1

Primary Care Quality Reporting (PCQR) Collaborative Project Design Team June 4, 2013 Work Session (Virtual)

8:00-9:00 AM Record of Learning

Participating

Design Team: Parminder Bajwa MD, John Davis, Vicki Diller, Sarah Durfee , Diana Riggsby Gardner, Lisa Kaiser, Christine Lester, Michelle Love, Bruce Wall MD Access HealthColumbus: Jeff Biehl, Carol Deibel, John Leite

Objectives

1- Update design team on project’s commitments. 2- Obtain design team input into report design.

TOPIC NOTES ACTION ITEMS

Review & Update

o Review project current design

Carol reviewed slides and content of design and path for 2013

o Update on practices committed to data sharing

Carol reviewed that seven organizations have committed to data sharing with 79 practice sites

Invitation and acceptance will continue through July for 1st version participation

Work

Session –

Report

Design

o Information for report display

Carol reviewed the set of Non-Clinical information and Clinical Measures being collected from participating practices

Report design considerations were reviewed: ‘at a glance’ elements, explanations, and the project’s design and intent

o Layout Samples A1 & A2

Single practice site, all measures

A1- contains result displayed with local and national average and

A2- contains result displayed with local and national averages and local percentiles

o Design Questions with voting on A1 versus A2

o Layout Sample B

Single measure, all practices

Use of four payer groups defined as the predominant payer(s) of the practice site (Commercial, Commercial+Medicare, Self Pay+Medicaid>33%, Self Pay+Medicaid)

Practices in alphabetic order

Practices in results order (high to low distribution)

o Design Questions with voting on B (usefulness, payer

The group felt A1 was useful and simple to read, preferred it over A2. The inclusion of the description of the measures’ clinical importance in the A reports was recommended. The group felt that B was useful. Use of payer grouping should be reviewed, using three payer groups: Commercial, Commercial+Medicare, Self Pay+Medicaid A specific % definition of the payer volumes should be used. Preferred use of practices in alphabetic order. Additional consideration for inclusion of the results order when actual data is available (Does it add value? Does it encourage practices in quality improvement?).

2

TOPIC NOTES ACTION ITEMS

groups, practice order views)

Closing and

Next Steps Next design team work session is tentatively scheduled for 8/6 as a virtual call again 8:00-9:00 AM. Subsequently the next design team work session will be planned in November when report preview can occur.

AHC will share work session Record of Learning, proceed with project invitation and data collection coordination, and use this work session’s input in the report designs (see attached).

3

Primary Care Quality Reporting Project

Purpose –

Primary care is front and center in an effort to improve the value of health care in our country. Many communities have advanced with transparent primary care quality reporting. A local multi-stakeholder collaborative formed in the fall of 2012 to implement this transparent all-patient local prototype of Primary Care Quality Reporting in 2013. The collaborative intends for this prototype to advance Central Ohio reporting readiness for future primary care quality improvement and demonstration. This project contributes to aims for better health, care, and value supporting continuous improvement driven by data, including:

Coordination of care across the medical neighborhood

Optimal use of health information technology

Planned care for chronic conditions & preventative care This report is the first of quarterly reports through 2014.

Collaborative participants are invited to view this report under the Participant Terms of Use (see Attachment A).

Participants are those organizations that provide data, view or review reports.

Thank you xxx Practice Site for participating in sharing your data with the collaborative.

35%

15% 38%

10% 2%

Payer Mix xxx Practice Site

Medicare

Medicaid

Commercial

SelfPay/Uninsured

25%

10% 58%

5% 2%

Payer Mix All Practices

Medicare

Medicaid

Commercial

SelfPay/Uninsured

22%

78%

Patient Age xxx Practice Site

Childrenunder 18

Adult

Primary Care Quality Report – Version 1.0

Primary Care Practice: xxx Practice Site

2222 Address St., City, OH xxxxx

Payer mix is displayed to provide some insight into the revenue sources and patient types of the practice site. The quality reports are not case mix adjusted.

