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Www.qualityforum.org Performance Measurement & Reporting: Future Directions Janet Corrigan, PhD, MBA President and CEO National Quality Forum.

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Presentation on theme: "Www.qualityforum.org Performance Measurement & Reporting: Future Directions Janet Corrigan, PhD, MBA President and CEO National Quality Forum."— Presentation transcript:

1 www.qualityforum.org Performance Measurement & Reporting: Future Directions Janet Corrigan, PhD, MBA President and CEO National Quality Forum

2 www.qualityforum.org National Quality Forum Mission Improve the quality of American healthcare by setting national priorities and goals for performance improvement Endorse national consensus standards for measuring and publicly reporting on performance Promote the attainment of national goals through education and outreach programs 2

3 www.qualityforum.org This Presentation at a Glance Key Components of Health Reform Aimed at Improving Quality and Affordability of Health Care National Quality Enterprise: Key Functions Role of the National Quality Forum 3

4 www.qualityforum.org Health Reform Legislation Patient Protection & Affordability of Care Act (ACA) of 2010 –Rapid expansion of public reporting –Alignment of payment with value –Development of accountable care organizations American Recovery and Reinvestment Act (ARRA) of 2009 –$32 billion to rapidly “wire” American healthcare 4

5 www.qualityforum.org ACA Transparency Provisions Broad Plan for Public Reporting –Requires a clear federal plan to make performance information widely available. Hospitals and Ambulatory Surgery Centers –Expands Hospital Compare; includes information on the Value Based Purchasing (VBP) program; report on health care acquired admissions, hospital readmissions, and hospital charge data. Physicians –Requires development of Physician Compare website by January 2011. –Annually, physician ownership or investments in hospitals and manufacturers (by September 2013) will be published. Nursing Homes, Skilled Nursing Facilities, LTC Facilities –New information will be added to Nursing Home Compare by March 2011. Nursing home ownership by March 2012. 5

6 www.qualityforum.org Public Reporting In 2009 more than half of Americans used the Internet to look up health information Source: CDC. National Center for Health Statistics http://www.cdc.gov/nchs/data/hestat/healthinfo2009/healthinfo2009.pdf 6

7 www.qualityforum.org ACA Payment Reforms Physician Payment –Provides 5-year, 10% bonus for primary care and general surgeons in health professional shortage areas beginning in 2011 based on reporting of quality measures. –Medicaid primary care rates will be 100% of adjusted Medicare rates for 2013 and 2014. –Secretary establishes a payment modifier that provides for differential payment to physicians based on quality of care compared to cost. Must be budget neutral and program starts in 2013. Hospital Payment –Reduces payments for “excess” readmissions in selected conditions starting in FY 2013. –Establishes a hospital VBP program to start in FY 2013. –Reduces payment for hospitals in top quartile of national health care acquired conditions rate by 1% starting in 2015. Expansion of Value-based Purchasing –VBP pilots for long-term care; rehabilitation facilities; PPS-except cancer hospitals; and hospice to be implemented by 2016. 7

8 www.qualityforum.org ACA Payment Reforms (cont’d.) CMS Innovation Center –Establishes an Innovation Center with the capacity to implement innovations program-wide that require review and assessment by the Office of the Actuary. –Center must be established by 2011. Piloting of New Programs –Authorizes a multitude of payment redesign programs to be rapidly tested and, as proven, expanded. –Bundled Payments, Shared Decision-Making, etc. 8

9 www.qualityforum.org ARRA & ACA Delivery System Reform Build technological infrastructure necessary to improve quality and reduce costs –$30B in Medicare and Medicaid incentive payments linked to “meaningful use” of EHRS Promote integration of personal health care and population health –Community health teams Encourage development of clinically integrated health systems –Medical Homes/ Health Care Homes –Accountable Care Organizations 9

10 www.qualityforum.org Accountable Care Organizations Patient-focused orientation –Follows the natural trajectory of care over time Directed at value –Quality, costs, and patient preferences Emphasizes care coordination –Care transitions and hand-offs Promotes shared accountability –Individual, team, system Addresses shared decision making –Attention to patient preferences Supports fundamental payment reform –Bundled payment for the episode of care 10

