Quality Soup: The Ingredients for Success in Managing Multiple - PowerPoint PPT Presentation

Quality Soup: The Ingredients for Success in Managing Multiple Quality Programs Holly Arends, CHSP Program Manager Great Plains Quality Innovation Network holly.arends@area-a.hcqis.org www.greatplainsqin.org

11SOW QIN-QIO Map

3

Objectives  Managing multiple quality initiatives • Explain the Requirements • Provide tips on How to be successful  Taking responsibility for a population • Strategies to develop a plan  Utensils/Tools to use • Guidance on resources and how to use them

What are the Drivers? Physician National CMS Quality Quality Quality Strategy Programs Strategy Strategic Vision

CMS Quality Strategy AIMS PRIORITIES 1. Better Care 1. Make Care Safer by Reducing Harm Caused in the Delivery of Care 2. Healthier People, Healthier Communities 2. Strengthen Person and Family Engagement as Partners in Their Care 3. Smarter Spending 3. Promote Effective Communication and Coordination of Care 4. Promote Effective Prevention and Treatment of Chronic Disease 5. Work with Communities to Promote Best Practices of Healthy Living 6. Make Care Affordable

Future State Vision Vision Statement Indicator of Success • CMS quality reporting programs are guided Patients, caregivers, and healthcare professionals are key contributors and active participants in by input from patients, caregivers and measure development, reporting, and quality improvement efforts healthcare professionals • Feedback and data drives rapid cycle Technology enables healthcare professionals to monitor quality measure performance on an quality improvement ongoing basis at the point of care. • Quality measurement results drive the planning of quality improvement initiatives. • Public reporting provides meaningful, Meaningful, actionable performance data are accessible to and used by variety of audiences transparent, and actionable information (e.g., patients, caregivers, and healthcare professionals). • Patients and caregivers have timely access to performance information tailored to their needs. • Quality reporting programs rely on an An aligned portfolio of health IT-enable quality measures supports all CMS public reporting, aligned measure portfolio quality improvement, and value-based purchasing programs. • A stable and robust infrastructure exists for developing and implementing health IT-enabled quality measures. • Quality reporting and value-based Principles, policies and processes for all CMS quality reporting and value-based purchasing purchasing program policies are aligned programs are coordinated. 7

APM Framework 8

Medicare Access and CHIP Reauthorization Act (MACRA)  Ends the Sustainable Growth Rate (SGR) formula for determining Medicare payments for health care providers’ services.  Make a new framework for rewarding health care providers for giving better care not more just more care.  Combines our existing quality reporting programs into one new system. 9

MACRA Challenges to Providers  Attribution of patients  Controlling spending  Population Management  Risk Adjustments 10

Managing It All 12

CMS Quality Programs  Physician Quality Reporting System (PQRS)  EHR Incentive Program (MU)  Value Modifier (VM or VBM)  Transforming Clinic Practice Initiative(TCPI)  Comprehensive Primary Care Initiative (CPCI)  …..  Actually, 30 different programs that are using quality measures

Future: Aligning Quality Programs EHR Incentive Program Value (MU) Modifier PQRS Merit-Based Incentive Payment System (MIPS)

MACRA NPRM Released TODAY!!!!!  Merit Based Incentive Payment System (MIPS) Proposed Framework • Quality • Advancing Care Information • Clinical Practice Improvement Activities • Cost  January 2017 performance year  2019 payment year 15

Proposed MIPS  All eligible clinicians will report through MIPS  Medicare Part B clinicians • Physicians • Physician Assistants • Nurse Practitioners • Clinical Nurse Specialists • Certified Nurse Anesthetists  Exempted • Newly enrolled in Medicare • Less than or equal to $10K in Medicare charges and less than or equal to 100 Medicare patients; OR • Are significantly participating in an Advanced Alternative Payment Model (APM) 16

Proposed MIPS  Quality • Replaces PQRS and Quality component of VBM • 50% of score • 6 measures versus 9- choose one cross cutting measure and one outcome  Population Health Measures  Individual and Grps 2-9 – 2 measures based on claims data  Groups 10 or more- 3 measures based on claims data • 200 measures with 80% specialty focused 17