SAMPLE A

FICTICIOUS DATA

4

Diabetes Patient Measures (National Quality Forum # 0064, 0061, 0059)

Controlling High Blood Pressure Appropriate Medications for Asthma

(National Quality Forum #0018) (National Quality Forum #0036)

xxxPCQRC OH

Nat'lComparativ

e

LDL<100 70% 57% 65%

0%

20%

40%

60%

80%

Diabetes: Cholesterol Control

xxxPCQRC OH

Nat'lComparat

ive

BP<140/90 70% 75% 66%

0%

20%

40%

60%

80%

Diabetes: Blood Pressure Management

xxxPCQRC OH

Nat'lComparativ

e

A1c>9% 11% 14% 17%

0%

5%

10%

15%

20%

Diabetes: Poor Blood Sugar Control (lower is better)

xxxPCQRC OH

Nat'lComparat

ive

BP<140/90 77% 70% 72%

0%

20%

40%

60%

80%

Patients with Hypertension Managed

xxxPCQR COH

Nat'lComparative

Ages 18-50 98% 97% 95%

90%

95%

100%

Appropriate Asthma Medications

Primary Care Quality Report

Primary Care Practice: xxx Practice Site

Adult Patient Quality Measures (summary descriptions & rationales in

Attachment B)

NOTES

1- PCQR C OH --

Primary Care Quality

Reporting Central

Ohio Average

2- All data sourced

from Electronic Medical

Records and was self-

reported by medical

practices

2- Diabetes Patient

Ages are 18-75

3- High Blood Pressure

patient ages are 18-85

4- Asthma patient ages

are 18-50

5- Measurement period

was 3rd quarter 2012-

2nd quarter 2013

5

Appropriate Medications for Asthma (National Quality Forum # 0036)

Preventive Influenza Immunizations

(National Quality Forum #0041)

xxxPCQR COH

Nat'lComparative

Ages 12-17 94% 97% 95%

80%

85%

90%

95%

100%

Asthma Patients 5-11

xxxPCQRC OH

Nat'lComparat

ive

Ages 5-17 91% 92% 92%

80%

85%

90%

95%

100%

Asthma Patients 12-17

xxxPCQRC OH

Nat'lComparat

ive

Ages 5-11 90% 93% 91%

80%

85%

90%

95%

100%

Asthma Patients 5-17

xxxPCQR COH

Nat'lComparative

6 mos & up 60% 52% 49%

0%

20%

40%

60%

80%

100%

Ages 6 months & up

Primary Care Quality Report

Primary Care Practice: xxx Practice Site

Pediatric Patient Quality Measures (summary descriptions & rationales in

Attachment C)

NOTES

1- PCQR C OH --

Primary Care Quality

Reporting Central

Ohio Average

2- All data sourced

from Electronic Medical

Records and was self-

reported by medical

practices

3- Asthma patient ages

are 5-17 4- Influenza

Immunization ages 6

months and up

5- Measurement period

was 3rd quarter 2012-

2nd quarter 2013

6

Attachment A

Participant Terms of Use, Primary Care Quality Prototype Reports ..Central Ohio stakeholders collaborating to improve quality reporting of local patient-centered primary care in 2013

A multi-stakeholder collaborative formed in the fall of 2012. The collaborative will implement a transparent all-patient

local prototype of Primary Care Quality Reporting in 2013. Local health care leadership sessions and a project design

team have readied this project for Central Ohio. The collaborative intends for this prototype to advance Central Ohio

reporting readiness for future primary care quality improvement and demonstration. Participants are those

organizations that provide data, view or review reports.

Participating Organizations

Terms of Use

Primary Care Practices -provide timely, de-identified (no Protected Health Information) data from Electronic Medical Records for the selected measures -respond timely to data inquiry questions -share experiences of participating in local quality reporting -will not use report content to promote or publicize physician practices -use reports to improve quality in your practice

Healthplans, Employers, & Other health care organizations

-share experiences of participating in local quality reporting -will not use report content to promote or publicize physician practices -use reports to work with practices to improve primary care

Access HealthColumbus & its Public-Private Partners

-facilitate the collaborative process in benefiting Central Ohio -maintain project support integrity and timeliness -provide technical services sufficient to support the prototype -manage report sharing with participating organizations

7

Attachment B

Primary Care Quality Reporting – 2013 Prototype EMR Measures Adult Practices

NQF# Quality Measure Steward

0059 Diabetes: Hemoglobin A1c Poor Control. Description: Percentage of patients 18-75 years of age with diabetes (type 1 or type 2) who had hemoglobin A1c > 9.0 %. Denominator: Patients 18-75 years of age with diabetes with a visit during the measurement period. Numerator: Patients whose most recent HbA1c level (performed during the measurement period) is > 9.0% Rationale: Diabetes mellitus (diabetes) is a group of diseases characterized by high blood glucose levels caused by the body’s inability to correctly produce or utilize the hormone insulin. It is recognized as a leading cause of death and disability in the U.S. and is highly underreported as a cause of death. Diabetes of either type may cause life‐threatening, life‐ending or life‐altering complications, including poor blood sugar control. Studies have shown that improved glycemic control is correlated with a 40%decline in the development of associated microvascular complications (i.e., eye, kidney and nerve diseases) (ADA 2009). Clinical guidelines recommend regular HbA1c testing to facilitate patients’ ability to improve and sustain acceptable levels (ADA 2009). This measure facilitates the prevention and long‐term management of high blood sugar levels for patients diagnosed with diabetes.

