Primary Care Quality Reporting Collaborative Project Design Team April 9, 2013 Work Session Record of Learning Longaberger Alumni House, Columbus, Ohio Participating Design Team: Michael Anthony, Susan Butler, Sarah Durfee, Lisa Kaiser, Christine Lester, Michelle Love, Diana Riggsby Gardner, Bruce Wall MD, Beth Weinstock MD Access HealthColumbus: Jeff Biehl, Carol Deibel, John Leite Objectives 1- Discuss Project Design Team participation principles, review local rapid prototype design. 2- Determine how project should proceed in light of Ohio receiving a State Innovation Model design grant. 3- Provide clarity on actions for rapid 2013 prototype: invitation, participation agreement, measures. TOPIC Objectives, Design Team Principles, Project Review
NOTES Purpose: o
o
Work Session A – Purpose: Local quality o reporting in light of State Innovation Model grant
ACTION ITEMS
Review project current design and path draft Carol reviewed slides and content of design and path for 2013 Carol described prototype and six measure focus to be detailed later in the work session Create understanding of design team collaborative and individual contribution principles (first meeting of design team) Carol reviewed design team principles (below) Determine: In light of Ohio receiving a State Innovation Model design grant, how should our local Primary Care Quality Reporting project proceed with rapid prototyping? Jeff updated the Design team on the Southwest Ohio Comprehensive Primary Care initiative with quality reporting imbedded, the Office of Health Transformation’s receipt of a State Innovation Model design grant focused on expanding qualified medical homes and episode based acute medical payments with specific plans to be determined by October, and the medical home current spread in Central Ohio and lack of transparent local quality reporting here. 1
TOPIC
NOTES
Work Session B – Review Drafts of Project Roadmap and Three Project Action Pieces
ACTION ITEMS
Table work groups were asked to discuss the question and then all were asked to give thumbs up or down. ‘Up’ would indicate proceeding with the local prototype quality reporting project, ‘down’ would indicate preference to not proceed or need to discuss additional concerns. All indicated up. Table discussion highlights were provided including: o ‘No reason to wait to build reporting for easy common measures, keeping patient needs in mind’ o ‘Let’s not wait to obtain lessons on demonstrating the value of primary care and engaging practices in using quality reporting’ o ‘Let’s overcome Central Ohio’s hesitancy’ Handout provided to capture written reflections (below).
Purpose: Obtain Design Team input into 2013 Project Roadmap (monthly milestones) and three project action pieces (Primary Care Practice Invitation, Collaborative Agreement of Participation, Measures). Do the roadmap and the action documents provide clarity on the proposed approach? Carol and Jeff reviewed the four pieces with the Design Team, describing their intended use and messages. 1. Project Roadmap – 2013 monthly plan with design team, primary care practices, data, and other breakouts 2. Primary Care Practice Invitation – Overview invitation displaying why, what, how, hosting committee, and Carol as contact. Invitation will primarily be conducted with system level outreach. 3. Collaborative Agreement of Participation – Agreement for participants emphasizing prototype for reporting readiness and quality improvement. 4. Measures – Six Electronic Medical Record (EMR) National Quality Forum measures for the prototype and future measures’ options for composite diabetes and access to care non-EMR measures. Table work groups were asked to discuss the pieces and respond to the question. Each table was asked to share with the entire Design Team their table’s discussion highlights and additional team wide reflections were made on a variety of points. • Invitations and attachments 2
Based on the consensus of the Design Team, AHC will proceed with Primary Care Quality Reporting 2013 prototype project coordination.
