*

Complete family history documented for patients with invasive colorectal cancer

32% 32%

Colorect al

Colonoscopy before or within 6 months of curative colorectal resection or completion of primary adjuvant antineoplastic treatment

70% 85%

NSCLC GCSF administered to patients who received antineoplastic treatment for metastatic NSCLC

(Lower Score Better)

27% 23%

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What do we do with the data?

Disseminate the findings
Present in a way that allows practices to see where

they stand (“benchmark”)

Identify key areas for improvement
Develop quality improvement initiatives
Reward practices for performance (for select

measures)

Marketing by practices is not allowed → agreement of participation

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MOQI

Measures quality using the QOPI platform
Selects a set of metrics from among the 177
Why not all 177 measures?

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What else does MOQC do?

Quality improvement projects
Education & outreach for providers and

patients

Harmonization of care
Advocacy for the medically-underserved
Asks provocative questions

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What are the benefits to practices?

Provides data benchmarked across region, state, nation
Helps providers improve quality by providing evidence-

based tools

Gives practices access to patient & caregiver

perspectives

Helps providers maintain board certification
Helps providers report required quality data to

Medicare

Provides opportunities for value-based reimbursement
Creates opportunities for collaboration around

improving care

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75% 83% 88% 87% 76% 82% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% A B C D E MOQC

Pain Managed Appropriately

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First two office visits and most recent office visits

2017 78% Calendar Year 2017 2018 87%

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Pain Managed Appropriately

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Last two visits prior to death

2017 80% Calendar Year 2017

78% 86% 87% 86% 84% 85% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% A B C D E MOQC

2018 87%

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75% 56% 57% 67% 41% 45%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

A B C D E MOQC

Tobacco Cessation

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Counseling administered or patient referred

2017 45% Calendar Year 2017 2018 60%

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Hospice Enrollment/Discussion or Palliative Care Services

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2017 70% Calendar Year 2017 2018 73%

42% 76% 67% 66% 61% 64%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

A B C D E MOQC

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Antiresorptive therapy given to patients with breast cancer who have bone metastases

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83% 62% 73% 74% 65% 69% 65% 54% 89% 50% 80% 67%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

A B C D E MOQC QOPI

QOPI Measure Number BR61 1st bar: S14-S17; 2nd bar: F17

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PET, CT, or bone scan ordered by practice within 60 days after diagnosis for stages I or II breast cancer (Lower Score - Better) (Top 5 Measure)

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21% 17% 25% 13% 32% 24% 23% 16% 14% 22% 12% 23% 18%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

A B C D E MOQC QOPI

QOPI Measure Number BR62a1 1st bar: S14-S17; 2nd bar: F17

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Serum tumor marker surveillance ordered by practice between 30 – 365 days after diagnosis of early stage breast cancer (Lower Score - Better) (Top 5 Measure)

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25% 0% 65% 88% 79% 68% 71% 71% 75% 97% 91% 95%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

A B C D E MOQC QOPI

QOPI Measure Number BR62c1 1st bar: S14-S17; 2nd bar: F17

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Oral chemotherapy medication adherence assessed following start of therapy

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64% 47% 88% 83% 56% 73% 65% 61% 92% 99% 93% 87% 89% 67%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

A B C D E MOQC QOPI

QOPI Measure Number Core13oral6a 1st bar: S14-S17; 2nd bar: F17

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Signed patient consent for chemotherapy (including oral chemotherapy)

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92% 79% 78% 76% 64% 76% 78% 84% 85% 79% 92% 66% 79% 67%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

A B C D E MOQC QOPI

QOPI Measure Number Core14 1st bar: S14-S17; 2nd bar: F17

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Complete family history documented for patients with invasive colorectal cancer

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2% 17% 23% 11% 18% 19% 23% 10% 17% 12% 16% 14% 14% 12%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

A B C D E MOQC QOPI

QOPI Measure Number CRC63 1st bar: S14-S17; 2nd bar: F17

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Colonoscopy before or within 6 months of curative resection or completion of adjuvant chemotherapy

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74% 89% 85% 92% 80% 84% 84% 93% 86% 84% 83% 76% 83% 82%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

A B C D E MOQC QOPI

QOPI Measure Number CRC73 1st bar: S14-S17; 2nd bar: F17

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Neurokinin-1 receptor antagonists for Cycle 1 low or moderate emetic risk chemotherapy (Lower Score - Better)

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17% 17% 26% 18% 4% 25% 23% 17% 26% 28% 22% 9%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

A B C D E MOQC QOPI

QOPI Measure Number SMT28 1st bar: S14-S17; 2nd bar: F17

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Infertility risks discussed before chemotherapy with patients of reproductive age

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17% 35% 35% 31% 49% 38% 38% 11% 33% 50% 33% 40% 39% 38%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

A B C D E MOQC QOPI

QOPI Measure Number SMT33 1st bar: S14-S17; 2nd bar: F17