CHASE Board Meeting April 24, 2018 Matt Haynes Special Finance - PowerPoint PPT Presentation

CHASE Board Meeting April 24, 2018 Matt Haynes — Special Finance Projects Manager Department of Health Care Policy and Financing PCG Project Team

Quality Measure Development

Proposed 2019 Framework • Framework was approved by the CHASE Board at the February 27, 2018 meeting • Focus on the following six areas of measurement: Maternal Health and Perinatal Care • Patient Safety • Patient Experience (renamed from HCAHPS) • Behavioral Health • Substance Use • Addressing Cost of Care (renamed from Cost of Care) • 3

HQIP Program Timing Two year Cycle • 2019 Measures = 2019-20 Provider Fee Model Year Payments • Five primary activities: • Develop Measures: Sept – Jan Yr. 1 • Develop Scoring Methodology: Apr – Aug Yr. 1 • Develop Data Collection Tool: Aug Yr.1 – Apr. Yr.2 • Collect Data: May Yr. 2 • Scoring: June – Sept. Yr. 2 •

Quality Measure Process Environmental scan of measures to identify best practices and review • measure alignment Identified potential priority areas for the Department and assess alignment • with other programs. Developed a proposed measure framework with subcommittee and received • approval of the framework from the CHASE board Develop and review measures that would fit in the framework • Consulted with quality measure experts, HCPF Chief Medical Officer, • Internal SME, the Colorado Hospital Association, and Public Consulting Group around the appropriateness and feasibility of particular measures. The Subcommittee reviewed each measure and the Department removed • some of the proposed measures, modified measures, and proposed replacements where possible. 5

Changes to HQIP Focused around six priority areas as approved by the • Subcommittee and the CHASE Board New areas added: behavioral health and addressing the cost • of care 11 new measures added; eight retired • Whenever possible outcome measures prioritized, and • Department reported measures used 6

Summary Measure Group Measure Status Data Goal Breast Feeding Existing Hospital Reported Process C-Section Existing Hospital Reported Outcome Pregnancy related Perinatal and Maternal Care depression New Hospital Reported Process Maternal Emergencies New Hospital Reported Process Family Planning New HCPF/Hospital Report Process C-Diff Existing HCPF/Hospital Report Outcome Adverse Event Existing Hospital Reported Process Patient Safety Falls w/Injury Existing Hospital Reported Outcome CoS Survey Existing Hospital Reported Process HCAHPS New HCPF Outcome Patient Experience Advance Care Plan Existing Hospital Reported Process Follow-Up after Hospitalization for Mental Illness 7/30 Days New HCPF Outcome Behavioral Health ED Utilization for MH New HCPF Outcome ED Utilization SUD New HCPF Outcome SUB Composite New Hospital Reported Outcome Substance Use ALTO and Post-Surg New Hospital Reported Process Addressing Cost of Care Hospital Index New HCPF Outcome 7

Removed Measures 2018 HQIP Measures Removed for Proposed 2019 HQIP Measure Group Measure Status Data Goal RCCO Engagement HTP Hospital Reported Process BHO Engagement HTP Hospital Reported Process CoS Obs Hospital Reported Process Care Transitions HTP Hospital Reported Process Removed Measures TOB 01 03 Obs Hospital Reported Outcome SUB 01 03 Obs Hospital Reported Outcome ED Process HTP Hospital Reported Process 30 day all cause readmit HTP HCPF Outcome 8

Maternal Health and Perinatal Care Currently there are 2 areas that are reported and scored at the hospital level and are proposed to continue: Breast feeding practices • Cesarean Section • Proposed new areas: Pregnancy Related Depression Screening • Reproductive Life/Family Planning • Maternal Emergencies Preparedness (e.g. pre-eclampsia) • 9

Patient Safety Patient Safety Hospital Acquired Clostridium Difficile Infections • Adverse Event Reporting • Falls with Injury • Culture of Safety Survey • 10

Patient Experience HCAHPS Survey Composites Communication about Medicines • Discharge Information • Care Transitions • Advance Care Planning Current HQIP measure based on NQF#0326 • 11

