The Quality Alliance Steering Committee: Developing a roadmap for a coordinated quality measurementr

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The Quality Alliance Steering Committee
Developing a road-map for a coordinated quality
measurement/reporting enterprise

• Joachim Roski, PhD MPH
• Managing Director, Engelberg Center Healthcare
  Reform

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Overview

• Vision for a Performance-Based Health Care System
• The Importance of Performance Information
• Progress to date
• Identifying gaps and barriers
• Strategies and actions steps to accelerate
  progress towards better information
• Milestones
• Appendix Additional Information

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A Performance-Based Health Care System of the
future is
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Envisioning the Future
Performance-Based Health Care

• Empower consumers to make prudent choices for
  health and health care
• Provide multiple access modes to culturally and
  linguistically appropriate information
• Provide incentives to consumers for seeking high
  value care
• Assess provider performance with
  nationally-endorsed measures
• Pay differentially based on provider performance
• Pay for coordinated care along continuum
• Offer evidence-based coverage products
• Minimize administrative costs to the greatest
  extent possible

• Participate actively in shared decision-making
• Review comparative information on treatments
• Review comparative information on providers
• Participate as evaluators and co-producers of
  care
• Seek high-value care
• Enjoy social and environmental support that
  encourages health promoting behaviors
• Enjoy easily navigable care coordination system
• Have timely access to good advice and support
  for self-care
• Experience seamlessly coordinated care that is
  easily navigable

• Provide patient-centered, safe, effective,
  efficient, equitable, and timely care
• Have access to real-time data, performance
  feedback and decision-support
• Systematically analyze and optimize their
  practice patterns in collaboration with other
  providers
• Effectively coordinate care with other providers
  and institutions in caring for patients
• Refer patients partially based on provider
  performance
• Are incented to do the right thing

Payers/ Plans
Consumers
Providers
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Comprehensive efforts needed to enable
Performance-Based Health Care

• To enable the vision we need
• Payment and coverage reform
• Consumer/patient activation and engagement
• Production and distribution of necessary evidence
  and innovation
• Interoperable IT systems
• Timely, comparative information about the
  performance of providers is a critical
  underpinning for these building blocks
• The generation and reporting of performance
  information is the focus of the QASC road-map
• Other requirements to realize the vision demand
  their own detailed road-maps

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Comprehensive data needed to generate
Performance Information
Laboratories
Pharmacies
Care Coordination
Quality Improvement
Medical Claims
EHRs
Pay for Performance
Consumer Activation
Data Aggregation
Hospitals/ Institutions
Registries
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Building the ideal system for performance-based
health care relies on
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Many critical partners needed to optimize the
system
NQF National Priorities Partners
AHRQ
Foundations Other
NCQA The Joint
Commission AMA PCPI
Medical Societies Medical Specialty
Boards CMS
AHRQ Others
Set national priorities and goals to drive
improvement and affordability
Continuously evaluate health and
health care
QIOs
Regional Collaboratives

Providers
Oversight Organizations
Employers
Health Plans
Improve quality and reduce waste
Consumer Outcomes High Quality Equitable
Affordable Patient-Centered
Develop and test evidence-based measures
Establish effective public policies, payment
policies, and consumer incentives to reward or
foster better performance
NQF
Fed/State Govt Health Plans Employers
Consumers Providers
Endorse and maintain measures and incorporate
specifications into EHRs
Develop coordinated and streamlined
implementation strategies prioritization,
timelines, and process solutions
Generate public reports on quality and cost
Aggregate data and pilot test and validate
standard performance information
QASC Quality Alliances
Joint Commission NCQA
Medical Specialty Boards
Regional Collaboratives Fed/State Govt.
Health Plans
Others
QASC Regional Collaboratives
RHIOs/HIEs CMS
States Health
Data Stewards
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List of all involved partners available.
Nursing, Academic
Communities, etc.
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QASC provides national coordination

