1. Person Centeredness in Quality Measurement
SNP Alliance
12th Annual Leadership Forum
October 13, 2016

2. Quality Measurement: An Overview

3. What Is a Healthcare Performance Measure?
4/18/2018
What Is a Healthcare Performance Measure?
Healthcare performance measures are tools used to quantify the quality or cost of care provided to patients and their families.
They allow us to gauge the quality of care that is provided and help us understand whether and how much improvement activities improve care and outcomes.

4. How is Performance Calculated?
Numerator (What, How, When)
# of individuals enrolled in a program
Denominator (Who, Where, When) – Exclusions (NOT)
# of individuals with a person-centered plan of care

5. What Are The Types of Healthcare Performance Measures?
Quality
Structures of care
Processes of care
Outcomes
Intermediate clinical outcomes
Health outcomes (mortality, complications, etc.)
Patient-reported outcomes (experience, functional status, engagement, quality of life, etc.)
Resource use/cost
Efficiency (combination of quality and resource use) 5

6. Who Uses Measures and Why?
4/18/2018
Who Uses Measures and Why?
Many people are interested in the quality, outcomes, and cost of care including:
Patients, Consumers, Families, & Caregivers
Primary Care, Specialists, & Other Health Professionals
Health Systems & Care Facilities
Employers & Payers (private & public)
Measure Developers and Programs
Health and Measurement Researchers

7. Why Measure? Measurement is a quality improvement tool,
For many reasons, including:
Measures drive improvement.
Measures inform consumers and other stakeholders.
Measures influence payment.
Measurement is a quality improvement tool,
not an end in and of itself
A performance measure is a way to calculate whether and how often the system does what it should.

8. Major Uses of Quality Measures
Internal quality improvement
Benchmarking
Accountability applications
Certification
Accreditation
Defining provider networks
Public reporting
Payment

9. What is NQF?
An independent, nonprofit, membership organization that brings together all stakeholders working to improve health and healthcare through quality measurement.

10. How Does NQF Improve Healthcare Quality?
Reviews, prioritizes, and endorses measures
Seeks opportunities to reduce the number of measures
Recommends measures for federal programs
Accelerates measure development
Identifies measure gaps
Serves as a trusted advisor to the U.S. government on federal policy development
Identifies what works and what does not in measurement

11. NQF and Measurement Goal: improved outcomes
Measure Gaps Projects
Consensus Development Projects
Measure Applications Partnership; National Quality Partners

12. Person Centeredness in Quality Measurement

13. Person & Family Centered Care
Person- and family-centered care (PFCC) is an approach to the planning and delivery of care across settings and time that is centered on collaborative partnerships among individuals, their defined family, and providers of care. It supports health and well-being by being consistent with, respectful of, and responsive to an individual’s priorities, goals, needs, and values.

14. Person and Family Centered Care Portfolio of Measures
Phase One: Experience with Care Measures
Phase Two: Health-related quality of life, including functional status and clinician-assessed function
Off-Cycle (Phase 2.5): Patient Activation and Annual Update Review
Phase Three ( ): Health-related quality of life, functional status, shared-decision making, symptom/symptom-burden, experience of care
NQF currently has more than sixty endorsed measures in the Person and Family Centered Care portfolio.

15. PFCC Measure Portfolio (October 2016)

16. PFCC Measure Gaps The next level of functional measures
measures not tied to traditional inpatient settings, and that focus on functional restoration, becoming independent and non-medical outcomes (e.g. return to employment)
Setting-specific measures that ensure issues and outcomes specific to that site are measure
Measures for partnerships between large health systems and community- based agencies
More measures of informed and shared decision making
Measures across the continuum of care, starting in primary care or Emergency Departments, through the completion of all services
Measures that specifically address eliciting and aligning patient goals with their plan of care