AHC will proceed on a two pronged invitation approach. 1. Meet with local health care systems’ leaders to invite their system to participate 2. Outreach to independent practices and all physician members of Central Ohio physician associations Invitation packages will be prepared using input from the Design Team and will include: o Outreach “Why and What” page o Q/A page with descriptions and links − Sharing/transparency (30 day window for preview, collaborative organizations ‘Terms of Use’) − Measures (5 for adult practices, 2 for pediatric practices) − Frequency (quarterly through 2014) − Crosswalk to other requirements − Practice/Site level reporting (not provider) − Data specifics (non-detailed, non-
TOPIC
NOTES
ACTION ITEMS
Suggest adding invitation clarity on ‘how is this different than the other reporting I do?’ o Suggest adding invitation clarity on the evolution of transparency, who and when will see reports o For included measures, recommend cross-walking them to other requirements (e.g. PQRS, PCMH, ACO) o Suggest including some physician champions in hosting o Suggest additional clarity on use of the reporting in the invitation o Value, with data provided, reporting comes back o Consider and specify timing frequency, quarterly or even monthly, practices can build into capabilities o Consider allowing for release timing to practice first o Offer additional learning with invitation, like webinar, FAQs o Keep transparent only the site level reporting, physician attribution even with EMR can be problematic • Measures o Consider sharing the measures details with the invitation o Questions on Asthma detail definitions o Flu immunization, from other sources can pose difficulties even if noted in EMR, sometimes not auto-retrievable, not always considered primary care improvement priority. o Flu immunization measure can encourage pediatric practice participation o Remember patient satisfaction in future measures • Other o Can we encourage this with desired payer streamlining of required reporting? o For quality improvement, more frequent timing keeps projects in view Handout provided to capture written reflections (below). o
Closing and Next Steps
Future design team work sessions are tentatively scheduled for 6/4, 8/6, 10/8, and 12/10. General collaborative updates will also be provided. 3
o
PHI) Live webinars and recorded webinar links
AHC will share Asthma e-measures specifications with design team
AHC will share work session Record of Learning, revise action pieces, and proceed with project coordination.
Design Team Principles – 1- Respecting all perspectives and grateful for team members’ time provided. 2- Project is getting team members’ perspective, not necessarily that of his or her organization. 3- Regardless of a team member’s primary care organization’s decision to share data with the project, team member is welcome to stay on the design team. Work Session A Handouts In light of Ohio receiving a State Innovation Model design grant, how should our local Primary Care Quality Reporting project proceed with rapid prototyping? Reflections
Basic common measures are essential.
CCF Area and Cincinnati but not Central Ohio? Really. Diabetes Don’t need to wait. Easy, common measures. For state, we believe this will help/better position for future success/application of additional grants. For the community, it will be valuable, whatever measures are selected, to see care variations vs. CLE and CIN. For those practices willing to participate, this can be a powerful feedback mechanism. Keep it simple to get it off the ground. Lessons learned will be in engaging PCPs to contribute to reporting not in deciding upon measures. Make it easy and reasonable. Must be focused on how this will get us to: 1. Continuous quality improvement. 2. Consistency among payers to financially reward/incentivize quality goals. Need to start on small basic measures. Even the most basic measure has the potential to be done very differently from practice to practice. No need to wait for other areas to “perfect” this project. No reason to wait when others in the state have already started. PCMHs or transforming practices will have transparency-in-reporting capability, so system is already in place. Rapid prototyping model makes sense in light of future expansion of CMMI (possibility) similar to what is happening in Cincinnati. We should be ready for that. Think of how “we” as patients would want it. We will need to demonstrate the value of PCMHs and reporting is important in that regard. “You don’t know what you don’t know.” 4
Work Session B Handouts Do the roadmap and the action documents provide clarity on the proposed approach? Topic Reflections
1- Invitation explanation of plans, level
Practice level reporting.
1- Invitation explanation of plans, level
Will data be practice or physician level? • Would practice be de-id in reports? • Is the project valuable if no one is identified? Benchmarking data
1- Invitation explanation of plans, other 1- Invitation explanation of plans, other
1- Invitation explanation of plans, other
Give the details • What is being measured? • Flu shots in particular may be a problem. Include “quality measures” page? Asthma measure—RX of appropriate meds—not use of appropriate meds. Include metrics in the invite.
1- Invitation explanation of plans, other
Probably need FAQs along with the introduction letter.
1- Invitation explanation of plans, other
Will metric details be included with invitation—so PCPs know and can make decision to participate or not. De-ID the site? Physicians should be de-identified. Do we need to ensure PCP—specific reporting is revealed to the PCP only, de-indentified to others (maybe beta test and concept first) may not be feasible given SIM grant timeframe. Does expectation of not sharing have to be managed?
1- Invitation explanation of plans, other
1- Invitation explanation of plans, sharing 1- Invitation explanation of plans, sharing 1- Invitation explanation of plans, sharing 1- Invitation explanation of plans, sharing
1- Invitation explanation of plans, timing
How transparent will this be? • By practice or by physician • Site or practice level easier to obtain than physician level. Last meeting group felt strongly that info initially should only be reported back to the practices, not to other groups. Agreement would indicate otherwise, which could be threatening to participation. Maybe should indicate that non-providers would initially only get trend data (% for example, not provider-identified results) 45-60 day rolling window
1- Invitation explanation of plans, timing
At a site level, avoids patient attribution.