• The Quality Alliance Steering Committee (QASC) is
  a collaborative effort among government agencies,
  physicians, nurses, pharmacists, hospitals,
  health insurers, consumers, accrediting agencies,
  foundations and others
• QASC co-chairs
• Carolyn Clancy, MD, Director, Agency for Health
  Care Research and Quality
• Mark McClellan, MD, PhD, Director, Engelberg
  Center for Health Care Reform at the Brookings
  Institution.
• Vision to advance a high-quality, affordable,
  patient-centered health care system through the
  coordination of various groups that are working
  to provide public information on health care
  providers performance.
• The QASC will actively support the implementation
  and use of standard health care performance
  information for
• Performance improvement directly by providers
• Public reporting and more informed consumer
  decision-making
• Effective public policies, payment policies, and
  consumer incentives that reward or foster better
  provider performance

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QASC membership (as of 6/1/08)

• Mark McClellan (co-chair)
• Carolyn Clancy (co-chair)
• Debra Ness (NPWF)
• Gerry Shea (AFL-CIO)
• Jim Guest (Consumers Union)
• John Rother (AARP)
• Peter Lee (PBGH)
• Bruce Bradley (GM)
• Pam French (Boeing)
• Clarion Johnson (Exxon Mobil)
• Brian Marcotte (Honeywell)
• Andy Webber (NBCH)
• Karen Ignangi (AHIP)
• Alan Korn (BCBSA)
• Nancy Nielsen (AMA)

• Frank Opelka (ACS)
• John Tooker (ACP)
• Laura Cranston (PQA)
• Mary Naylor (Nursing)
• Bob Dickler (AAMC)
• Rich Umbdenstock (AHA)
• Chip Kahn (FAH)
• Barry Straube (CMS)
• Peggy OKane (NCQA)
• Janet Corrigan (NQF)
• Mark Chassin (JC)
• Kevin Weiss (ABMS)
• John Lumpkin (RWJF)
• Chris Queram (WI Collaborative)

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Practice-based Feedback Regional-National
Innovation

• National Coordination
• Performance Measure Standard
• Methodological Standards
• Technical Standards
• Data Aggregation Standards
• Implementation Strategies
• Promotion of Best Practices

Regional Experience
Regional Experience
Consistency
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gaps need to be overcome

• the nation still lacks a coherent,
  goal-oriented, consistent, and efficient system
  for assessing and reporting on the performance of
  the health care system.
• - Institute of Medicine, 2006

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Identifying Barriers
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Strategies toAccelerate Progress

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Strategies

• Reinforce the Foundations by promulgating
  agreement on priority health care goals,
  promotion of critical performance measure
  development, and efficient endorsement processes
• Enhance the Generation of Performance Information
  through collaborative and technologically sound
  processes for data integration and aggregation
• Rapidly expand the Reporting of Performance
  Information for consumers, providers and payers
  of health care
• Promote effective Use of Performance Information
  to make informed decisions and continuously
  improve performance

Initial, main focus of QASC
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Strategies Generating Information
Detailed strategies currently under
discussion Illustrative Examples
QASC Focus
Partner Focus
Regional Focus
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High-Value Healthcare Efforts supporting QASC
strategies IData Aggregation
Collaboration

• AHIP Foundation, Brookings
• Multiple health plans participating, and more
  coming, including BCBS FL, CIGNA, HealthPartners,
  Humana, and United
• Close coordination with CMS
• Develop approaches and infrastructure to generate
  physician performance information based on
  limited set of performance measures
• Focus on AQA/NQF endorsed measures
• Test and implement methods and software for
  securely and consistently extracting and
  aggregating claims from national and regional
  health plans to construct the broadest possible
  empirical basis for performance reports
• Potential testing of additional quality and cost
  measures for future NQF endorsement
• Thought model distributed data network
• Provider-level summary data (not individual
  patient data) across plans
• Results will be made available to regional
  collaboratives for computation of physician
  performance reports that span experience of
  multiple plans

Scope of Work
Results
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High-Value Healthcare Efforts supporting QASC
strategies IICost-of-care measure development
Collaboration

