clinical quality measures (cqms) cop · 2016. 4. 6. · november 5, 2015 2:00 pm eastern time...
TRANSCRIPT
eCQM Use Cases
Clinical Quality Measures (CQMs) CoP
November 5, 2015
2:00 PM Eastern Time
Medicaid Electronic Health Record (EHR) Team (MeT)
Centers for Medicare and Medicaid Services (CMS)
This is an advanced copy of the Clinical Quality
Measures presentation for your review only. This
presentation is subject to change and should not be
reproduced. The final version of the presentation
will be posted to the Medicaid HITECH TA Web site
at a later date.
Today’s CMS & MeT Resources
2
David Koppel: [email protected]
CMS, Health Information Technology for Economic and Clinical Health - HITECH Coordinator
Phone: (410) 786-3255
Izanne Leonard-Haak: [email protected] MeT, Team Member
Health Management Associates
Matt McGeorge [email protected]
MeT, Team Member
Health Management Associates
Agenda
1. CMS Updates
2. CQM Project Development Considerations
3. eCQM Use Cases - MITRE
4. Upcoming Schedule
3
4
CMS Updates
Updated CQM Requirements Effective December 14, 2015
No changes to CQM selection or reporting scheme (9 CQMs for EPs & 16 CQMs for EHs across at least 3 domains)
All providers only required to report CQMs for 90 day period in 2015
New providers only required to report CQMs for 90 day period for 2016 and 2017; all others must report for full year
All providers must report CQMs for full year in 2018
Continues to encourage the electronic capture, calculation and reporting of key clinical data through use of CEHRT(Medicare requires electronic submission in 2018)
Notes long term vision seeks to have hospitals, clinicians and other health care providers report through single aligned mechanism for multiple CMS programs
5
See Clinical Quality Measure discussion on page 62767 of Federal Register Vol.80, No. 200
6
CQM Project Development
Considerations
CQM Project Development Considerations
7
•CQMs are defined, maintained and updated in order to produce standardized measures to make collection, use and comparisons easier
•A large group of Medicare and Medicaid Providers are already required to report CQMs
•Funding is available to build capacity to collect CQMs and to incentivize provider reporting
Can build on an existing infrastructure
•Standardized data enables sharing of clinical information that can drive improved decisions and care
•Helps save money through improved operational efficiencies at practice, payer and state level
•Provides state policy makers robust information needed make important decisions
CQM can help improve health care service
delivery
•Helps Medicaid and other agencies to align with Triple Aim (better health, better health care, more cost effective) and to measure clinical actions and results
•Focuses on quality over just straight encounters which creates efficiencies by looking at outcomes
•Can use for P4P at practice, payer and state level
CQMs can help focus on healthcare outcomes
CQM Project Development Considerations
8
Structure and Team Members
Steering/Oversight
Governor’s Office
Medicaid
Other Agency Leadership
Project Team
Medicaid:
• Policy
• Quality
• Managed Care Oversight
• Information Systems
• EHR Incentive Program
Others:
• State Health IT
• Health Information Exchange(s)
• Managed Care Plans
• All Payer Database
9
eCQM Use Cases –
MITRE
Cl in ica l Qual i ty Measure Communi ty o f
Pract ice
Electronic Clinical Quality Measure
(eCQM) Use Cases
November 5, 2015
CMS Alliance to Modernize Healthcare
MITRE and its tasking
11
We are a not-for-profit company that operates Federally Funded
Research and Development Centers (FFRDCs) on behalf of federal
agencies.
We have been tasked by CMS to gather information about states’
needs and requirements for implementing eCQM systems
– What strategic uses are states considering for eCQM data?
– What are the challenges faced in gathering and analyzing the
data?
– How can MITRE assist in developing strategies and tools for use
by multiple states?
In the near future, we will reach out to states to gather
information and welcome dialog even before then
– Please contact Sejal Patel at [email protected]
CMS Alliance to Modernize Healthcare
Agenda
1. Introduction to eCQMs and QRDA Files
2. eCQM Use Cases
3. Questions / Discussion
4. Poll Questions
12
CMS Alliance to Modernize Healthcare
Introduction to eCQMs and QRDA files
13
CMS Alliance to Modernize Healthcare
Why are we discussing eCQMs?
An effective way to orient healthcare delivery and payment around quality
– Better quality
– Reduced costs
– Improved population health
eCQM systems help address the need for better, more
functional quality data
Can be used by state Medicaid agencies for:
– Program oversight
– Health policy
– Population health
eCQM systems are eligible for HITECH 90/10 funding until 2021!