Proposed MIPS  Advancing Care Information • Replaces Medicare EHR Incentive Program (MU) • 25% of score (year 1)  Base Score- 6 MU objectives/measures  Performance Score- 3 objectives/measures • Focus on interoperability and information exchange • Not all or nothing reporting as was seen in MU • Customizable selections 18

Proposed MIPS  Clinical Practice Improvement • Rewards  Care Coordination  Patient Safety  Beneficiary Engagement • 15% of score (year 1) • Select activities from 90 options  Expanded Practice Access  Population Management  Care Coordination  Beneficiary Engagement  Patient Safety and Practice Assessment  Participation in an APM, including a medical home model  Achieving Health Equity  Emergency Preparedness and Response  Integrated Behavioral and Mental Health  Credit for APM and PCMH activity 19

Proposed MIPS  Cost • Based on Medicare claims- no reporting requirement • 10% of score (year 1) • 40 episode specific measures 20

Proposed MIPS  Advanced Alternative Payment Models  These include: • Comprehensive ESRD Care Model (Large Dialysis Organization arrangement) • Comprehensive Primary Care Plus (CPC+) • Medicare Shared Savings Program – Track 2 • Medicare Shared Savings Program – Track 3 • Next Generation ACO Model • Oncology Care Model Two-Sided Risk Arrangement (available in 2018)  List update annually  Non Medicare models considered in 2019 21

Proposed MIPS  Budget neutral • Negative payment adjustments no more than 4%  4%, 5%, 7%, 9%- increase over time • Positive payment adjustment no more than 4% -increase over time  $500 million for exceptional performance (exception to budget neutrality) up to 10% additional, first 5 years 22

Proposed MIPS  Bear Certain Amount of Financial Risk • If CMS would withhold payments, reduce rates or require repayment if actual expenditures exceeded expenditures  Total risk ( max amt. of losses possible under Adv APM) must be at least 4% of APM spending target  Marginal risk (the % of spending above the APM benchmark (or target price for bundles) for which the Adv APM Entity is responsible (i.e. sharing rate) must be at least 30%  Minimum loss rate (amt. by which spending can exceed the APM benchmark (or bundle target price) before the Adv APM Entity has responsibility for losses) must be no greater than 4% 23

Requirements for Incentive Payments for Significant Participation in Advanced APMs (Clinicians must meet payment or patient requirements) Payment Year 2019 2020 2021 2022 2023 2024 and later Percentage of 25% 25% 50% 50% 75% 75% Payments through an Advanced APM Percentage of 20% 20% 35% 35% 50% 50% Patients through an Advanced APM 24

Managing Multiple Quality Initiatives  Aggregate data from disparate sources  Risk Stratification- Identify High Risk Patient Populations  Filter and view through the measure’s lens  Provide feedback to clinicians and staff  Real time administrative and clinical tracking  Simplified reporting of quality data  Transparency to Consumers  Focus on Outcome Measures, when possible

Future: Core Quality Measures Collaborative  The core measures are in the following seven sets: • Accountable Care Organizations (ACOs), Patient Centered Medical Homes (PCMH), and Primary Care • Cardiology • Gastroenterology • HIV and Hepatitis C • Medical Oncology • Obstetrics and Gynecology • Orthopedics

Quality Program Requirements Impact on Your Office  Data collection  Data aggregation  Workflow assessment  Quality Improvement  Data reporting  Data feedback to providers  Resources  Time  Financial  Reputational

First Things First….  Commitment and Involvement • Leadership • Clinician 28

What are Your Drivers? What is Your Vision?  Mission  Vision  Values  Stakeholders  Measures and Indicators of Success Build your business case for improvement activities! 29

30

Vision Examples  Imagine • Fully Engaged Consumer and Patients • Transparency of Quality Data • Feedback reports support rapid cycle improvement • Full view of patient – all data sources • Graduated participation in Alternative Payment Model 31