1- Invitation explanation of plans, timing
Frequency of data upload • Yearly? • Monthly with quarterly refresh?
1- Invitation explanation of plans, sharing
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1- Invitation explanation of plans, timing
How frequent will you report? Quarterly may be most beneficial.
1- Invitation explanation of plans, timing
How often will data need to be submitted? (monthly, quarterly, annually? Biannually?)
1- Invitation explanation of plans, timing
Lag/Frequency
1- Invitation explanation of plans, timing
Monthly or quarterly data frequency, 60 days past service date
1- Invitation explanation of plans, timing
Potential for quarterly refresh.
1- Invitation explanation of plans, timing
1a- Invitation intros
Timing • Quarterly good • One private review would be good—call beta—may slow it, but keeps trust going (not as slow as CIN 2 years) Add next steps: you can influence, CLE and CIN doing it.
1a- Invitation intros
Appeal to ego—“Do you want to know how you stack up?”
1a- Invitation intros
Could communicate you have an opportunity to help shape quality reporting.
1a- Invitation intros
1a- Invitation intros
FAQ add to invite more context setting • Webinar/video for added learning • Leadership discussion (some leaders would do both) • Should we have “release only after review” process for practices? (not 2 year delay) • Practice level or physician level… attribution issue. Only share with collaborative. Ground floor? Beta?
1a- Invitation intros 1a- Invitation intros
Have additional learning opportunity (webinar) Have physician’s names on invitation.
1a- Invitation intros
Is there a need to provide more context in invitation? • MDs may not see unique value of project. • Include FAQs in invite. Play on MD’s competitive nature in the intro, almost marketing, “Do you know how you compare to your peers?” Webinar
1a- Invitation intros 1a- Invitation intros 1a- Invitation intros 1b- Invitation rationales
Would help to have MD leaders on the Quality Reporting Hosting Committee—PCMHs will recognize those leaders vs MD associations. Begin to use the data to support accurate benchmarking.
1b- Invitation rationales
Focused reporting to promote meaningful evaluation to take to payer and show care improvement.
1b- Invitation rationales
Make clear that this will be required in near future.
1b- Invitation rationales
Need the WHY
1b- Invitation rationales
Need to clarify why and how the info plays into ACO, meaningful use, NCQA PCMH report requests—make it relevant. 6
1b- Invitation rationales
Need to make it clear the info can be used to improve the quality of care.
1b- Invitation rationales
Payer consistency intent should be stressed
1b- Invitation rationales
Peers – give that focus/make a wedge(sp)
1b- Invitation rationales
Provide continual medium to evaluate care delivery.
1b- Invitation rationales
1b- Invitation rationales
Provider question—Why? • How is this reporting any different than what I’m already doing? What is the added value? • Peer group, 2-way communication (not just one-way like other reporting already being done) Show how this lines up with other initiatives (crosswalk) • Meaningful use, NCQF, PCMH, PQRS, CMS, ACOs • Need to be completed by 2015 to avoid penalties. • Build crosswalk to show we are not trying to create something new—this data will need to be reported elsewhere in 2015. • This will help them be ahead of the game. • Take advantage of the help. Used to promote more consistency of quality reporting measures across payers.
1b- Invitation rationales
What gets measured gets done
1b- Invitation rationales
Will create one report rather than one per health plan.
1b- Invitation rationales
2- Participation Agreement
Clarify the “will not use reports content to promote or publicize physician practices.”
2- Participation Agreement
Named or masked?
2- Participation Agreement
3- Measures
Was there a need to manage the no-advertising clause? • Create a safe space without having to wait and build trust. • Have a timeline for release to broader group. Asthma meds—more details needed for docs? Can this be tied to avoiding ER usage?
3- Measures
Consider rolled up measure reporting from systems
3- Measures
Immunization measure needs additional review.
3- Measures
Is flu shot a deal breaker?
