Post on 17-May-2018
Bruce Siegel, MD, MPH President & Chief Executive Officer
America’s Essential Hospitals
Chair, NQF Board of Directors
@siegelmd @OurHospitals
Shantanu Agrawal, MD, MPhil President & Chief Executive Officer
National Quality Forum
@NatQualityForum
2017 NQF Annual Conference Sponsors
Thank you!
2017 NQF Annual Conference Sponsors
Thank you!
Susan Frampton, PhD President
Planetree International
National Quality Partners Leadership Consortium
National Quality Partners Leadership Consortium
� Agency for Healthcare Research and Quality
� American Academy of Family Physicians
� American Case Management Association
� American College of Obstetricians and
Gynecologists
� American Institutes for Research
� Association of Women’s Health, Obstetric &
Neonatal Nurses
Association of Rehabilitation Nurses
� Centers for Disease Control and Prevention
� Centers for Medicare & Medicaid Services
� Children’s National Medical Center
� Coalition to Transform Advanced Care
� Council of Medical Specialty Societies
� HCA
� Henry Ford Hospital
� Infectious Diseases Society of America
� Informed Patient Institute
� Johnson & Johnson Health Care Systems
� Magellan Health, Inc.
� Merck & Co., Inc.
� MN Community Measurement
� National Partnership for Women & Families
� Nursing Alliance for Quality Care
� Planetree International
� Quality Insights
� The Joint Commission
� The Leapfrog Group
� University of Texas-MD Anderson Cancer Center
� URAC
� Veterans Health Administration
� Vizient, Inc.
William Kramer, MBA Executive Director, National Health Policy
Pacific Business Group on Health
Member, NQF Board of Directors
@PBGH_updates
Quality and Value in Payment Innovation
Kate Goodrich, MD, MHS Director, Center for Clinical Standards and
Quality, and CMS Chief Medical Officer
Centers for Medicare & Medicaid Services
@CMSGov
Quality and Value in Payment Innovation
National Quality Forum Conference
Kate Goodrich, MD MHS
Director, Center for Clinical
Standards & Quality
Chief Medical Officer
9
DisclaimersThis presentation was prepared as a tool to assist providers and is not intended to grant rights or
impose obligations. Although every reasonable effort has been made to assure the accuracy of the
information within these pages, the ultimate responsibility for the correct submission of claims
and response to any remittance advice lies with the provider of services.
This publication is a general summary that explains certain aspects of the Medicare Program, but
is not a legal document. The official Medicare Program provisions are contained in the relevant
laws, regulations, and rulings. Medicare policy changes frequently, and links to the source
documents have been provided within the document for your reference
The Centers for Medicare & Medicaid Services (CMS) employees, agents, and staff make no
representation, warranty, or guarantee that this compilation of Medicare information is error-
free and will bear no responsibility or liability for the results or consequences of the use of this
guide.
10
Agenda
• Delivery System Reform and Results to Date
• Quality Payment Program and Measure Development
• Partnership between CMS and NQF
A Value-Based System requires focusing on how we pay providers, deliver care, and distribute information
Improving the way providers are incentivized, the way care is delivered, and the way information is distributed will help provide better care at lower cost across the health care system.
Distribute Information
DeliverCare
Pay Providers
FOCUS AREAS
Source: Burwell SM. Setting Value-Based Payment Goals ─ HHS Efforts to Improve U.S. Health Care. NEJM 2015 Jan 26; published online first.
CMS has adopted a framework that categorizes payment to providers
Source: Rajkumar R, Conway PH, Tavenner M. CMS ─ engaging multiple payers in payment reform. JAMA 2014; 311: 1967-8.
Category 1 Category 2 Category 3 Category 4
Fee for Service – No Link to
Quality & Value
Fee for Service– Link to Quality
& Value
APMs Built on Fee-for-Service
Architecture
Population-Based Payment
Population-Based Accountability
MARCH 2016
HHS announced that goal of 30%
payments t ied to qual i ty through APMs
achieved one year ahead of schedule!
