Gynecology-Oncology Initiative Inaugural M Meeting October 14, 14, 2017 2017 Inn at St. John’s, Pl Plymouth M MI
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Welcome Shitanshu Uppal Emily Mackler Louise Bedard Jennifer J. Griggs Program Co-Director Clinical Pharmacist Program Manager Program Director Sam Beusterien Arthi Ramakrishnan Jennifer Yanchula Project Manager Project Manager Outreach Manager 3
A Few Details Documents at Seat • Group Photo at Break • Q & A Opportunities • Six Question Evaluation • Confidentiality Agreement • Food and Beverage • Cell Phones • 4
Resources • MOQC Pathway Measures • MOQC-BCBSM VBR FAQs • ASCO-QOPI material • BCBSM Value Partnerships/CQI • Business cards 5
For Your Use On MOQC.org/ Today’s Slides: Monday October 16th Today’s Videos: November 1st Password: None Point your browser to “Inn at St. John’s” @MOQCTeam or #moqc
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Dedicated to all the women and their families who have suffered with cancer 10
Acronyms MOQC – Michigan Oncology Quality Consortium MSQC – Michigan Surgical Quality Collaborative QOPI – Quality Oncology Practice Initiative APM – Alternative Payment Models MACRA - The Medicare Access and CHIP Reauthorization Act of 2015 MIPS – Merit based Incentive Payment System POQC – Patient and Caregiver Oncology Quality Council EOL – End of life SSI – Surgical Site Infections
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QOPI Data & MOQC • MOQC has a standing agreement to receive data twice- yearly from QOPI • All participating MOQC sites’ practice-level data • Regional, MOQC (state) and national aggregate • MOQC provides practices with comparative reports & statistical analyses • Data are used to identify areas for improvement & to monitor outcomes Page 16
Michigan Oncology Quality Consortium Colors denotes MOQC’s five regions
MOQC Practices Type pe o of Practice e 3 Academic Private Practice System or Hospital Owned Group 18 26 Source: MOQC Landscape Survey, 2017 18 N=47 practices
Practice Size 20 18 16 Number of Practices 16 13 14 12 10 7 8 6 5 6 4 2 0 1 2 3-5 6-10 >10 Number of Medical Oncologist FTEs Source: MOQC Landscape Survey, 2017 N=47 practices 19
BCBSM/CQI Value Partnerships Patient & Caregiver MOQC Steering Oncology Quality Council Committee Leadership (POQC) Coordinating Measures Center/Team Group Quality Projects Practices • Chemotherapy consent • Participate in QI projects (2017) • Align with CMS & MOC • Advance care planning • Regional structure for (2016) data sharing and • Data abstraction (2016) collaboration • Oral oncolytic (2015) • Tobacco cessation (2014) 21
Role of Coordinating Center Four priorities 1. Quality/performance improvement support • Training • Advisory role • Resources 2. Data abstraction 3. Data reporting with statistical analyses 4. Support opportunities for state-wide improvement 22
Role of the Steering Committee 1. Support MOQC leadership in decision-making 2. Set priorities of the Collaborative 3. Ensure broad multidisciplinary representation 4. Select speakers & help set agendas 5. Attend Biannual Meetings 6. Participate in teleconference meetings • 30 – 60 minutes • 3-4 times a year 7. Review agenda, documents and feedback via email 8. Enhance practice engagement as needed 23
Patient & Caregiver Oncology Name Residence Diane Drago Ann Arbor Quality Mary Duncan Ionia Council Marilyn Gilin Waterford Mike Harrison Allen Park Cynthia Koch Ann Arbor Erika Jane Lojko St. Clair Shores Johanna Mabry Ann Arbor William Polkinghorne Houghton Barbara Rau Lake Isabella Samantha Schadel Sterling Heights Shanna Simpson-Simpson Taylor Derek Singleton Taylor Deborah Stocking Morrice Peggy Taylor-Albaugh Britton 24
POQC Priorities 1. Improve access to resources for all cancer patients across the State of Michigan – 100 100% 2. Improve patient-provider communication – 72% 72% 3. Present the patient- and/or patient-caregiver story to MOQC practices – 36% 36% 2018 priorities will be established by December 2017 Regional meetings are identifying opportunities 25
POQC Members participate in these ways Improve patient outcomes by Offer patient/patient-caregiver contributing to a quality initiative - 82% input at meetings - 82% Tell my story at meetings 55% Review patient materials 72%
Why Participate? 27