11 www.qualityforum.org Quality Enterprise Functions: Contributions of NQF Establish National Priorities National Priorities Partnership Top 20 conditions Identify Measure Gaps Agenda for Measure Development and Endorsement Measure Development Endorse Measures, Practices, and SREs Over 600 measures covering all settings, including Safe Practices and SREs Build Data Platforms Health Information Technology Expert Panel Publicly Report Results Guidance for performance reporting on safety MAPs & Dashboard Align Payment and Other Incentives Analysis of measurement implications of various payment reform models Improve Performance Webinars Measures database Evaluate Measure use evaluation 11

12 www.qualityforum.org Why Set National Priorities? Current state of performance measurement is a cacophony of well-meaning but uncoordinated signals National priorities help align strategies and efforts of multiple groups around common goals for improvement Drive fundamental change in the delivery system New link to ACA: –Secretary to establish and implement a national strategy to improve care delivery, health outcomes and population health 12

13 www.qualityforum.org National Priorities Partnership 32 multi-stakeholder organizations: Consumers Purchasers/Employers Health Professionals/Providers Health Plans Accreditation/Certification Groups Quality Alliances Suppliers/Industry Community/Regional Collaboratives Public Sector: CMS, AHRQ, CDC, NIH, NGA Co-Chairs: Donald Berwick Institute for Healthcare Improvement Margaret O'Kane National Committee for Quality Assurance 13

14 www.qualityforum.org Criteria for Selecting the Priorities © National Priorities Partnership Remove Waste Eradicate Disparities Eliminate Harm Reduce Disease Burden High Impact Areas 14

15 www.qualityforum.org 15 National Priorities Population health - Key preventive services - Healthy lifestyle behaviors Safety –Hospital-level mortality rates –Serious adverse events –Healthcare-Acquired Infections Care Coordination –Medication reconciliation –Preventable hospital readmissions –Preventable emergency department visits Patient/family engagement –Informed decision-making –Patient experience of care –Patient self-management Palliative Care: –Relief of physical symptoms –Help with psychological, social and spiritual needs –Communication regarding treatment options, prognosis –Access to palliative care services Overuse –9 major areas

16 www.qualityforum.org Potential Areas of Overuse Inappropriate medication use Unnecessary laboratory testing Unwarranted diagnostic procedures Unnecessary maternity care interventions Unnecessary consultations Potentially harmful preventive services (USPSTF “D” list) Preventable hospitalization and ED visits Inappropriate non-palliative care at end-of-life 16

17 www.qualityforum.org Drivers of Change Performance Measurement Payment Accreditation & Certification COLLABORATIVE, ACTION-ORIENTED STRATEGIES Applied Research Infrastructure (Information Technology & Workforce Public Reporting 17

18 www.qualityforum.org Quality Enterprise Functions: Contributions of NQF Establish National Priorities National Priorities Partnership Top 20 conditions Identify Measure Gaps Agenda for Measure Development and Endorsement Measure Development Endorse Measures, Practices, and SREs Over 600 measures covering all settings, including Safe Practices and SREs Build Data Platforms Health Information Technology Expert Panel Publicly Report Results Guidance for performance reporting on safety MAPs & Dashboard Align Payment and Other Incentives Analysis of measurement implications of various payment reform models Improve Performance Webinars Measures database Evaluate Measure use evaluation 18

19 www.qualityforum.org ACA: Measure Development AHRQ and CMS to conduct triennial assessment to identify measures gaps Consider gaps identified by NQF, pediatric program, and Medicaid Priority to health outcomes, functional status, coordination of care, shared decision-making, MU, safety, patient experience, efficiency and disparities $75M for measure development (not yet appropriated) 19

20 www.qualityforum.org Measure Development & Endorsement Agenda National Priorities Leading Medicare Conditions Child and Family Health HIT Meaningful Use Community Needs Population Health 20

21 www.qualityforum.org Prioritized Medicare Conditions Major depression CHF IHD Diabetes Stroke/TIA Alzheimer’s dx Breast CA COPD AMI Colorectal CA Hip/pelvic fracture Chronic renal dx Prostate CA Rheumatoid & osteoarthritis Atrial fibrillation Lung CA Cataract Osteoporosis Glaucoma Endometrial CA 21

22 www.qualityforum.org Quality Enterprise Functions: Contributions of NQF Establish National Priorities National Priorities Partnership Top 20 conditions Identify Measure Gaps Agenda for Measure Development and Endorsement Measure Development Endorse Measures, Practices, and SREs Over 600 measures covering all settings, including Safe Practices and SREs Build Data Platforms Health Information Technology Expert Panel Publicly Report Results Guidance for performance reporting on safety MAPs & Dashboard Align Payment and Other Incentives Analysis of measurement implications of various payment reform models Improve Performance Webinars Measures database Evaluate Measure use evaluation 22

