WCHQ and Pediatric Quality Measurement in Wisconsin Matt Gigot, MPH Program Manager, Reporting and Analytics

WCHQ Background Current WCHQ Pediatric Quality Measurement Opportunities for Pediatric Quality Measurement at WCHQ in the Future Outline

Our Vision The Wisconsin Collaborative for Healthcare Quality (WCHQ) dramatically improves the health and increases the value of healthcare for the people of Wisconsin. Our Mission WCHQ publicly reports and brings meaning to performance measurement information that improves the quality and affordability of healthcare in Wisconsin, in turn improving the health of individuals and communities. Our Values WCHQ builds consensus and drives improvement by practicing these values: trust, participation, inclusiveness, shared responsibility, openness, adaptive self-governance, intellectual output, acknowledgement, and transparency WCHQ: A Voluntary Member Organization

WCHQ Member Organizations Access Community Health Centers Agnesian HealthCare Aspirus Associated Physicians Aurora Health Care Bellin Health Beloit Health System Columbia St. Mary’s Dean Clinic/St. Mary’s Hospital Divine Savior Healthcare Fort HealthCare Froedtert Health Group Health Cooperative of South Central WI Gundersen Health System Holy Family Memorial Marshfield Clinic Mayo Clinic Health System Medical College of Wisconsin Mercy Health System Meriter-UnityPoint Health Monroe Clinic Physicians' Health Network Prairie Clinic Prevea Health Primary Care Associates of Appleton ProHealth Care QuadMed Reedsburg Area Medical Center Richland Medical Center Sacred Heart Hospital Sauk Prairie Healthcare Sixteenth Street Community Health Centers ThedaCare UW Health UW Health Partners Watertown Wheaton Franciscan Healthcare Wildwood Family Clinic Wisconsin health systems, physician groups, and hospitals Representing approximately 65% of Wisconsin’s primary care providers

WCHQ Stakeholders AARP Wisconsin American Cancer Society Business Health Care Group Coalition of Wisconsin Aging Groups GE Healthcare Greater Milwaukee Business Foundation on Health HOPE of Wisconsin MetaStar Robert Wood Johnson Foundation Rural Wisconsin Health Cooperative Survey of the Health of Wisconsin The Alliance The Center for Patient Partnerships The Commonwealth Fund ThedaCare Center for Healthcare Value UW Center for Nonprofits UW Health Innovation Program UW Population Health Institute WEA Trust Webcrafters, Inc. Wisconsin Chapter of the American Academy of Pediatrics Wisconsin Dept. of Employee Trust Funds Wisconsin Department of Health Services Wisconsin Health Information Organization Wisconsin Hospital Association Wisconsin Manufacturers & Commerce Wisconsin Medical Society Wisconsin Primary Health Care Association WPS Health Insurance These organizations collaborate with WCHQ:

Values and Guiding Principles Trust – Avoid using performance data for market advantage. Participation – Engage in dialogue, capacity-building, and sharing of best practices. Inclusiveness – Deliberate and make decisions in ways that represent all affected parties. Shared Responsibility – Commit to enhancing capacity for individual growth and organizational improvement. Openness – Transcend competitive/intellectual boundaries that diminish learning. Adaptive Self-Governance – Encourage adaptability, diversity, flexibility, and innovation. Intellectual Output – Use measurement data to benefit all. Acknowledgement – Recognize intellectual contributions from inside and outside of WCHQ. Transparency – Openly share data and processes among WCHQ members and the public.

WCHQ Core Competencies Performance Measure Priorities: We help to facilitate consensus on priority measures for assessing the quality and cost of healthcare in Wisconsin. Collect and Validate Measurement Data: We guide the collection, validation and analysis of both administrative and clinical data. Publicly Report Measurement Results: We publicly report comparative performance results for healthcare providers, purchasers and consumers. Share Best Practices: We share the best practices of healthcare organizations that demonstrate high quality, enabling all providers to adopt successful methods. Performance Improvement: We facilitate performance improvement through goal setting, member-led improvement teams, and the sharing of best practices through site- visits, webinars, and statewide improvement events. WCHQ publicly reports and brings meaning to healthcare performance information.

WCHQ Data Collection Repository Based Data Submission (RBS): Alternative Data Submission Method: WCHQ members submit global files of patient demographic, encounter, and clinical data via a web-based tool. The RBS tool’s centrally programmed measure specifications calculate performance results for reporting. Members can run monthly reports down the physician and patient-level WCHQ members use detailed measure specifications to program measures internally and submit numerator and denominator data to WCHQ’s web-based tool.