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Primary Care Quality Reporting Collaborative Project Design Team Work Session April 9, 2013 8:00-10:00 AM Longaberger Alumni House
Lead Support
Major Support
Additional Support 100% Access HealthColumbus Board & Staff Individual & Corporate 1 Donations
Today’s objectives 1. Discuss Project Design Team participation principles, review local rapid prototype design. 2. Determine how project should proceed in light of Ohio receiving a State Innovation Model design grant. 3. Provide clarity on actions for rapid 2013 prototype: • Invitation • Participation agreement • Measures 2
Today’s agenda 8:00 Welcome 8:10 Objectives, Design Team Principles, Project Review 8:20 Work Session A – Consider local quality reporting in light of State Innovation Model grant 9:05 Work Session B – Project Roadmap Taking Action on the Rapid Prototype •Primary Care Practice invitation •Collaborative Agreement of Participation •Measures 9:50 Next Steps, Closing 3
Design Team Principles 1. Respecting all perspectives and grateful for team members’ time provided. 2. Project is getting team members’ perspective, not necessarily that of his or her organization. 3. Regardless of a team member’s primary care organization’s decision to share data with the project, team member is welcome to stay on the design team.
4
Primary Care Quality Reporting 2013 Rapid Prototype Design •
Build a local rapid prototype in 2013
•
Begin with an invitation to all Primary Care practices, include choice of determined measures
•
Collect data and report semi-annually on National Quality Forum measures
•
Use measures that reflect Central Ohio priorities that are aligned with the SW Ohio region’s Comprehensive Primary Care Initiative
•
Measures – Participating practices can provide EMR data for six measures, Diabetes(3) , Asthma(1), Blood Pressure Control (1), Influenza Immunization(1)
4/9/2013 5
Primary Care Quality Reporting Proposed Local Project Path
11/9/2012
2/1/2013
2nd Qtr 2013
3rd & 4th Qtrs 2013
WHY & WHAT
DESIGN
INVITE & ENROLL
BUILD & SHARE
Begin Shaping Project Design (version 1.0)
Finalize Project Prototype Design (version 1.0)
Primary Care Practices invited to share their data
Local Prototype Primary Care Quality Reporting built
6
Work Session A – Consider local quality reporting in light of State Innovation Model grant
CMMI: Comprehensive Primary Care Initiative (CPCI) Testing two models simultaneously: a service delivery model and a payment model 7 regions • 500 primary care practices • 2,144 providers • 313,000 Medicare beneficiaries
Ohio & Kentucky: Cincinnati-Dayton Region • 75 Primary Care Practices • 261 Providers • 10 Payers • Estimated 44,500 Beneficiaries Served • Aetna CareSource (Ohio only), Centene Corporation (Ohio only), Amerigroup (Ohio only), Anthem Blue Cross Blue Shield of Ohio, Humana, HealthSpan, Medical Mutual, Ohio Medicaid, UnitedHealthcare
NATIONAL: brief list of the 21 adopted SW Ohio quality measures (from the National Quality Forum measures set) 1. 2. 3. 4.
Patient Experience-CG-CAHPS Health/Functional Status Prevention-Colorectal Screening Prevention-Influenza Immunization 5. Prevention-Tobacco Assessment/Cessation Intervention 6. Prevention-Glaucoma Screening 7. Prevention-Mammography Screening 8. Diabetes HbA1c Poor Control 9. Diabetes LDL Control 10. Diabetes Blood Pressure Control 11. Ischemic Vascular-Lipid Profile & LDL Control 12. Hypertension-Blood Pressure Control
13. Coronary Artery Disease-ACE or ARB for CAD+Diabetes and/or LVSD 14. Heart Failure-Beta Blocker Therapy for LVSD 15. Asthma-Use of Appropriate Asthma Medications 16. Children-Appropriate Treatment for Upper Respiratory Infections 17. Care Coordination-Risk-Std, All condition readmission 18. Care Coordination-COPD Admission Rate 19. Care Coordination-CHF Admission Rate 20. Future-Depression Screening 21. Future-Screening for fall risk 9
CMMI: 2013 State Innovation Models Initiative
nearly $300 million to support the development and testing of state based models for multi-payer payment and health care delivery system transformation with the aim of improving health system performance
Testing (6) Pre-testing (3) Design (16)
Ohio’s State Innovation Model Design (4/13-10/13)
1. Expand the capacity and availability of qualified medical homes to most Ohioans across Medicaid, Medicare, and commercially insured patients in a 3-5 year timeframe 2. Define and administer episode-based payments for a majority of acute medical events across Medicaid, Medicare, and commercially insured patients in a 3-5 year timeframe
SOURCE: State Innovation Model Design Grant Application, Ohio Office of Health Transformation, September 21, 2012.