NCQA

0064

Diabetes: Low Density Lipoprotein (LDL) Management. Description: Percentage of patients 18–75 years of age with diabetes whose LDL-C was adequately controlled (<100 mg/dL) during the measurement period. Denominator: Patients 18-75 years of age with diabetes with a visit during the measurement period. Numerator: Patients whose most recent LDL-C level performed during the measurement period is <100 mg/dL. Rationale: Diabetes mellitus (diabetes) is a group of diseases characterized by high blood glucose levels caused by the body’s inability to correctly produce or utilize the hormone insulin. It is recognized as a leading cause of death and disability in the U.S. and is highly underreported as a cause of death. Diabetes of either type may cause life‐threatening, life‐ending or life‐altering complications, including poor cholesterol, specifically LDL. Clinical guidelines recommend lifestyle modifications that include reducing intake of saturated fat, trans fat and cholesterol; weight loss; and increased physical activity (ADA 2009). Statin therapy is suggested for eligible patients whose levels are consistently and significantly higher (ADA 2009). This measure facilitates long‐term management of LDL cholesterol levels for patients diagnosed with diabetes.

NCQA

0061

Diabetes: Blood Pressure Management. Description: Percentage of patients 18-75 years of age with diabetes (type 1 or 2) who had a blood pressure < 140/90. Denominator: Patients in the initial population with a diagnosis of diabetes and at least 2 non-acute inpatient or outpatient encounters, or currently receiving medications indicative of diabetes during the measurement period or in the 12 months prior to the measurement period. Numerator: The number of patients whose most recent BP reading during the measurement period was <140/90 mm Hg. Rationale: Diabetes mellitus (diabetes) is a group of diseases characterized by high

NCQA

8

blood glucose levels caused by the body’s inability to correctly produce or utilize the hormone insulin It is recognized as a leading cause of death and disability in the U.S. and is highly underreported as a cause of death. Diabetes of either type may cause life‐threatening, life‐ending or life‐altering complications, including poor blood pressure control and subsequent cardiovascular disease of varying severity. Maintaining a healthy blood pressure has been shown to reduce complications due to diabetes, with a 10 mm Hg reduction in systolic blood pressure lowering the risk of complications by 12% It also reduces the chance of cardiovascular disease among patient with diabetes by up to 50% and reduces the chance of other related complications (eye, kidney, nerve) by more than 25% This measure facilitates long‐term management of blood pressure levels for patients diagnosed with diabetes.

0036 Use of Appropriate Medications for Asthma. Description: Percentage of patients 5-50 years of age who were identified as having persistent asthma and were appropriately prescribed medication during the measurement period. Denominator: Patients 5-50 years of age with persistent asthma and a visit during the measurement period. Numerator: Patients who were dispensed (or ordered or active) at least one prescription for a preferred therapy during the measurement period. Three age stratifications to report, 5-11 years, 12-50 years, and total. Rationale: This measure assesses the appropriate and timely use of medications for long‐term control of asthma symptoms and offers meaningful and actionable information to health care providers and consumers. Asthma is the most common chronic childhood disease, affecting an estimated 6.2 million children and resulting in more than 6.5 million office visits, 500,000 hospitalizations, 1.51 million nonemergency outpatient department visits and 1.81 million ER visits for children and adults. In 1998, over $10 billion was spent on related medical expenditures in the United States. The financial and disease burden can be alleviated if patients have appropriate medications and medical management. This measure facilitates efforts toward effective disease management and prevention of traumatic outcomes.

NCQA

0018 Controlling High Blood Pressure. Description: Percentage of 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. Denominator: Patients 18-85 years of age who had a diagnosis of essential hypertension within the first six months of the measurement period or any time prior to the measurement period. Numerator: Patients whose blood pressure is adequately controlled ( systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mm Hg) during the measurement period. Rationale: This measure assesses the percentage of patients demonstrating adequate control of systolic and diastolic blood pressure levels. Over 50 million Americans warrant treatment for high blood pressure, according to the NHANES survey (JNC‐7 2003). Financially, hypertension and associated disorders and heath complications, such as coronary heart disease and congestive heart failure, cost the U.S. economy more than $100 billion each year. The United States Preventive Services Task Force (USPSTF) recommends that clinicians screen adults 18 and older for high blood pressure (2007). This guideline is further endorsed by research studies and clinical trials that have demonstrated decline in costly health outcomes as a direct result of improved blood pressure control. This measure is important in efforts to promote blood pressure control and improve quality of life.