WCHQ Measure Development WCHQ began publicly reporting in 2005 Motivation to improve was largely “intrinsic” Denominator definition designed to measure a population of patients that providers had a relationship with Measurement Advisory Committee oversees all measurement work at WCHQ Measure selection driven by: Payer/Purchaser Harmonization Member Reporting Burden Innovation Quality Improvement

Number of WCHQ Measures by Year

Performance & Progress Report

WCHQ Public Reporting of Performance at the Organization and Clinic Level

Why Publicly Report Quality Information? “Public Reporting Helped Drive Quality Improvement in Outpatient Diabetes Care Among Wisconsin Physician Groups” Maureen Smith Alexandra Wright Christopher Queram Geoffrey Lamb

Pediatric Quality Measurement Relatively new measurement area for WCHQ WCHQ has placed a priority on moving beyond the adult primary care population First public report in November 2015 Childhood Immunization Status Adolescent Immunization Status

Childhood Immunization Status Measure Numerator Patients who have evidence of the following vaccinations: Four Diphtheria Tetanus and Acellular Pertussis (DTaP) Three Polio (IPV) One Measles, Mumps and Rubella (MMR) Three H Influenza Type B (HiB) Three Hepatitis B (Hep B) One Chicken Pox/Varicella (VZV) Four Pneumococcal Conjugate (PCV) Denominator Patients who turn two years of age during the measurement period, and Have two PCP office visits in the past 24 months, and Have one PCP office visits in the most recent 12 months (measurement period)

Childhood Immunization Status Measure Measure Expansion WCHQ is currently publicly reporting “Combination 3” Future area of measurement expansion is “Combination 10”, which would include: Hepatitis A, Rotavirus, and Influenza Some data collection concerns with Influenza Are there data sources, like WIR, that could supplement data captured by the health systems? Combination 3 Results WCHQ Population Average – 80.22% 30,599 patients in the denominator National Immunization Survey Estimates (2014) National – 71.6% ± 1.5 National Range – 63.4% to 84.7% Wisconsin – 70.9% ± 7.6

Childhood Immunization Status – System Results

Childhood Immunization Status – Clinic Results

Adolescent Immunization Status Measure Numerator Patients who have evidence of the following vaccinations: One does of meningococcal vaccine, and One tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), or One tetanus, diphtheria toxoids vaccine (Td) Denominator Patients who turn thirteen years of age during the measurement period, and Have two PCP office visits in the past 24 months, and Have one PCP office visits in the most recent 12 months (measurement period) Results WCHQ Population Average – 79.59% 22,494 patients in the denominator HEDIS Commercial Average – 64%

Adolescent Immunization Status – System Results

Adolescent Immunization Status – Clinic Results

Future Pediatric Quality Measurement – Near Term September 2015 – WCHQ Consults with WIAAP leadership on potential areas of measurement expansion: ADHD Adolescent Mental Health Asthma BMI Chlamydia HPV Developmental Screening Lead Screening Well Child Visits March 2016 – WCHQ Measurement Advisory Committee and Board of Directors approve new measures: Chlamydia Screening HPV Immunization (males and females) Well Child Visits in the First 15 Months Public reporting targeted for 2017

Future Pediatric Quality Measurement – Long Term Payer Harmonization Medicaid/CHIP Commercial Payers and Purchasers Manage Member Reporting Burden Primary Measure Set Limit Number of Metrics Clinical Strength Innovation Disparities Patient Reported Outcomes Composite Metrics Choosing Wisely WCHQ QI Activities Assembly Meetings Site visitsToolkits New: data sharing prior to public reporting WCHQ Measure Portfolio “Value Drivers”

Portfolio Value Driver – Payer Harmonization Children’s Health Insurance Program Reauthorization Act (CHIPRA) passed in 2009 CHIPRA contains provisions to strengthen the quality of care provided to children in Medicaid and CHIP Requires HHS to identify and publish a core measure set of children’s healthcare quality metrics Creates voluntary reporting mechanism for state Medicaid programs to report core quality metrics to CMS Core measure set – 23 total measures/12 ambulatory WI reported on 4 of 23 measures in 2015

Portfolio Value Driver – Payer Harmonization CHIP Core Quality Measures Reported by WCHQ – Ambulatory Specific Measures not reported by WCHQ: Well-Child in the 4 th, 5 th, and 6 th Years of Life Adolescent Well-Care Visits BMI Assessment for Children and Adolescents Follow-Up After Hospitalization for Mental Illness Follow-Up Care for Children Prescribed ADHD Medication Developmental Screening in the First Three Years of Life Medication Management for People with Asthma