14
“Triple Aim”
CMS Alliance to Modernize Healthcare
What exactly are eCQMs?
eCQMs use data from electronic health records (EHR) and/or health Information technology systems to calculate measures related to patient care
eCQMs measure many aspects of patient care: – health outcomes, clinical processes, patient safety, efficient use of
resources, care coordination, patient engagements, population and public health, and clinical guidelines
eCQMs were designed to enable organizations to more effectively track diseases, monitor healthcare quality, track the results over time, and determine outcomes for specific populations
15
CMS Alliance to Modernize Healthcare
What exactly are eCQMs?, cont’d
16
Each eCQM is
calculated from
EHR information
that identifies
patients who
should receive
care
(denominator) and
the patients who
did receive care
(numerator)
CMS Alliance to Modernize Healthcare
QRDA category 1, 2, and 3 files
17
𝑵𝒖𝒎𝒆𝒓𝒂𝒕𝒐𝒓
𝑫𝒆𝒏𝒐𝒎𝒊𝒂𝒕𝒐𝒓− 𝑬𝒙𝒄𝒍𝒖𝒔𝒊𝒐𝒏𝒔
Patient 1
Data
Patient 2
Data
Patient 3
Data
Patient 4
Data
Patient 1
Data
Patient 2
Data
Patient 3
Data
Patient 4
Data
QRDA Cat 1
Patient Level Data
QRDA Cat 3
QRDA Cat 2
(Aggregate) Report of Calculated
eCQM
Patient 1
Data
Note: QRDA Cat 2 was a standard that was dropped
X
CMS Alliance to Modernize Healthcare
How QRDA files are calculated
18
QRDA Cat 1 and 3 files can be
provided by Certified EHR
Technology (CEHRT).*
* 2015 CEHRT criteria requires EHRs to have the capability of exporting
and importing QRDA Cat 1 and 3 files without additional vendor support
Entities that collect
QRDA Cat 1 files can
use available engines
like popHealth to convert
Cat 1 files into
population health reports
Note that
QRDA Cat 1
files cannot
be
calculated
from QRDA
Cat 3 files
System that
collects Cat 1 data
and produces
reports, e.g.,
popHeatlh
QRDA
Cat 3 file
CMS Alliance to Modernize Healthcare
Data available through QRDA Cat 1 files
19
Provides patient-level data, including patient demographic
information, providers, and all clinical data needed to
calculate collected quality measures
From: http://projectpophealth.org/screen_shots.html
CMS Alliance to Modernize Healthcare
Data available through QRDA Cat 1 files, cont.
20
Cat 1 files
include provider
and practice
information.
As a result,
quality measures
can be calculated
at the practice, or
MCO, level as
well.
From: http://projectpophealth.org/screen_shots.html
CMS Alliance to Modernize Healthcare
Data available through eCQM Cat 3 files
21
Provider: Smith, John
Cat 3 files capture
numerators and
denominators at
the provider or
hospital level.
Numerators and
denominators
include Medicaid
and non-Medicaid
patients seen by
the provider or
hospital.
From: http://projectpophealth.org/screen_shots.html
CMS Alliance to Modernize Healthcare
eCQM Use Cases
22
CMS Alliance to Modernize Healthcare
Why are use cases important?
Enables SMAs to align HIT toward achieving state health goals
– Improves ROI
– Aligns IT development with MITA 3.0 principles
Enables SMAs to communicate the value-added of eCQM systems
Informs high-level HIT planning by identifying critical interfaces and
system needs, e.g.,
– QRDA Cat 1 versus Cat 3 for eCQMs?
Identifies eCQM collection priorities
Identifies required IT, resources, and partners
Provides foundation for better testing and verification
**For more information on developing use cases for HITECH, refer to
the MITA HITECH Toolkit , available through the HITECH TA site**
23
CMS Alliance to Modernize Healthcare
What can an SMA do with eCQMs?
It depends on the type of files.
Here are few examples …
24
QRDA Cat 3 Files (EH / CAH / EPs reporting their aggregated
results)
QRDA Cat 1 Files (EH / CAH / EPs reporting their patients’ raw health data)
• Compare provider and hospital
performance across regions
• Compare quality of care across
provider type / specialty
• Determine if state health initiatives are
having an impact on provider behaviors
and provider-level patient outcomes
• Inform provider-level pay-for-
performance decisions
• Aggregate health data by MCO, region,
etc., instead of on a provider-by-provider
basis.
• Inform value-based purchasing decisions
• Determine if state health initiatives are
having impact on population health
• Identify healthcare disparities within the
Medicaid population
Measures provider and hospital performance Enables population health analysis
CMS Alliance to Modernize Healthcare
Health policy: QRDA Cat 3 use case
Scenario: An incentive program is launched that gives bonuses to pediatric
physicians who exceed an 80% threshold on immunization
measures.
Data Source: CMS117 v4 Childhood Immunization Status,
QRDA Cat 3 files
Method: State uses CMS117 data to identify providers who qualify for bonuses.
Provider 1
Provider 2
Provider 3
Provider 4
80% threshold
CMS117 results for
2016
Providers 1
and 3
receive
bonus
payments
CMS Alliance to Modernize Healthcare
Program oversight: QRDA Cat 1 use case
Scenario: The SMA is exploring using eCQMs to collect quality data
normally gathered by External Quality Reporting Organizations (EQROs) Data Source: CMS 125v4 Breast Cancer Screening
QRDA Cat 1
Method: SMA calculates quality measures for each MCO from CMS 125v4 Cat 1 data,
which will be used to inform future contracting and reduces the reporting
requirements of EQROs.