NCQA

9

Attachment C

Primary Care Quality Reporting – 2013 Prototype EMR Measures Pediatric Practices

NQF# Quality Measure Steward

0036 Use of Appropriate Medications for Asthma. Description: Percentage of patients 5-50 years of age who were identified as having persistent asthma and were appropriately prescribed medication during the measurement period. Denominator: Patients 5-50 years of age with persistent asthma and a visit during the measurement period. Numerator: Patients who were dispensed (or ordered or active) at least one prescription for a preferred therapy during the measurement period. Three age stratifications to report, 5-11 years, 12-50 years, and total. Rationale: This measure assesses the appropriate and timely use of medications for long‐term control of asthma symptoms and offers meaningful and actionable information to health care providers and consumers. Asthma is the most common chronic childhood disease, affecting an estimated 6.2 million children and resulting in more than 6.5 million office visits, 500,000 hospitalizations, 1.51 million nonemergency outpatient department visits and 1.81 million ER visits for children and adults. In 1998, over $10 billion was spent on related medical expenditures in the United States. The financial and disease burden can be alleviated if patients have appropriate medications and medical management. This measure facilitates efforts toward effective disease management and prevention of traumatic outcomes.

NCQA

0041 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. Denominator: All patients 6 months and older and seen for a visit between October 1 and March 31. Numerator: Patients who received an influenza immunization OR who reported previous receipt of an influenza immunization. Rationale: Annual influenza vaccination is the most effective method for preventing influenza virus infection and its complications. Influenza vaccine is recommended for all persons aged >=6 months who do not have contraindications to vaccination.

AMA-PCPI

10

Primary Care Quality Reporting Project

Overview –

Primary care is front and center in an effort to improve the value of health care in our country. Many communities have advanced with transparent primary care quality reporting. A local multi-stakeholder collaborative formed in the fall of 2012 to implement this transparent all-patient local prototype of Primary Care Quality Reporting in 2013. The collaborative intends for this prototype to advance Central Ohio reporting readiness for future primary care quality improvement and demonstration. This project contributes to aims for better health, care, and value supporting continuous improvement driven by data, including:

Coordination of care across the medical neighborhood

Optimal use of health information technology

Planned care for chronic conditions & preventative care This report is the first of quarterly reports through 2014.

Collaborative participants are invited to view this report under the Participant Terms of Use (see Attachment A).

Participants are those organizations that provide data, view or review reports.

The displayed practice sites have voluntarily participated in sharing their data with the collaborative.

Adult Practices Measure, Diabetes Patients, Cholesterol Control

Low Density Lipoprotein (LDL) Management (National Quality Forum Measure #0064)

Description -

Percentage of patients 18-75 years of age with diabetes (type 1 or type 2) whose LDL-C was adequately controlled

(<100 mg/dL) during the measurement period. The measurement period was 3rd quarter 2012 through 2nd quarter

2013.

Diabetes mellitus (diabetes) is a group of diseases characterized by high blood glucose levels caused by the body’s

inability to correctly produce or utilize the hormone insulin. It is recognized as a leading cause of death and disability

in the U.S. and is highly underreported as a cause of death. Diabetes of either type may cause life‐threatening,

life‐ending or life‐altering complications, including poor cholesterol, specifically LDL. Clinical guidelines recommend

lifestyle modifications that include reducing intake of saturated fat, trans fat and cholesterol; weight loss; and

increased physical activity (ADA 2009). Statin therapy is suggested for eligible patients whose levels are consistently

and significantly higher (ADA 2009). This measure facilitates long‐term management of LDL cholesterol levels for

patients diagnosed with diabetes.

Primary Care Quality Report – Version 1.0

Adult Practices Measure, Diabetes Patients, Cholesterol Control

Low Density Lipoprotein (LDL) Management

SAMPLE B

(FICTICIOUS DATA)

11

Practices with predominantly commercial payers.

