Patient engagement in Quality of Care Measurement Reena Duseja, MD MS Director, Division of Quality Measurement Center for Clinical Standards & Quality 1

General Principles Alignment with CMS Quality Strategy Alignment with Commercial payers and states Address performance gaps Evidence-based measure concepts Scientific rigor Patient/caregiver and front line clinician inclusion Rapid-cycle development Prioritize Patient-reported outcomes Monitor disparities and unintended consequences

Strategic Vision Measures should be: Patient Centered with a focus on patient experience and preferences High Value with an emphasis on – outcomes for patients and spanning the care continuum Current with clinical practice updates Applicable to other payers and across care settings Agile in their development, with an emphasis on innovation

Priorities for Measure Development by Quality Domain Clinical Care Measures incorporating shared decision-making Outcome and Patient-reported Outcome Measures Cross-cutting measures (patients with MCCs) Focused measures for specialties that have clear gaps Safety Measures of diagnostic accuracy Medication safety

Priorities for Measure Development by Quality Domain (continued) Care Coordination Assessing team-based care Effective use of new technologies Patient and Caregiver Experience Disease specific and cross-cutting PROMs Patient experience surveys (general and specialty-specific where needed)

Priorities for Measure Development by Quality Domain (continued) Population Health and Prevention Developing or adapting outcome measures at a population level to assess the effectiveness of the health promotion and preventive services delivered by professionals Affordable Care Overuse measures Episode based resource use

Person & Family Engagement Network Composition Fiscal Year 2017 began with 43 members and as of 9/1/17 has 68 members

Conditions Represented in Person and Family Engagement Network Member Experiences Palliative and end-of-life care; advance directives Cardiac Care: heart attack and failure, coronary artery disease, heart transplant, cardiac rehab Cancer Care: breast cancer, non-Hodgkin’s lymphoma, colorectal cancer, ovarian cancer Family Caregiving Disability/Chronic Illness: multiple sclerosis, spinal muscular atrophy, Spastic quadriplegia Cerebral Palsy, Ehlers-Danlos syndrome, down syndrome, kidney disease, endometriosis, chronic pain Health care chaplaincy/ministry Mental health conditions and comorbidities Hip/joint replacement Diabetes Health care disparities: race, ethnicity, socioeconomic status, sexual orientation Aging Patient Safety

Engagement mechanisms CMS uses in Patient Engagement Technical Expert Panels Network-Wide Surveys Targeted one to one cognitive interviews Listening sessions and Surveys Targeted Working Group and Survey

Role of Patient Reported Outcome (PRO) Measures Consistent with the National and CMS Quality Strategies, CMS has embarked on multiple PRO-based measure development projects These projects have created opportunities for engaging stakeholders and advancing clinical practice, which has been traditionally slow to incorporate PROs.

Using PRO data to build quality measures ensures that patient’s voice is heard. The voluntary PRO data collection in the Comprehensive Care for Joint Replacement model is the first demonstration that hospitals recognize the value and importance of collecting PRO data. Patient’s self-reported pain and functional outcomes after elective knee and hip arthroplasty

Lessons learned Partnering with persons and families means operating outside the “Nine-Five” day Persons & families have differing needs, preferences, and expectations from one another Persons & families know best how they should be engaged Language impacts relationship building and engagement success

Lessons Learned Person & Family Engagement vision and impact One-time Network-wide engagements can have significant impacts Successful engagement requires an organization-wide person & family engagement vision

Contact Information Reena Duseja, M.D., MS Director, Division of Quality Measurement, Center for Clinical Standards and Quality Chief Medical Officer Centers for Medicare and Medicaid Services Reena.Duseja@cms.hhs.gov