23 www.qualityforum.org NTTAA National Technology and Transfer Advancement of Act of 1995 (NTTAA)  Defines the five key attributes of a “voluntary consensus standards-setting body” (i.e., openness, balance of interest, due process, consensus, and an appeals process)  Obligates federal government to adopt voluntary consensus standards (when the government is adopting standards)  Encourages federal government to participate in setting voluntary consensus standards NTTAA 23

24 www.qualityforum.org 24 Measurement & Improvement Paths NQF, 2002

25 www.qualityforum.org NQF Consensus Development Process Call for nominations for steering committee and technical panels Call for measures Measure evaluation Member and public comment NQF member voting Consensus Standards Approval Committee (CSAC) Board of Directors endorsement Appeals Consensus Development Process Steps 25

26 www.qualityforum.org NQF Evaluation Criteria Importance to measure and report What is the level of evidence for the measures? Is there an opportunity for improvement? Relation to a priority area or high impact area of care? Scientific acceptability of the measurement properties What is the reliability and validity of the measure? Usability Can the intended audiences understand and use the results for decision-making? Feasibility Can the measure be implemented without undue burden, capture with electronic data/EHRs? 26

27 www.qualityforum.org Types of Quality Measures Process Outcome Structure/management Access Efficiency/cost Use of services (used as proxy for outcome, cost) Patient experience of care Composite (two or more measures combined into a single score) 27

28 www.qualityforum.org Drive toward higher performance Shift toward composite measures Measure disparities in all we do Harmonize measures across sites and providers Promote shared accountability & measurement across patient-focused episodes of care: –Outcome measures –Appropriateness measures –Cost/resource use measures coupled with quality measures, including overuse Quality Measurement in Evolution 28

29 www.qualityforum.org Patient-Focused Episodes of Care Model Population at Risk Evaluation & Initial Management Rehabilitation & Follow-up Care Clinical episode begins Appropriate Times Throughout Episode - Determination of key patient attributes for risk adjustment - Assessment of informed patient preferences and the degree of alignment of care processes with these preferences - Assessment of symptom, functional, and emotional status PHASE 1 PHASE 2 PHASE 3 End of Episode - Risk-adjusted health outcomes (i.e. mortality & functional status) - Risk-adjusted total cost of care Time 29

30 www.qualityforum.org Episodes Model Measurement Domains Patient-level outcomes (better health) –Morbidity and mortality –Avoidance of complications (e.g., HAIs) –Functional status –Health-related quality of life –Patient experience of care Processes of care (better care) –Technical –Care coordination and transitions –Alignment with patients’ preferences; shared decision- making Cost and resource use (overuse, waste, misuse) –Total cost of care across the episode –Indirect costs 30

31 www.qualityforum.org Patient-Focused Episodes of Care Model Patient-focused orientation –Follows the natural trajectory of care over time Directed at value –Quality, costs, and patient preferences Emphasizes care coordination –Care transitions and hand-offs Promotes shared accountability –Individual, team, system Addresses shared decision making –Attention to patient preferences Supports fundamental payment reform –Bundled payment for the episode of care 31

32 www.qualityforum.org Integrated Performance Measurement Framework 32 Population at Risk Evaluation & Initial Management Follow-up Care Clinical Episode Begins PHASE 1 PHASE 2 PHASE 3 End of Episode ~ Risk- Adjusted Health Outcomes and Total Cost of Care Time Patient & Family Engagement Safety Care Coordination Overuse Palliative CarePopulation Health

33 www.qualityforum.org 33 Not everything that counts can be counted, and not everything that can be counted counts. Albert Einstein

34 www.qualityforum.org Quality Enterprise Functions: Contributions of NQF Establish National Priorities National Priorities Partnership Top 20 conditions Identify Measure Gaps Agenda for Measure Development and Endorsement Measure Development Endorse Measures, Practices, and SREs Over 600 measures covering all settings, including Safe Practices and SREs Build Data Platforms Health Information Technology Expert Panel Publicly Report Results Guidance for performance reporting on safety MAPs & Dashboard Align Payment and Other Incentives Analysis of measurement implications of various payment reform models Improve Performance Webinars Measures database Evaluate Measure use evaluation 34