17. HCBS Quality Measurement Project
Provide multi-stakeholder guidance on the highest priorities for measurement of home and community-based services that support high-quality community living
An opportunity to address the gaps in HCBS measurement and provide direction for future performance measurement
Supported the aims of the Affordable Care Act, the National Quality Strategy, and HHS’ Community Living Council
Maintained a broad and inclusive orientation to community living and maximize opportunities for public input
Inclusive of all payers, settings and services

18. Make recommendations for HCBS measure development
Project Objectives
Create a conceptual framework for measurement, including an HCBS definition
Perform a synthesis of evidence and environmental scan for measures and measure concepts
Identify gaps in HCBS measures based on the framework and environmental scan
Make recommendations for HCBS measure development

19. Domains of HCBS Quality Measurement
Service Delivery and Effectiveness
Person-centered Planning and Coordination
Consumer Leadership in System Development
Choice and Control
Community Inclusion
Caregiver Support
Workforce
Human and Legal Rights
Equity
Holistic Health and Functioning
System Performance and Accountability

20. Global Recommendations
Support quality measurement across all domains and subdomains.
Build upon existing quality measurement efforts.
Develop and implement a standardized approach to data collection, storage, analysis, and reporting.
Ensure that emerging technology standards, development, and implementation are structured to facilitate quality measurement.
Triangulate assessment of HCBS quality using an appropriate balance of measure types and units of analysis.
Develop a core set of standard measures for use across the HCBS system, along with a menu of supplemental measures that are tailorable to the population, setting, and program.
Convene a standing panel of HCBS experts to evaluate and approve candidate measures.

21. MAP Dual Eligible Beneficiary Workgroup
Identifies performance measures for use in dual beneficiary and sub-populations (family of measures)
Prioritizes measurement gap areas
Provides strategic input for maximizing quality of life for Medicare-Medicaid enrollees
Focus on measurement topics for individuals with multiple chronic conditions
Explore topics of community integration and connection to resources

22. Key Characteristics of the Family of Measures

23. Challenges to Measuring Person Centered Care in the Dual Beneficiary Population
Complexity and heterogeneity of the needs of the dual eligible population
Tracking of beneficiaries and the services received across various programs, providers, and settings
Variation across states in the programs offered and the structure of those programs
Measures often developed for the program, not the person
Data, Data, Data
Difficult to access and often not timely
Resources needed to support data collection, analysis, and storage

24. Another option for Person Centered Measurement….
NQF does not endorse surveys, tools, or instruments.
Example: a satisfaction survey is not endorsed by NQF; however, NQF would endorse the measures (% satisfaction with coordination of care) based on the survey items/domains.
The PROM or tool is considered a data source for the performance measure. As such, testing of the tool and reporting on reliability and validity of the tool can assist in establishing scientific acceptability. This requirement should be true for both PRO-PMs and ANY tool based measure (e.g., Functional Status, Depression Remission, Quality of Life)

25. The Pathway from PROs to PRO-PMs
Identify the quality performance issue (include broad input)
Identify outcomes meaningful to target population and amenable to change
Determine whether (PRO) is the best way to assess the outcome of interest
PROM
Identify existing PROMs for measuring the outcome in the target population
Select PROM suitable for use in performance measurement (e.g., reliable, valid, feasible)
Use the PROM in real world with the intended target population and setting
PRO-PM
Specify the outcome performance measure (e.g., average change, percentage improved or meeting a benchmark)
Test PRO-PM for reliability, validity, and threats to validity (e.g., measure exclusions; missing data; poor response rate; risk adjustment; discrimination of performance; equivalence of results across PROMs)

26. PROMs and PRO-PMs Target Population Patients with clinical depression
(concept)
Symptom: depression
PROM
(instrument, tool, single-item measure)
PHQ-9 ©, a standardized tool to assess depression
PRO-PM
(PRO-based performance measure)
Percentage of patients with diagnosis of major depression or dysthymia and initial PHQ-9 score >9 with a follow-up PHQ-9 score <5 at 6 months (NQF #0711) and at 12 months (NQF #0710)

27. Vision: Quality Equations

28. 4/18/2018