GOAL:
Medicare Fee-for Service
Next Steps
Medicare payments are tied to quality or value through alternative payment models (categories 3-4) by the end of 2016
Testing of new models and expansion of existing models
Health Care Payment Learning and Action Network
1
2
CMS established large-scale, action -oriented networks to spread quality improvement and safety activities on a national scale
Partnership for Patients
• 4,000 Hospitals
Quality Innovation Networks –Quality Improvement Organizations
• 250+ Communities• 10,000+ Nursing Homes• 3,800 Home Health
Organizations• 300 Hospices• 1,700 Pharmacies
15
Transforming Clinical Practices Initiative• 140,000 Clinicians
End Stage Renal Disease Networks• 6,000 Dialysis Facilities
MACRA and Quality Payment Program - Small, Underserved, Rural Support
• Up to 200,000 Clinicians
National Results on Patient Safety Substantial progress thru 2015, compared to 2010 baseline
16
� 21 percent decline in overall harm
� 125,000 lives saved
� $28B in cost savings from harms avoided
� 3.1M fewer harms over 5 years
� Think about what these means for so many patients and families
Source: Agency for Healthcare Research & Quality. “Saving Lives and Saving Money: Hospital-Acquired Conditions Update. Interim Data from National Efforts to Make Care Safer, 2010 – 2014.” December 1, 2015
Qual i t y Payment Program
The Merit-based Incentive
Payment System (MIPS)
If you decide to participate in traditional
Medicare, you may earn a performance-based
payment adjustment through MIPS.
The Quality Payment ProgramThe Quality Payment Program policy will:• Reform Medicare Part B payments for more than 600,000 clinicians• Improve care across the entire health care delivery system
Clinicians have two tracks to choose from:
11
OR
Advanced Alternate Payment Models
(APMs)
If you decide to take part in an Advanced APM, you
may earn a Medicare incentive payment for
participating in an innovative payment model.
Quality Payment Program Strategic Goals
19
Improve beneficiary outcomes
Increase adoption of Advanced APMs
Improve data and information sharing
Enhance clinician experience
Maximize participation
Ensure operational excellence in program implementation
Quick Tip:For additional information on the Quality Payment Program, please visit QPP.CMS.GOV
What is the Merit-based Incentive Payment System?
• Moves Medicare Part B clinicians to a performance-based payment system
• Provides clinicians with flexibility to choose the activities and measures that are most meaningful to their practice
• Reporting standards align with Advanced APMs wherever possible
20
Quality Cost Improvement Activities
Advancing Care Information
Performance Categories
Advanced Alternative Payment ModelsClinicians and practices can:• Receive greater rewards for taking on some risk related to patient outcomes.
21
Advanced APMs
Advanced APM-
specific rewards
5% lump sum
incentive
+
“So what?” - It is important to understand that the Quality Payment Program does not change the design of any particular APM. Instead, it creates extra incentives for a sufficient degree of participation in Advanced APMs.
Advanced APMs in 2017For the 2017 performance year, the following models are Advanced APMs:
The list of Advanced APMs is posted at QPP.CMS.GOV and will be updated with new announcements as needed.
22
Comprehensive End Stage Renal Disease Care Model
(Two-Sided Risk Arrangements)Comprehensive Primary Care Plus (CPC+)
Shared Savings Program Track 2 Shared Savings Program Track 3
Next Generation ACO ModelOncology Care Model
(Two-Sided Risk Arrangement)
Future Advanced APM OpportunitiesIn future performance years, we anticipate that the following models will be Advanced APMs:
23
Advancing Care Coordination through Episode
Payment Models Track 1 (CEHRT)
New Voluntary Bundled Payment Model
ACO Track 1+
Vermont Medicare ACO Initiative (as part of the
Vermont All-Payer ACO Model)
Comprehensive Care for Joint Replacement (CJR)
Payment Model (CEHRT)
Keep in mind: The Physician-Focused Payment Model Technical Advisory Committee (PTAC) will review and assess proposals for Physician-Focused Payment Models based on proposals submitted by stakeholders to the committee.
24
Where can I go t o l ea rn more?