Behavioral Health Follow-up appointments within 7 days after hospital discharge • for a mental health condition Follow-up appointments within 30 days after hospital • discharge for a mental health condition Emergency Department Utilization for mental health condition • Emergency Department Utilization for substance use condition • 12

Substance Use Using Alternatives to Opioids (ALTOs) in Hospital Emergency • Departments Post-surgical Opioid Prescribing • Tobacco and Substance Use Screening and Intervention • 13

Addressing Cost of Care • Hospital Index - PROMETHEUS – composite The Prometheus tool is an episode of care grouper that allows us to measure risk in ways • outside of the traditional utilization and unit cost metrics. Prometheus splits episode service costs into Typical and Potentially Avoidable Complications • (PAC) from which we are able to calculate PAC rates. Episodes have been defined and refined by expert clinicians assembled in Clinical Working • Groups Tool is transparent without added expense to hospitals; definitions are available on Altarum's • website and methodology is described in detail Study period consists of claims incurred in SFY14, SFY15, and SFY16 time periods (36 • months), and this will be used as benchmark data moving forward SFY17 and SFY18 data will be used for additional trending and as the measurement period • Lower hospital index indicates lower PAC cost relative to the total episode cost; lower score • can be interpreted as better quality and cost effectiveness 14

Addressing Cost of Care Hospital Index – Methodology Weighted average of PAC % with episode weights across all episodes generates the • Hospital Index The methodology normalizes for credibility, accounting for low utilization in specific • episodes for each hospital Hospitals can be compared to themselves over time by tracking their Hospital Index • through successive years to measure improvement and can be compared to benchmark targets Hospital Index – A Valuable Tool for Hospitals The detail behind the Hospital Index allows facilities to drill down into their episode- • specific performance Detailed summaries will be provided to each hospital allowing for deeper dives into the • output Hospital Index will identify intervention targets as well as areas that are currently • operating at an above average level of cost effectiveness Hospitals will be able to review output to better understand inner operations at the • physician level and evaluate drivers of PAC levels 15

Summary of Proposed Measures Measure Group Measure Status Data Goal Breast Feeding Existing Hospital Reported Process C-Section Existing Hospital Reported Outcome Pregnancy related Perinatal and Maternal Care depression New Hospital Reported Process Maternal Emergencies New Hospital Reported Process Family Planning New HCPF/Hospital Report Process C-Diff Existing HCPF/Hospital Report Outcome Adverse Event Existing Hospital Reported Process Patient Safety Falls w/Injury Existing Hospital Reported Outcome CoS Survey Existing Hospital Reported Process HCAHPS New HCPF Outcome Patient Experience Advance Care Plan Existing Hospital Reported Process Follow-Up after Hospitalization for Mental Illness 7/30 Days New HCPF Outcome Behavioral Health ED Utilization for MH New HCPF Outcome ED Utilization SUD New HCPF Outcome SUB Composite New Hospital Reported Outcome Substance Use ALTO and Post-Surg New Hospital Reported Process Addressing Cost of Care Hospital Index New HCPF Outcome 16

HQIP Subcommittee Members Contact Name Organization David Solawetz Middle Park Medical Center Thomas Mackenzie Denver Health Medical Center Lindy Garvin Health One Cynthia Parson Littleton Adventist Hospital Ann Marie Stein Valley View Katherine Bilys Health One Dorma Eastman Banner Western Division John Savage Colorado Hospital Association Janet Mclntyre Colorado Hospital Association Stephanie Marziano Gunnison Valley Health Shari Aman Parker Adventist Hospital Jaclyn Vaught Parkview Medical Center Glenn Sommerfeld Yampa Valley Medical Center Jennifferr Baird San Luis Valley Health Regional Medical Center Wendy DeHerrera San Luis Valley Health Regional Medical Center Melinda Sandgren Gunnison Valley Health 17

Next Steps • Finalize measure specifications • Determine point assignment by measure and total points • Determine # of required measures • Determine tiering and payment methodology • Actual scoring “buckets” for any measures that are based on ranking are determined once we the data is collected 18