• Kevin Weiss, MD, MPH (American Board of Medical
  Specialties), Brookings
• Workgroups with broad technical/strategic
  stakeholder representation including physician
  specialties, researchers/methodologists,
  purchasers/payers, consumers, and others
• Identify/construct cost of care measures for an
  initial set of 20 prioritized conditions
  consistent with emerging NQF framework on
  episode-based efficiency
• Conditions include
• Acute myocardial infarction (heart attack),
  Angina, Asthma, Breast cancer, Bronchitis,
  Chronic obstructive pulmonary disease, Colon
  cancer, Congestive heart failure, Depression,
  Diabetes, Hiatal hernia/ Gastroesophageal reflux
  disease (GERD), Hip fracture, Hypertension,
  Hysterectomy, Osteoarthritis, Pneumonia, Prostate
  cancer, Sinusitis, Spine lumbar, Stroke
• Broadly-supported, transparent set of efficiency
  measures that take into account appropriate use
  of resources and provide an overall picture of
  high value care

Scope of Work
Results
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High-Value Healthcare Efforts supporting QASC
strategies IIIPerformance Measurement
Infrastructure
Collaboration

• Brookings Institution
• Close collaboration with AHRQ, CMS and others
• Operational/strategic plan for QASC
• Effective integration of nationally generated
  performance information in regionally distributed
  report cards
• Identifying options for expanding performance
  reporting beyond claims-only based performance
  reports
• Establishing knowledge resource for performance
  reporting
• White papers/manuscripts
• Tested prototypes for expanding performance
  measurement infrastructure
• Successful integration of nationally produced
  performance information into regional
  dissemiantion/improvement efforts

Scope of Work
Results
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High-Value Healthcare Efforts supporting QASC
strategies IVIncreasing racial/ethnic equity
Collaboration

• Key stakeholders and experts focused on next
  steps to measure and address disparities,
  including through upcoming workshop
• Identify practical steps to assist communities
  and others to understand disparities in health
  care performance
• Identify and test state-of-the-art approaches to
  estimating disparities for application with
  administrative data sets
• Develop and test state-of-the art methods for
  direction data collection on racial/ethnic
  identified
• National conferences on findings
• Easy-to-use software modules for estimating
  community-specific disparities

Scope of Work
Results
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QASC coordinates monitors Progress

• The Quality Alliance Steering Committee (QASC)
  provides national support for these activities by
• Regularly convening all key stakeholders
• Stimulating and monitoring progress by reporting
  on accomplishments relative to stated goals and
  vision
• Educating policy-makers and others about
  advancing a high-value health care system
• Gathering feedback from regional initiatives to
  identify best practices
• Providing oversight to RWJF-funded efforts by the
  Brookings Institution, AHIP Foundation and ABMS
  intended to addressing several critical gaps.
• Sector-specific alliances (HQA, AQA, PQA, etc.)
  engage their constituencies in implementation
  towards goals

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DRAFT NOT FOR DISTRIBUTION
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Transparency Targets

• 2011
• 50 of health plans participate in data
  aggregation systems to generate performance
  reprots
• 50 of physicians have access to compelling
  performance reports
• 50 of consumers have access to compelling
  performance reports
• 50 of payers have linked provider payments to
  provider performance

• 2014
• 90 of health plans participate in data
  aggregation systems to generate performance
  reprots
• 90 of physicians have access to compelling
  performance reports
• 90 of consumers have access to compelling
  performance reports
• 90 of payers have linked provider payments to
  provider performance

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Next steps for QASC

• Endorse road-map on June 25, 2008
• Seek broad agreement and buy-in from key
  stakeholders and decision-makers into necessary
  actions outlined in road-map
• Publicize and disseminate road-map widely as of
  09/08
• Establish effective and efficient coordination
  process involving identified key partners and
  alliances for implementation
• Monitor progress towards high-value health care,
  and issue status reports regularly

June 6, 2008