Core Quality Measures Collaborative Partnership between America’s Health Insurance Plans (AHIP) and CMS Developed seven core measure sets to be used in CMS and health plan incentive programs A pediatric measure set will be coming in the next few months Portfolio Value Driver – Payer Harmonization Measure SetNumber of Measures ACO/PCMH21 HIV/Hepatitis C8 Orthopedics3 Gastrointestinal8 Cardiovascular25 OB/GYN11 Medical Oncology14

Portfolio Value Driver – Payer Harmonization Working more closely with the Wisconsin payer and purchaser community around measurement is one way to work toward a harmonized measure set A workgroup to explore greater collaboration has been formed Current participants: Initial focus is developing a commonly agreed upon measure set that: Highlights measures that are of interest to the payer and purchaser community Draws upon WCHQ’s unique ability to measure and report quality metrics using clinical data Future exploration – can reporting WCHQ measures satisfy commercial payer quality reporting requirements? The Alliance Anthem Business Health Care Group United Healthcare WCHQ WEA Trust WPS Health Insurance

WCHQ Measure Portfolio “Value Drivers” Payer Harmonization Medicaid/CHIP Commercial Payers and Purchasers Manage Member Reporting Burden Primary Measure Set Limit Number of Metrics Clinical Strength Innovation Disparities Patient Reported Outcomes Composite Metrics Choosing Wisely WCHQ QI Activities Assembly Meetings Site visitsToolkits New: data sharing prior to public reporting Future Pediatric Quality Measurement – Long Term

Portfolio Value Driver – Manage Member Reporting Burden Portfolio Management Primary Measure Set All members must report Attention paid to the size of the measure set Harmonized with pay for performance initiatives Primary Measure Set Focus Areas Chronic Disease Asthma/COPD Behavioral Health CHF Chronic Kidney Disease Diabetes Hypertension IVD Obesity Prevention Cancer Prevention Osteoporosis Pediatric Prevention Immunizations Tobacco Use and Cessation

WCHQ Measure Portfolio “Value Drivers” Payer Harmonization Medicaid/CHIP Commercial Payers and Purchasers Manage Member Reporting Burden Primary Measure Set Limit Number of Metrics Clinical Strength Innovation Disparities Patient Reported Outcomes Composite Metrics Choosing Wisely WCHQ QI Activities Assembly Meetings Site visitsToolkits New: data sharing prior to public reporting Future Pediatric Quality Measurement – Long Term

Innovative WCHQ Measures IVD outcome composite (Adult) Diabetes outcome composite (Adult) Possible Areas of Pediatric Innovation Pediatric Prevention Composite Patient-reported outcomes Asthma Control (ACT, C-ACT, ATAQ) Measures accounting for the social determinants of health Measures accounting for racial and ethnic diversity Choosing Wisely/Appropriateness Other Areas? Portfolio Value Drivers – Innovation

WCHQ Measure Portfolio “Value Drivers” Payer Harmonization Medicaid/CHIP Commercial Payers and Purchasers Manage Member Reporting Burden Primary Measure Set Limit Number of Metrics Clinical Strength Innovation Disparities Patient Reported Outcomes Composite Metrics Choosing Wisely WCHQ QI Activities Assembly Meetings Site visitsToolkits New: data sharing prior to public reporting Future Pediatric Quality Measurement – Long Term

Quality improvement is a major focus of WCHQ and its membership In 2015 WCHQ hosted 10 learning events 92% of WCHQ member organizations participated in a QI activity in 2015 WCHQ has member-led quality improvement steering teams that focus on improvement in three areas: Diabetes Hypertension Colorectal Cancer Screening Is there member interest to focus on pediatric QI? Measures need to reflect areas of QI opportunity and focus How can measurement support quality improvement? More frequent reporting – biannual reporting in Spring 2016 Data available prior to and between public reporting periods Many organizations submit data monthly Portfolio Value Drivers – Quality Improvement

Conclusion Pediatric quality measurement is, and will continue to be an area of focus for WCHQ Variation exists, and there is room for improvement Pediatric measurement expansion will be driven both by local preferences and national trends

Questions/Comments/Suggestions Contact Info: Matt Gigot, MPH Program Manager, Reporting and Analytics Wisconsin Collaborative for Healthcare Quality