Why Participate? 1. Receive rewards 2. Receive practice performance data with benchmarks against other statewide & national data 3. Share & acquire best practices 4. Access clinical & performance improvement resources 5. Receive profession and payer quality “points” 6. Collaborate & influence priorities of the consortium Page 28
Rewards • One ASCO Membership • Annual Reimbursement • Value of $600 + $35 initiation fee (as of 1/2017) • Costs of abstraction are reimbursed • Value-Based Reimbursement (VBR) from BCBSM and CMS • Reimbursement is submitted to Provider Organization Page 29
Expectations Data Collection Practice Participates Physician Participation in Quality Improvement 30
QOPI Data & MOQC • MOQC has a standing agreement to receive data twice- yearly from QOPI • All participating MOQC sites’ practice-level data • Regional, MOQC (state) and national aggregate • MOQC provides practices with comparative reports & statistical analyses • Data are used to identify areas for improvement & to monitor outcomes Page 31
Measures QOP OPI M Measures es MOQC QC P Pat athway • Nearly 200 measures • 17 selected measures
MOQC Pathway Domain QOPI Measures CORE Pain management • Tobacco cessation counseling/referral • Signed consent for chemotherapy • Inappropriate chemotherapy in • patients with advanced disease & poor performance status Assessment of adherence to oral • chemotherapy END OF LIFE Pain management • Dyspnea management • Death on hospice • Palliative care/hospice services or • documented discussion 33
MOQC Pathway Domain QOPI Measures SYMPTOM Counseling regarding infertility • & TOXICITY risks for patients of reproductive MANAGEMENT age Inappropriate use of • aprepitant/fosaprepitant or netupitant administered for low or moderate emetic risk chemotherapy (cycle 1) 34
Vision and Direction
Gynecology Oncology Initiative Opportunities Ovarian Cancer: - Registry to monitor short- term and long-term outcomes - Underlying layer for homegrown region multi- centric clinical trials - Funding opportunities Endometrial Cancer: ( ⬆ sample size) - Sentinel Lymph nodes (SLN) - Studies with patient - Dr. Rabbi Hanna (HFH) reported outcomes - Registry SLN outcomes - Outcomes of type II cancers Cervical Cancer: - Access to care - Adherence to guideline based care - Access to fertility sparing options 36
Gynecology Oncology Initiative Opportunities Ovarian Cancer - BRCA testing of all OVCA patients - Population based reduction in breast and ovarian cancer as a result of increased BRCA testing in OVCA patients Endometrial Cancer - Cost-effective ways of lynch syndrome testing in Endometrial cancer 37
Goals for First Year What is Reasonable to Achieve Year One? • Application to BCBS to include gynecologic cancers • Start with one cancer site Ovarian cancer • Participation of Gynecology Oncology practices in MOQC • Steering committee meeting June 13 th , 2017 • Select measures for the first year • Pending • Practice agreements • Start data abstraction for the first year Priorities for year 2 • 38
Ovarian Cancer Quality Matrix Surgical Chemotherapy Surveillance/ End-of-life Genetics Access to surgical Guideline based Imaging utilization Aggressive care chemotherapy (CT/PET-CT/MRI) end-of-life care Proportion of in surveillance • patients undergoing debulking surgery Quality of surgery Time from Proportion of Hospice utilization Rate of optimal diagnosis/surgery patients referred to • debulking to initiation of genetic counselling Documentation of • therapy residual disease Symptom 30-day measure Proportion of Advance care management SSI patients with directives • Readmissions Nausea/Vomiting • • documented genetic 30 & 90 day Pain control • • testing mortality 39
Steering Committee Team • Bonnie Dockham, MSW • Robert Morris, MD • Beegal Ganti, PharmD, BCOP • Adnan Munkarah, MD • Charles Harrison, MD • Rebecca Liu, MD • Soumit Pendharkar, MHA, FACHE • Roxanna Miller, RN • Renae Vaughn, MSN, ANP-C, AOCNP • Shitanshu Uppal, MBBS • Jennifer Griggs, MD MPH 40
Measures
Measures for Gynecology Oncology 42
Gynecology Oncology Measures Criteria for choosing the measures • An evidence link to provision of care within the time period • Assurance of a high degree of precision in measurement • Accurate risk adjustment • Avoidance of unintended consequences 43
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