SPREAD: Patient-Centered Medical Homes (PCMH)
In coordination with Access HealthColumbus: Coordinated by others: Recognized PCMHs
Recognized PCMHs
Emerging PCMHs
SPREAD: Patient-Centered Medical Homes (PCMH) 1200
500,000 450,000
1000
400,000
800
350,000
600 400 200
Emerging PCMHs
1,205 175 230
Total PCPs Emerging PCMHs Recognized PCMHs
0 Recognized Total Primary PCMH Care Practitioners* Practitioners (PCPs)** Sources * National Committee for Quality Assurance (NCQA) ** Practicing PCPs in Franklin County provided by Columbus Medical Association
300,000 250,000 200,000
Recognized PCMHs
150,000 100,000 50,000 0 Estimated Patients Served by PCMHs
In light of Ohio receiving a State Innovation Model design grant, how should our local Primary Care Quality Reporting project proceed with rapid prototyping?
14
Work Session B – Project Roadmap Taking Action on the Rapid Prototype • Primary Care Practice invitation • Collaborative Agreement of Participation • Measures
Taking Action on the Rapid Prototype – Primary Care Practice Invitation
Taking Action on the Rapid Prototype – Collaborative Agreement of Participation
Taking Action on the Rapid Prototype – Measures
Primary Care Quality Reporting – 2013 Rapid Prototype EMR Measures – A good place to start Domain
NQF#
DRAFT
Quality Measure Diabetes: Hemoglobin A1c Poor Control. Description:
Steward
Clinical Process/Effecti veness
0059
Clinical Process/Effecti veness
0064
Diabetes: Low Density Lipoprotein (LDL) Management.
NCQA
Clinical Process/Effecti veness
0061
Diabetes: Blood Pressure Management. Description:
NCQA
Clinical Process/Effecti veness
0036
Use of Appropriate Medications for Asthma. Description:
NCQA
Clinical Process/Effecti veness
0018
Controlling High Blood Pressure. Description: Percentage of
NCQA
Population/Pub 0041 lic Health
Percentage of patients 18-75 years of age with diabetes (type 1 or type 2) who had hemoglobin A1c > 9.0 %. Description: Percentage of patients 18–75 years of age with diabetes whose LDL-C was adequately controlled (<100 mg/dL) during the measurement period. Percentage of patients 18-75 years of age with diabetes (type 1 or 2) who had a blood pressure < 140/90.
Percentage of patients 5-50 years of age who were identified as having persistent asthma and were appropriately prescribed medication during the measurement period.
patients 18-85 years of age who had a diagnosis of hypertension and whose blood pressure was adequately controlled (<140/90 mmHg) during the measurement period.
Preventive Care and Screening: Influenza Immunization.
Description: Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization.
NCQA
AMA-PCPI
Taking Action on the Rapid Prototype – Measures
Primary Care Quality Reporting – Parking Lot for Future Additional Measures Domain
NQF#
DRAFT
Quality Measure
Steward
Composite Diabetes Options No eMeasure Available
0729
Composite Diabetes. Optimal Diabetes Care – five measures
No eMeasure Available
0731
Composite Diabetes. Comprehensive Diabetes Care – ten measures
Will this be eMeasureable?
Not
Composite Diabetes. PCQR 3a – A1c<8.0 (NQF#0575),LDL<100,BP<140/90
na
Will this be eMeasureable?
Not
Composite Diabetes. PCQR3b – Patients receiving all three tests (A1c, LDL,
na
MN Comm Msmt NCQA
[note the A1c is from an additional measure]
BP)
Access to Care Options Not from EMR
Not
Access to Care. Same Day Appointments -- Average percent of appointments available at the beginning of each work day.
Not from EMR
Not
Access to Care. Continuity of Care – Percent of appointments in which patients were seen by their Physician/Clinician of Record.
Not from EMR
Not from EMR
Not NQF, IHI
Access to Care. Third Next Available – Average time between patient
IHI
Not NQF, IHI
Access to Care. Future Capacity – Percent of appointment slots that are
IHI
appointment request and the third available appointment for a physician (eliminates chance open occurrences)
open and available for booking over the next four weeks
Do the roadmap and the action documents provide clarity on the proposed approach?
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Primary Care Quality Reporting Collaborative Project Design Team Work Session April 9, 2013 8:00-10:00 AM Longaberger Alumni House
THANK YOU!
Lead Support
Major Support
Additional Support 100% Access HealthColumbus Board & Staff Individual & Corporate 22 Donations