qpp.cms.gov
F u t u r e o f o u r h e a l t h s y s t e m
� Alternative Payment Models • ACOs• Comprehensive Primary Care• Physician-focused APMs
� Private payer and CMS collaboration critical� States and Communities driving innovation and delivery
system reform� Increasing integration of public health and population
health with health care delivery system� Patient-centered, coordinated care is the norm� Focus on quality and outcomes
CMS Quality Measure Development Plan
• Required under MACRA to set priorities for MIPS and APMs
• Initially focuses on measure gaps identified in the CMS portfolio of quality measures
• Over 80% of MIPS measures are for specialists, but gaps remain
• Recommends prioritized approaches to close gaps through the development, adoption, and refinement of quality measures
• Sets expectations for CMS-funded measure developers
• Make progress on the data infrastructure for QM development (data elements, testing)
• Makes available technical and subject matter expertise to clinician organizations
26
Priorities for Measure Development
�Outcome and Patient-reported Outcome Measures �Cross-cutting measures (patients with MCCs)�Focused measures for specialties that have clear
gaps�Palliative care, oncology, orthopedics
�Measures of diagnostic accuracy�Novel and real-time ways to measure patient
experience (mobile technology, e.g.)�Appropriate Use of technology, services�Episode based resource use
27
Challenges
• Defining the right outcome/performance gap• Engaging patients and front-line clinicians in the
measure development process• Advancing the science for critical measure types:
PROMs, resource use, appropriate use, etc.• Robust feasibility, reliability and validity testing• Reduction of provider burden and cost to reporting
measures• Cycle time and cost to develop measures
28
The Impor tance o f the NQF / CMS Par tnersh ip
NQF and CMS
• Measure endorsement• Development of the measurement science• Multi-stakeholder review of measures for
CMS programs• Collaboration on feedback loops• Continuous improvement
30
NQF’s Measure Application Partnership (MAP)
• MAP is a multi-stakeholder partnership that guides the U.S. Department of Health and Human Services (HHS) on the selection of performance measures for federal health programs.
• Congress recognized the benefit of an approach that encourages consensus building among diverse private-and public-sector stakeholders.
• The MAP provides a coordinated look across federal programs at performance measures being considered
31
Pre-rulemaking Process: Measure Selection
• The Pre-rulemaking Process – provides for more formalized and thoughtful process for considering measure adoption:
• Early public preview of potential measures• Multi-stakeholder groups seek feedback and consider prior to
rulemaking • Review measures for alignment and to fill measurement gaps prior to
rulemaking • Endorsement status considered favorable; lack of endorsement must
be justified for adoption. • Potential impact of new measures and actual impact of implemented
measures considered in selection determination (feedback loop)
32
Partnership in Continuous Improvement
NQF and CMS must work together to streamline, reduce cost and cycle time, establish feedback loops and integrate endorsement and multi-stakeholder input
Contact Information
Kate Goodrich, MD MHS
Director, Center for Clinical Standards and Quality
Chief Medical Officer
410-786-6841kate.goodrich@cms.hhs.gov
34
Laurel Pickering, MPH President & Chief Executive Officer
Northeast Business Group on Health
Member, NQF Board of Directors
Quality and Value in Payment Innovation
Alan Weil, MPP, JD
Editor-in-Chief
Health Affairs
@alanrweil @Health_Affairs
Quality and Value in Payment Innovation
Dan Mendelson, MPH President
Avalere Health
@dnmendelson
@avalerehealth
Quality and Value in Payment Innovation
Don Crane, JD President and CEO
CAPG
@CAPGVoice
Austin Frakt, PhD Dept. of Veterans Affairs
Contributor, The New
York Times
@afrakt
@nytimes
Carol Cronin Executive Director
Informed Patient Institute
Member, NQF Board of Directors
Amplifying the Patient’s Voice
Thomas H. Lee, MD Chief Medical Officer
Press Ganey
@ThomasHLeeMD @PressGaney
Amplifying the Patient’s Voice
Amplifying the Patient’s Voice
Thomas H. Lee, MDChief Medical Officer, Press GaneyApril 4, 2017
41© 2015 Press Ganey Associates, Inc.
What We Are After In Seven Words
Email after query on behalf of patient with newly diagnosed ALS
Dear Sven and Tom
We recently completed enrollment in the US phase 2 trial of NurOwn (Brainstorm) -the same treatment reported by Haddasah. The study in Haddassah was the first study- phase 1 - it was small, dose finding, uncontrolled. While I really hope they are right in their interpretation of the results, I think it isn't yet so clear. The US study enrolled 48 participants, using the highest concentration of cells used in the Haddassah phase 1 trials. We should have results late spring I hope.
There are a lot of other options now-- the science in ALS has really taken off -thank goodness! and there are a lot of great ideas and targets-- we would be available to talk to your friend - either in person or phone to go through some of these. If your friend agrees, please connect him directly with me and Katie Tee (cc'd above), who is our research access nurse.
We are here to help your friend. Merit
42
Start With the Why
� Simon Sinek’s famous 2009 TED talk. Start with the Why. Then turn to the How. Then turn to the What.
� In healthcare, I think the Why that resonates with patients and clinicians is the Reduction of Suffering
� The How is delivering care that is safe, coordinated, empathic.
© 2015 Press Ganey Associates, Inc.
