Pay for Performance: Choosing Measures
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Transcript of Pay for Performance: Choosing Measures
Pay for Pay for Performance:Performance:
Choosing MeasuresChoosing Measures
Linda K. SheltonLinda K. Shelton
AVP, Product DevelopmentAVP, Product Development
PFP Boot Camp for Physicians and PFP Boot Camp for Physicians and Physician OrganizationsPhysician Organizations
February 2006February 2006
Overview
• Framework for quality measures• Use of medical evidence to develop
measures• Desirable attributes of measures• Examples of measures used for reports
and rewards
What is the Health CareSystem Supposed to Do?
A value-based health care system
20% of peoplegenerate
80% of costs
A: Move people from right to left—and keep them there
Healthy/Low Risk
At-Risk
HighRisk
ActiveDisease
Health care spending
Early Symptoms
Source: HealthPartners
Using Medical Evidence:Guidelines and Measures
• National, trusted sources – rate evidence and develop guidelines
• Guidelines--indicate what to do, based on the best evidence, to achieve the desired result
• Measures--indicate what result you have achieved (threshold, bands, absolute values)– Indicator – Fully developed measure
• The progression from evidence to fully developed measure is NOT assured
General Types of Measures
• Structure
• Process
• Outcomes
Desirable Attributes of Measures--NCQA
• Relevance• Scientific soundness• Feasibility• Level of specification and sampling required
related to use of measure and level of system measured
Desirable Attributes of Measures—Health Plans
• Based on evidence-based medicine• Target prevalent conditions• Relevant to practice for specialty/region• Focus on improvement opportunities• Communicate effectively to MD and patient
Source: Kathleen Curtin, from Conference on Benchmarking Physician Performance, NCQA/AHRQ, January 11, 2006
N C Q AB oard of D irec tors
fin al overs ig h t
M easu rem en tA d visory P an el
M A P
Tech n icalA d visory G rou p
TA G
F ield Testin gcon trac tu al
in tern al
N C Q A S taffflow of work
m easu re work -u p
P u b licC om m en t
d raftresp on se to com m m en ts
C P Msets p riorit ies
reviews p rop osals
S p ec ia l A d visoryC om m ittees
P h ys ic ianH ealth P lan
ID E A SV ariou s sou rces
An example of weighing the
evidence
Data collectionData collectionDefinition of
Implementation rules
Definition of Implementation
rulesConsensus ProcessConsensus Process Measure
Development
Measure Development
Data transmissionData transmission
VerificationVerification Data AnalysisData Analysis ReportingReporting MaintenanceMaintenance
Standardization needs for benchmarking
Some measures that can rely on administrative data
Chronic Disease• Asthma Med. Mgmt.• Antidep. Med. Mgmt. – Acute Phase• Antidep. Med. Mgmt. – Conti Phase• Follow-up After MH Hosp – 30 day• Follow-up After MH Hosp – 7 day• Beta Blocker After AMI – On Disch.• Beta Blocker After AMI – Persistent• Diabetes: LDL Screening• Diabetes: HbA1c Testing• Diabetes: Nephropathy Screening• ADHD: Initiation Visit• ADHD: Follow-up Visits• Osteoporosis Management Post
Fracture
Prevention• Cervical Cancer Screening• Breast Cancer Screening• Colorectal Cancer Screening• Glaucoma Screening• Chlamydia Screening
Medication monitoring• ACE Inhibitors• Anticonvulsants• Digoxin• Diuretics• Statins
Overuse• Children with Upper Respiratory
Infection• Pharyngitis Testing• Adults with Bronchitis• Imaging for Low Back Pain
NCQA Recognition Programs: Physicians’ data
• What measures included: Structure, process and outcomes of excellent care management
• Where they come from: partnership with leading national health organizations
• Who rewards recognized physicians: many health plans and Bridges to Excellence employers
• Who is recognized: over 3800 physicians nationally
Measures in NCQA Recognition Programs
OU
TC
OM
ES
(C
linic
al)
ST
RU
CT
UR
EP
RO
CE
SS
DPRP
BP controlled
LDL <100 and <130
HbA1c good control high
HbA1c poor control low
HSRP
DPRP: • eye exams• foot exams
• nephropathy testing
HSRP: • lipid profiles• anticoagulants
ALL: • smoking assessment and advice
PPC: • patients in registries • risk factors assessed• use of e-prescribing • patients with EMRs• e-results • reporting across practice
PPC: • electronic systems • test follow-up process• care management processes • patient education & support• e-reminders • case management
Tracking Improvement
Physicians Achieving Diabetes Physician Recognition Show Substantial Improvement In Key Clinical Measures
% of adult patients with
60
18
38
51
25
21
59
37
9
70
49
7
79
37
63
84
53
79
0 20 40 60 80 100
Monitoring for Nephropathy
Lipid Control (<100 mg dl)
Lipid Control (<130 mg dl)
BP < 140/90 mm Hg
Good HbA1c Control (<7.0%)
Poor HbA1c Control* (>9.5%)
200420001997
Diabetes Physician Recognition Program, average performance of applicants, 1997-2003 data.* Lower is better for this measure.
Physician Practice Connections (PPC)
• What it is: recognition for practices that use systematic processes and IT
• What it measures:– Access & communication– Registry functions– Care management– Patient self-management support– E-Prescribing– Test tracking and management– Referral tracking & management– Performance measurement & improvement– Interoperability
Patient – Care Team Interaction
● in person
● by telephone
● by e-mail
The Systematic Practice & PPC Standards
Systematic InputsSystematic Follow-up & Outcomes
2. Patient Tracking & Registries● patient’s demographic &
visit data● patient’s clinical data● population-based
reporting● identifying top conditions
3. Care Management● guidelines or protocols● team roles – internal &
external● pre-visit planning● clinician reminders (decision
support)● PHR and self-monitoring tools
● patient reminders● self-management resources
4. E-prescribing Information● safety (interactions)● efficiency (formulary)
5. Test Results History
6. Referral Results
2. Patient Tracking & Registries ● updated database
3. Care Management● further reminders &
contact● disease management &
case management● referrals to self
management resources● self-management
tools including PHR● updated care plans & goals
4. E-Prescribing, Checks for Safety & Efficiency
5. Test Follow-up across practice
6. Referral Follow-up across practice
7. Performance Measurement, Feedback & Reporting
8. Interoperability
1. Access & Scheduling
● open access
● care coordination
● 24/7 telephone
● web site
Access NCQA & BTE
• NCQA Web site www.ncqa.org• Diabetes Physician Recognition Program page
www.ncqa.org/dprp • Heart Stroke Recognition Program page
www.ncqa.org/hsrp• Physician Practice Connections page
www.ncqa.org/ppc • Recognized physicians:
www.ncqa.org/PhysicianQualityReports.htm• NCQA Customer Support (888) 275-7585