Sort order is practice name. %tiles are derived from all practices. Measurement period: 7/2012-6/2013

Primary Care Quality Report – Version 1.0

Adult Practices Measure, Diabetes Patients, Cholesterol Control

Low Density Lipoprotein (LDL) Management

practice LDL<100

%tile

(tens) quartile

m3 49% 40% 2nd

m2 45% 40% 2nd

m1 36% 20% 1st

l3 73% 90% 4th

l2 56% 50% 2nd

l1 54% 50% 2nd

k3 71% 90% 4th

k2 32% 10% 1st

k1 59% 50% 2nd

j3 43% 30% 2nd

j2 72% 90% 4th

j1 48% 40% 2nd

i3 76% 100% 4th

i2 51% 40% 2nd

i1 38% 30% 1st

h3 72% 90% 4th

h2 70% 80% 4th

h1 32% 10% 1st

g3 66% 80% 3rd

g2 42% 30% 2nd

g1 66% 70% 3rd

f3 58% 60% 3rd

f2 74% 100% 4th

f1 35% 20% 1st

e3 68% 80% 3rd

e2 65% 70% 3rd

e1 37% 20% 1st

d3 35% 20% 1st

d2 38% 20% 1st

d1 69% 80% 4th

c3 67% 80% 3rd

c2 47% 40% 2nd

c1 71% 90% 4th

b3 76% 100% 4th

b2 50% 40% 2nd

b1 33% 10% 1st

a3 57% 60% 3rd

a2 62% 70% 3rd

a1 61% 60% 3rd

Average 55%

National 49%

61%

62%

57%

33%

50%

76%

71%

47%

67%

69%

38%

35%

37%

65%

68%

35%

74%

58%

66%

42%

66%

32%

70%

72%

38%

51%

76%

48%

72%

43%

59%

32%

71%

54%

56%

73%

36%

45%

49%

a1

a2

a3

b1

b2

b3

c1

c2

c3

d1

d2

d3

e1

e2

e3

f1

f2

f3

g1

g2

g3

h1

h2

h3

i1

i2

i3

j1

j2

j3

k1

k2

k3

l1

l2

l3

m1

m2

m3

LDL<100

12

Practices with commercial+Medicare as predominant payers.

Sort order is practice name. %tiles are derived from all practices. Measurement period: 7/2012-6/2013

Practices with Self Pay+Medicaid as predominant payers.

Sort order is practice name. %tiles are derived from all practices. Measurement period: 7/2012-6/2013

Primary Care Quality Report – Version 1.0

Adult Practices Measure, Diabetes Patients, Cholesterol Control

Low Density Lipoprotein (LDL) Management

practice LDL<100

%tile

(tens) quartile

v1 75% 100% 4th

u2 39% 30% 1st

u1 64% 70% 3rd

t2 36% 20% 1st

t1 61% 70% 3rd

s2 55% 50% 2nd

s1 44% 40% 2nd

r2 60% 70% 3rd

r1 63% 60% 3rd

q2 53% 50% 2nd

q1 60% 60% 3rd

p2 62% 60% 3rd

p1 63% 70% 3rd

o2 59% 60% 3rd

o1 72% 90% 4th

n2 74% 100% 4th

n1 75% 100% 4th

Average 55%

National 49%

75%

74%

72%

59%

63%

62%

60%

53%

63%

60%

44%

55%

61%

36%

64%

39%

75%

n1

n2

o1

o2

p1

p2

q1

q2

r1

r2

s1

s2

t1

t2

u1

u2

v1

LDL<100

practice LDL<100

%tile

(tens) quartile

y1 34% 10% 1st

xxx 70% 80% 4th

x2 57% 50% 2nd

x1 34% 10% 1st

w2 33% 10% 1st

w1 39% 30% 1st

v2 41% 30% 2nd

Average 55%

National 49%

41%

39%

33%

34%

57%

70%

34%

v2

w1

w2

x1

x2

xxx

y1

LDL<100

13

Attachment A

Participant Terms of Use, Primary Care Quality Prototype Reports ..Central Ohio stakeholders collaborating to improve quality reporting of local patient-centered primary care in 2013

A multi-stakeholder collaborative formed in the fall of 2012. The collaborative will implement a transparent all-patient

local prototype of Primary Care Quality Reporting in 2013. Local health care leadership sessions and a project design

team have readied this project for Central Ohio. The collaborative intends for this prototype to advance Central Ohio

reporting readiness for future primary care quality improvement and demonstration. Participants are those

organizations that provide data, view or review reports.

Participating Organizations

Terms of Use

Primary Care Practices -provide timely, de-identified (no Protected Health Information) data from Electronic Medical Records for the selected measures -respond timely to data inquiry questions -share experiences of participating in local quality reporting -will not use report content to promote or publicize physician practices -use reports to improve quality in your practice

Healthplans, Employers, & Other health care organizations

-share experiences of participating in local quality reporting -will not use report content to promote or publicize physician practices -use reports to work with practices to improve primary care

Access HealthColumbus & its Public-Private Partners

-facilitate the collaborative process in benefiting Central Ohio -maintain project support integrity and timeliness -provide technical services sufficient to support the prototype -manage report sharing with participating organizations