43
Our Challenges Are Historic in Nature
� We have a crisis in the reliability and the coordination of care -- throughout the world
� Irresistible drivers of change include:� Medical progress� Aging population� Global economy
� Challenges for providers and patients:
� Too many people involved, too much to do, no one with all the information, no one with full accountability
� Result: Chaos � gaps in quality and safety, inefficiency� Patients are afraid not just of their diseases, but of lack of coordination
© 2015 Press Ganey Associates, Inc.
Question: If somehow, magically, health care costs were not a
problem, would you say that health care is working just fine?
44© 2015 Press Ganey Associates, Inc.
What Do Patients Really Value?
High: Confidence in Provider
1.9% Fail to Recommend
High: Worked Together
28% Fail to Recommend
Low: Worked Together
90% Fail to Recommend
Low: Confidence in Provider
74.6% Fail to Recommend
High:
Concern for
Worries
0.6% Fail
Low:
Concern for
Worries
5.6% Fail
High:
Concern for
Worries
6.3% Fail
Low:
Concern for
Worries
22.3% Fail
High:
Listens
Carefully
24.7% Fail
Low:
Listens
Carefully
45.7% Fail
High:
Courtesy
78.2% Fail
Low:
Courtesy
92.8% Fail
3% of patients 68.4% of patients2.4% of patients 5.9% of patients0.8% of patients 3.4% of patients11.4% of patients 2.5% of patients
High: Worked Together
1% Fail to Recommend
Low: Worked Together
11% Fail to Recommend
8% of patients 72% of patients14% of patients 5% of patients
81% of patients19% of patients
All Patients
15.7%
Recommendation Failure Rate
High Risk Low Risk
45© 2015 Press Ganey Associates, Inc.
Emergency Departments
High:
Info re
delays97.0% LTR
Low:
Info re
delays82.6% LTR
High: Info
care at
home77.5% LTR
Low: Info
care at
home56.0% LTR
High: RN
attn to
needs58.1% LTR
Low: RN
attn to
needs 33.3% LTR
High: Info
care at
home38.4% LTR
Low: Info
care at
home10.3% LTR
8.5% of patients 37.3% of patients2.6% of patients 3.7% of patients6.5% of patients 6.2% of patients20.4% of patients 2.1% of patients
Low: Dr Courtesy
12.9% Top Box LTR
High: Staff cared about you
91.4% Top Box LTR
High: Dr Courtesy
45.4% Top Box LTR
Low: Staff cared about you
24.1% Top Box LTR
High: Dr kept you informed
94.5% Top Box LTR
Low: Dr kept you informed
68.6% Top Box LTR
6.6% of patients 51.2% of patients23.6% of patients 12.9% of patients
59.0% of patients37.4% of patients
All Patients
65.0%
Top Box LTR (% Very Good)
Low = Non-Top Box Response
High = Top Box Response
46© 2015 Press Ganey Associates, Inc.
Association Disappears When Information is Accounted For
Mean Score Likelihood to Recommend
47© 2015 Press Ganey Associates, Inc.
Employee Ratings of Teamwork vs Other Quality Data
48
And Now for the Hard Part …
© 2015 Press Ganey Associates, Inc.
49
Max Weber’s Four Models for Social Action
1. Tradition – e.g., Mayo Dress Code
2. Self-interest – e.g., Performance bonuses
3. Affection – e.g., Peer pressure
4. Shared purpose – e.g., Reducing suffering
• We need to press all four levers. • But the first lever that must be pressed is creatio n of Shared
Purpose.• In isolation, any of the other three levers is inef fective or
potentially perverse.• But in pursuit of a shared purpose, all three other levers can
be embraced.
© 2015 Press Ganey Associates, Inc.
50
Transparency: Screen Shot From University of Utah Find-a-Doctor Site
© 2014 Press Ganey Associates, Inc.
Percent of Providers at 99%tile
*All Facilities Database includes the following
Number of Physicians: 142,411
Number of Patients: 2,783,597
1%
3%
13%
17%
25%26%
24%
0%
10%
20%
30%
2009 2010 2011 2012 2013 2014 2015
1 of 4 Providers above
And the number of dollars that U of Utah physicians have in incentives for improving
patient experience is …
$0
53© 2015 Press Ganey Associates, Inc.
Patients Care Most About the “Why” and the “How”
� Coordination
� Communication
� Compassion
� Implications: If we have the right “Why”, and we work relentless on the “How,” patients will work with us on the difficult “What” issues, such as control of their pain and other types of suffering
Kirsten Sloan Senior Policy Director
American Cancer Society Cancer Action
Network, Inc.
