1. Accountable Care Quality Measures Subgroup October 28, 2013

2. Initial Charge to ACQM Subgroup Develop recommendations for the next generation of e-measure constructs that are patient-centered, longitudinal, cross settings of care where appropriate and address efficiency of care delivery. – Focus will be on the domains, concepts, and infrastructure that can be applied to Accountable Care Organizations (ACOs). Office of the National Coordinator for Health Information Technology 1

3. Expanded Charge Overarching Charge to QM WG and ACQM Subgroup: Develop recommendations for how electronic clinical quality measure concepts and specific measures could be used in place of MU objective measures to “deem” eligible providers (EPs) and eligible hospitals (EHs) as meaningful users through their ability to perform on quality outcomes. HIT-sensitive outcome measures for EPs and EHs – What are the criteria and the potential framework for deeming? – Which measures that currently exist in CMS programs are appropriate to use for deeming? Eligible professionals and group reporting (still to be discussed) – What parameters should be used for a group reporting option for MU overall (including deeming). – If there is a group reporting option, how do you attribute a provider's membership in a group and his/her ability to receive incentives (or avoid penalties)? Office of the National Coordinator for Health Information Technology 2

4. Goals for this Call Discuss and refine draft criteria developed by Quality Measure Workgroup and this subgroup Develop draft recommendations on the criteria and exemplars and any specific questions for HIT Policy Committee meeting on November 6 Office of the National Coordinator for Health Information Technology 3

5. Overarching Thoughts on Deeming Approach to deeming: – HIT-sensitive, outcome-oriented – Population focused (i.e., Million Hearts, disparities, frail elderly) Framework would support: – High or improved performance – Reduction in disparities – Encompass the aspects of the MU Stage 2 objectives but does not need to map one-to-one – Patient-reported outcome measures Office of the National Coordinator for Health Information Technology 4

6. Overarching Thoughts on Deeming cont. Health is the primary outcome Several factors influence how the criteria are applied to a given measure within ACOs: – Ability to define the population of focus – Accountability vs. reporting for organization – Operationalization of the measure – For example, some criteria may be more important or prioritized when a measure is applied at a population level or for accountability purposes within an organization Currently exploring: – whether the criteria applies or is weighted equally – how to indicate that low ratings of some criteria reflect work that must be accomplished to achieve the measure concept and overall goal Office of the National Coordinator for Health Information Technology 5

7. Overarching Thoughts on Deeming cont. Infrastructure requirements to ensure successful implementation: – Will ensure success if pathway is developed – Determine if data exists today – If yes, develop into measures that best leverage the data (may be from different data sets and not solely EHRs) – If no, first develop data fields and followed by measures Office of the National Coordinator for Health Information Technology 6

8. DRAFT ACO Framework Office of the National Coordinator for Health Information Technology 7 OVERALL MEASURES

9. Reframing our thinking Office of the National Coordinator for Health Information Technology 8 Currently Healthcare is the primary area of focus and where measures are available. In the future, it is hoped that there will be an increasing focus and availability of measures on Health.

10. Office of the National Coordinator for Health Information Technology 9 Accountable Care Population (Total Patient Population)

11. Criteria Discussion Criteria were discussed in parallel at the ACQM subgroup and the QM workgroup Attempts to reconcile criteria were limited by differences in level of analysis (population, ACO, EH, EP) and focus on accountability v. reporting. There is no expectation that all measures considered for deeming would meet all proposed criteria. Further efforts at prioritization/weighting will be required after input from the HIT Policy Committee. Office of the National Coordinator for Health Information Technology 10

12. Current Iteration of the Combined Draft Criteria Applies across EP, EH, and Populations: Preference for eCQMs or measures that leverage data from HIT systems (e.g., clinical decision support) Enables patient-focused view of longitudinal care: enables assessment of care over time from the patient’s perspective Supports health risk status assessment and outcomes: supports assessment of patient health risks that can be used for risk adjusting other measures and assessing change in outcomes to drive improvement Office of the National Coordinator for Health Information Technology 11

13. Current Iteration of the Combined Draft Criteria cont. May be more applicable at the population level or for accountability purposes: Preference for reporting once across programs that aggregate data reporting (e.g., PCMH, MSSP, HRRP, CAHPS) Applicable to populations: preference for measures that can be used to assess population health Benefit Outweighs Burden: Benefits of measuring & improving population health outweighs the burden of organizational data collection and implementation Office of the National Coordinator for Health Information Technology 12

14. Frail Elderly Exemplar with a Population Focus MeasurePrefer eCQM/Levera ges HIT Patient-focused View of Longitudinal Care Health Risk/Outcomes & Improvement Prefer Report Once Applicable to Populations Benefit Outweighs Burden PRO on Coordi-nation by System High LowHighMedium Re-admissionHigh MediumHigh Falls RateMedium HighMediumHigh Pressure Ulcer Rate MediumHighMediumHigh # Days Living in Com- munity MediumHighMediumLowHighMedium Total Cost of Care High MediumHigh 13

15. Frail Elderly Exemplar with an EP Focus MeasurePrefer eCQM/Levera ges HIT Patient-focused View of Longitudinal Care Health Risk/Outcomes & Improvement Prefer Report Once Applicable to Populations Benefit Outweighs Burden Screening for Future Fall Risk High MediumHighMediumHigh Use of High- risk Meds in the Elderly High LowHigh CG-CAHPSMediumHighMedium High Closing the referral loop High Medium HighMedium Re-admissionsLowHigh LowHigh Total Cost of Care High Medium High 14

16. Questions for Discussion – Are the draft criteria appropriate as outlined? – What addition or changes should be made? – Are the exemplars included appropriate and aligned with the criteria? – Are there specific questions that should be posed to the HIT Policy Committee? Office of the National Coordinator for Health Information Technology 15