MCO 1
MCO 2
MCO 3
MCO 4
CMS125v4 results for
2016
Predetermined
threshold
SMA uses
practice
information from
QRDA Cat 1
files to compare
performance
across MCOs
CMS Alliance to Modernize Healthcare
Population health: QRDA Cat 1 use cases
27
Scenario: The SMA wants to identify health care disparities within the Medicaid diabetic
population across ethnic groups or foreign language speakers.
Data Sources: CMS123v4 Diabetes: Foot Exam
QRDA Cat 1 files
Method: SMA uses demographic data in Cat I files to compare care provided across
ethnic groups among Medicaid beneficiaries
Caucasian
African American
Hispanic
Other
CMS123v4 results for
2016
Predetermined
threshold
SMA uses
patient ID and
demographic
information to
identify
disparities in
care quality
among ethnic
groups
CMS Alliance to Modernize Healthcare
Population health: QRDA Cat 1 use case
28
Scenario: The SMA wants to begin charting the percent of Medicaid patients
receiving flu vaccinations on a yearly basis
Data Source: CMS147v5 Influenza Immunization
QRDA Cat 1 files
Method: SMA batches and calculates flu vaccination rates among Medicaid
beneficiaries using QRDA Cat 1 files for four consecutive years
2012
2013
2014
2015
CMS147v5 results for Medicaid Flu vaccination Trends –
2012 through 2015
Predetermined
threshold
SMA uses
patient ID to
identify
Medicaid
beneficiaries,
then calculates
percentage of
vaccinations per
year.
CMS Alliance to Modernize Healthcare
Pros & cons of Cat 1 and Cat 3 files
29
QRDA Cat 3 Files (EH / CAH / EPs reporting their aggregated
results)
QRDA Cat 1 Files (EH / CAH / EPs reporting their patients’ raw health data)
• Pro: No privacy concerns
• Pro: Can be used to evaluate quality of
care by providers and hospitals
• Pro: Does not require as much storage
capacity as QRDA Cat 1 files.
• Con: Cannot perform state-wide
population level health analytics (only
provider / hospital level)
• Con: Cannot be used to evaluate the
Managed Care plans performance
• Con: Not all providers are submitting data
• Pro: Can analyze state-wide Medicaid
population health
• Pro: Can be used to evaluate practices,
including MCO performance
• Pro: Can generate Cat 3 files and reap Cat 3
benefits
• Pro: Enables wider range of analytics
• Con: Increased risk around privacy and
security issues in acquiring and safeguarding
patient health information
• Con: Not all providers are submitting data
• Con: Requires large storage capacity which
is costly to maintain and safeguard
CMS Alliance to Modernize Healthcare
Next steps?
Learn more about eCQMs!
– See “Resources for additional information” slide
Share CQM CoP decks with other staff in the SMA
– Quality office
– MCO office
– Policy office
– SIM leads
Inform other SMA staff about funding opportunities for eCQM
systems
30
CMS Alliance to Modernize Healthcare
Resources for additional information on eCQMs
A. Medicaid HITECH eCQM Toolkit*
B. May 2014 CQM CoP: CQM and eCQM Resources*
C. CMS eCQM Library
D. eCQI Resource Center
E. PopHealth
CMS Alliance to Modernize Healthcare
Follow-up Opportunity
32
If you are interested in MITRE contacting you to gather information about your state’s needs and requirements for system implementation related to eCQMs, please enter your name, state and contact information into the chat box now.
CMS Alliance to Modernize Healthcare
Questions??
33
34
Upcoming Schedule
CQM Learning Opportunities Schedule
35
Schedule Target Audience Objectives
Understanding
CQMs November 17,
2015
-Staff new to the Medicaid EHR
Incentive Program
-Staff new to the CQM concepts
-Staff who would like a refresher
on CQMs
To provide a robust overview of CQMs
eCQM
Advanced
User Group
Next Session:
December 17,
2015
-Staff from states in the more
advanced stages of CQM data
collection
-Staff who have responsibility for
leading, using or supporting the
collection or employment of
patient level clinical quality data
for program operations and
oversight and population health
management
ADDITIONAL STAFF FROM
MEDICAID PROGRAM UNITS
NOT LIMITED TO EHR
INCENTIVE PROGRAM STAFF
ONLY
To support a forum in which staff from states can
brainstorm and share breakthroughs, on ways to
address challenges they are facing in capitalizing
on CQMs being available electronically.
36
David Koppel: [email protected]
CMS, Health Information Technology for Economic and Clinical Health
(HITECH) Coordinator
Phone: (410) 786-3255
Elizabeth Lebreton: [email protected]
CMS, Health Information Technology for Economic and Clinical Health
(HITECH) Coordinator
Phone: (312) 353-3822
Izanne Leonard-Haak: [email protected]
MeT, Team Member
Health Management Associates