35 www.qualityforum.org Comprehensive Data Needed to Generate Performance Information Data Integration Patients Pay for Performance Consumer Activation Hospitals/ Institutions EHRs Laboratories Pharmacies Medical Claims Registries Quality Improvement Care Evaluation Data Aggregation RWJF Aligning Forces for Quality 35

36 www.qualityforum.org Linkage of HIT and Measurement Data Source s Capture the right dataCalculate the performance measure Provide real-time information to the clinician with decision support Publicly report for secondary uses: accountability, payment, public health, and comparative effectiveness Data Sources Performance Measures EHRs and HIT tools E-Infra structure 36

37 www.qualityforum.org Performance measurement 600 + Measures Dozens of stewards Performance measurement 600 + Measures Dozens of stewards Health IT Advisory Committee Translate (QDS) Harmonize measure standards and HIT standards Health IT Advisory Committee Translate (QDS) Harmonize measure standards and HIT standards Health IT Vendors Standard Development Orgs Health IT Vendors Standard Development Orgs Interfacing Measurement and Health IT 37

38 www.qualityforum.org Shared Data Elements: “Sweet Spot” Clinical Guidelines Decision Support Quality Measures 38

39 www.qualityforum.org QDS Data Element 39

40 www.qualityforum.org QDS Data Flow 40

41 www.qualityforum.org Shared Supply Chain 01110100 01101000 01100001 01101100 00100000 01010010 01101111 01110011 01100101 01101110 01000100 01100001 01101110 01101110 01111001 Guideline diabetes aspirin hemoglobin lumpectomy smoker EKG QDS data element repository QM CDS CDS rule repository QM specification repository CDS map EHR 01101001 01110011 00100000 01100011 01101111 01101111 01101100 00100001 quality report 41

42 www.qualityforum.org Quality Enterprise Functions: Contributions of NQF Establish National Priorities National Priorities Partnership Top 20 conditions Identify Measure Gaps Agenda for Measure Development and Endorsement Measure Development Endorse Measures, Practices, and SREs Over 600 measures covering all settings, including Safe Practices and SREs Build Data Platforms Health Information Technology Expert Panel Publicly Report Results Guidance for performance reporting on safety MAPs & Dashboard Align Payment and Other Incentives Analysis of measurement implications of various payment reform models Improve Performance Webinars Measures database Evaluate Measure use evaluation 42

43 www.qualityforum.org Applications of Performance Information 43

44 www.qualityforum.org NQF and RAND Project: Measurement Implications of Payment Reform Models Performance-based payment incentives as a driver of change –Pay for performance –Episode-based payment –Population-based payment Increasing aggregation of services into a unit of payment Payment for service Payment for event or condition Payment for care of a population Fee-for- service Augmented fee-for- service (e.g., P4P) Bundled payment (single provider) Bundled payment (multiple providers) Partial capitation Full capitation 44

45 www.qualityforum.org Payment Reform Models 45

46 www.qualityforum.org NQF and RAND Project: Measurement Implications of Payment Reform Models Measurement analysis for selected payment reform models –Assessment of measure needs Proposed measure sets –Analysis of methodological issues raised by application of measures Attribution Risk adjustment Benchmarking Data source Small numbers 46

47 www.qualityforum.org Quality Enterprise Functions: Contributions of NQF Establish National Priorities National Priorities Partnership Top 20 conditions Identify Measure Gaps Agenda for Measure Development and Endorsement Measure Development Endorse Measures, Practices, and SREs Over 600 measures covering all settings, including Safe Practices and SREs Build Data Platforms Health Information Technology Expert Panel Publicly Report Results Guidance for performance reporting on safety MAPs & Dashboard Align Payment and Other Incentives Analysis of measurement implications of various payment reform models Improve Performance Webinars Measures database Evaluate Measure use evaluation 47

48 www.qualityforum.org Searchable Database of Endorsed Measures 48

49 www.qualityforum.org Measure Use Evaluation Getting Underway To assess the use of performance measures for driving system change: –Public reporting –Payment incentives –Accreditation and certification –Quality improvement To inform measure development, endorsement, and implementation Independent contractor 49

50 www.qualityforum.org Take Home Messages Entering a period of extraordinary challenges and opportunities Two critical drivers–- public reporting and payment alignment Early investment in HIT is critical Delivery system reform is essential to succeed –Integration of personal and population health to address behavioral change –Clinical integration to manage patient-focused episodes and maximize value 50

51 www.qualityforum.org Thank You www.qualityforum.org


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