Member, NQF Board of Directors
@ACSCAN
Amplifying the Patient’s Voice
Amplifying the Patient’s Voice
Marc Boutin, JD Chief Executive Officer
National Health Council
@NHCouncil
Sally Okun, RN, MMHS Vice President, Advocacy,
Policy & Patient Safety
PatientsLikeMe
@SallyOkun
Thomas H. Lee, MD Chief Medical Officer
Press Ganey
@ThomasHLeeMD
@PressGaney
Cristie Upshaw Travis Chief Executive Officer
Memphis Business Group on Health
Member, NQF Board of Directors
@MemphisBGH
Quality for Vulnerable Populations
Ramanathan Raju, MD, MBA, FACS, FACHE Senior Vice President & Community Health
Investment Officer
Northwell Health
@RamRajuMD @NorthwellHealth
Quality for Vulnerable Populations
Nancy Wilson, MD, MPH Senior Advisor to the Director
Agency for Health Research and Quality
Member, NQF Board of Directors
@AHRQNews
Fostering Quality Care for Vulnerable Populations
Noam Levey National Health Reporter
Los Angeles Times
@NoamLevey
@latimes
Fostering Quality Care for Vulnerable Populations
Fostering Quality Care for Vulnerable Populations
Bruce Chernof, MD, FACP President & CEO SCAN Foundation @DrBruce_TSF @TheSCANFndtn
Mark Wietecha, MBA President & CEO
Children’s Hospital Association
@hospitals4kids
Norman Kahn, MD Executive Vice President &
Chief Executive Officer
Council of Medical Specialty Societies
National Quality Partners Shared Decision Making Action Team
National Quality Partners Shared Decision Making Action Team
� American College of Obstetricians and Gynecologists
� Association of Rehabilitation Nurses
� Centers for Medicare & Medicaid Services
� Connecticut Center for Patient Safety
� Council of Medical Specialty Societies
� Genentech
� Homewatch CareGivers International
� Hospice and Palliative Nurses Association
� Informed Medical Decisions Foundation
� National Coalition for Cancer Survivorship
� National Partnership for Women & Families
� Planetree International
� University of Texas-MD Anderson Cancer Center
� Vizient, Inc.
Louise Probst
Executive Director
St. Louis Area Business Health
Coalition
@stlbhc
Bringing Together Health Information Technology, Data, Policy,
and Quality Measurement to Improve Outcomes
Mahesh Krishnan, MD, MPH, MBA, FASN Group Vice President Research and Development &
International Chief Medical Officer
DaVita
@DoctorKrishnan @DaVita
Bringing Together Health Information Technology, Data, Policy,
and Quality Measurement to Improve Outcomes
Henry DePhillips, MD Chief Medical Officer
Teladoc
@Henry436 @Teladoc
Bringing Together Health Information Technology, Data, Policy,
and Quality Measurement to Improve Outcomes
Bryan Sivak former Chief Technical
Officer
U.S. Dept. of Health and
Human Services
@BryanSivak
Henry Wei, MD Benefits Medical Director
@henryweimd
Vishal Agrawal, MD Chief Growth Officer &
President, Retrieval
Solutions
Ciox Health
@CioxHealth
David Longnecker, MD Chief Clinical Innovations Officer
Coalition to Transform Advanced Care
@CTACorg
National Quality Partners Shared Decision Making Action Team
National Quality Partners Shared Decision Making Action Team
� AARP
� Aetna
� AMDA – The Society for Post-Acute and Long
Term Care Medicine
� American Case Management Association
� American Health Care Association
� American Society of Clinical Oncology
� Anthem
� Carolinas Healthcare System
� Coalition to Transform Advanced Care
� Community Health Accreditation Partner
� Compassion & Choices
� Compassus
� Connecticut Center for Patient Safety
� HealthCare Chaplaincy Network
� Healthwise/Informed Medical Decisions
Foundation
� Hospice and Palliative Nurses Association
� Johns Hopkins Medicine
� MD Anderson Cancer Center
� National Coalition for Cancer Survivorship
� National Coalition for Hospice and Palliative
Care
� National Committee for Quality Assurance
� National Partnership for Hospice Innovation
� Patient & Family Centered Care Partners
� Planetree International
� Providence Institute for Human Caring
� University of Pennsylvania Health System
National Quality Partners Shared Decision Making Action Team
James Chase, MHA Minnesota Community Measurement
Member, NQF Board of Directors
@mnhealthscores
Joseph Antos, PhD Resident Scholar & Wilson H. Taylor
Scholar in Health Care and
Reimbursement Policy
American Enterprise Institute
@joeantos @AEI