1. www.qualityforum.org Measuring Quality and Value Keys to Reducing Disparities Janet M. Corrigan, PhD President and CEO National Quality Forum

2. www.qualityforum.org 2D Framework for Measure Development Cross-cutting National Priorities –Population health, safety, care coordination, patient/family engagement, palliative care, overuse Patient Focused Episodes –Top 20 Medicare Conditions –Supplemented by Conditions for <65 2

3. www.qualityforum.org 3 3 National Priorities—Key Cross 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

4. www.qualityforum.org National Priorities: Overuse Goals Inappropriate medication use Unnecessary lab tests Unwarranted maternity care interventions Unwarranted diagnostic procedures Unwarranted procedures Unnecessary consultations Preventable ED visits and hospitalizations Inappropriate end of life care Non-beneficial preventive services 4

5. www.qualityforum.org National Priorities Partnership

6. 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 6

7. www.qualityforum.org Getting Better Living w/ Illness/Disability (T1) Coping w/ End of Life (T2) Staying Healthy Post Acute/ Rehabilitation Phase 2 0 Prevention Episode begins – onset of symptoms Post AMI Trajectory 2 (T2) Adult with multiple co-morbidities Focus on: Palliative Care Functional Status Advanced Care Planning Patient & Family Engagement Acute Phase PHASE 1 PHASE 2 PHASE 3 PHASE 4 Safety Episode ends – 1 year post AMI Population Health 1 0 Prevention 2 0 Prevention (CAD with prior AMI) Post AMI Trajectory 1 (T1) Relatively healthy adult Focus on: Secondary prevention Quality of Life Functional Status Advanced care planning Care Coordination Overuse Palliative/End of Life Care Population Health 2-D Measurement Framework: AMI Episode 7

8. www.qualityforum.org Key Measurement Domains to Get at Value Patient-level outcomes (better health) –Morbidity and mortality –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 Resource use (lower cost) –Total cost of care across the episode –Indirect costs –Appropriateness measures targeting “overused” services 8