Sarah Hudson ScholleAssistant Vice President, Research
June 7, 2008
Opportunities for Improving Quality Opportunities for Improving Quality Measurement in Women’s Health Measurement in Women’s Health
© 2008 National Committee for Quality Assurance
Agenda
• NCQA• Current quality measures of
particular interest to women • Opportunities for the future
© 2008 National Committee for Quality Assurance
NCQA: Mission and Vision
• Mission– To improve the quality of
health care • Vision
– To transform health care through measurement, transparency and accountability
© 2008 National Committee for Quality Assurance
• Over 500 plans report HEDIS data to NCQA (Commercial, Medicaid, Medicare)
• Over 200 commercial MCO plans are accredited by NCQA
• Over 75 Medicare Advantage plans are accredited by NCQA (more than any other accrediting body)
• Over 76.5 million patients are impacted through the plans NCQA accredits
• Over 10,000 physicians are recognized by NCQA programs
Achieving the MissionImpact of Accreditation & Certification
Programs
© 2008 National Committee for Quality Assurance
HEDIS® - Effectiveness of Care
• Prevention– Breast cancer screen– Cervical cancer screen– Colon cancer screen– Immunizations for
Children and Adults– Chlamydia screen– Glaucoma– Physical Activity– Falls risk management– BMI
• Chronic disease– Hypertension– Diabetes – Cardiovascular disease– Smoking cessation– Osteoporosis testing– Asthma– Depression – Urinary incontinence– Follow up after mental
illness hospitalization– Medication management– High risk medications
• Overuse/Misuse– Imaging in low back
pain– Use of antibiotics
• Relative Resource Use
© 2008 National Committee for Quality Assurance
Access & Utilization
• Frequency of Ongoing Prenatal Care – Reports an unduplicated count of deliveries who had <21 percent,
21–40 percent, 41–60 percent, 61–80 percent or ≥81 percent of the number of expected visits, adjusted for the month the member enrolled and the MCO and gestational age.
• Prenatal and Postpartum Care– Timeliness of Prenatal Care. The percentage of deliveries that
received a prenatal care visit as a member of the MCO in the first trimester or within 42 days of enrollment in the MCO.
– Postpartum Care. The percentage of deliveries that had a postpartum visit on or between 21 and 56 days after delivery.
• Retired– Discharges and ALOS—Maternity Care (including C-section rate)– Births and ALOS, Newborns
© 2008 National Committee for Quality Assurance
NCQA Physician Recognition Programs
• Identify physicians whodeliver superior care
• Measure against evidence-based standards
• Assess for diabetes, heart/stroke and back pain care, and evaluate office systems
• Publicly report Recognized physicians
• Encourage purchasers, plans and patients to reward Recognized physicians
• More than 10,000* physicians Recognized
*As of March 21, 2008
5,285*physicians
1,431*physicians
3,456* physicians
273* practices
35*physicians
5* practices
© 2008 National Committee for Quality Assurance
Physician Practice Connections (PPC)• Developed in Response to a Need
– To Err is Human and Crossing the Quality Chasm provide evidence on importance of practice systems
– Raise physician awareness of importance of systems in enhancing quality
– Link health services research on systems and clinical outcomes to practice
• Measures – Systematically provide preventive and
chronic care management – Actionable at physician practice level– Validated by relating them to performance
© 2008 National Committee for Quality Assurance
Theoretical Frameworks Informing Physician Practice Connections
Chronic Care Model
Patient Centered Care
Cultural Competence
Joint Principles of Medical
HomeClinical information
SystemsDecision SupportPatient Self-
ManagementDelivery System
RedesignCommunity LinkagesHealth Systems
Respect Patient ValuesAccessible Family-Centered Continuous Coordinated Community LinkagesCompassionate Culturally Appropriate Emotional Support Information and
Education Physical ComfortQuality Improvement
Culturally competent interactions
Language services
Reducing disparities
Personal physicianPhysician directed
teamWhole person
orientationCare is coordinated
and integratedQuality and safetyEnhanced access
© 2008 National Committee for Quality Assurance
PPC-PCMH Content and ScoringStandard 1: Access and CommunicationA. Has written standards for patient access and
patient communication**B. Uses data to show it meets its standards for
patient access and communication**
Pts
45
9
Standard 2: Patient Tracking and Registry Functions A. Uses data system for basic patient information
(mostly non-clinical data) B. Has clinical data system with clinical data in
searchable data fields C. Uses the clinical data system D. Uses paper or electronic-based charting
tools to organize clinical information**E. Uses data to identify important diagnoses
and conditions in practice**F. Generates lists of patients and reminds patients
and clinicians of services needed (population management)
Pts
2
33
64
3
21
Standard 3: Care ManagementA. Adopts and implements evidence-based
guidelines for three conditions **B. Generates reminders about preventive services
for clinicians C. Uses non-physician staff to manage patient care D. Conducts care management, including care plans,
assessing progress, addressing barriers E. Coordinates care//follow-up for patients who
receive care in inpatient and outpatient facilities
Pts
3
4
35
5
20
Standard 4: Patient Self-Management Support A. Assesses language preference and other
communication barriersB. Actively supports patient self-management**
Pts
24
6
Standard 5: Electronic Prescribing A. Uses electronic system to write prescriptions B. Has electronic prescription writer with safety
checksC. Has electronic prescription writer with cost
checks
Pts33
2
8
Standard 6: Test Tracking A. Tracks tests and identifies abnormal
results systematically** B. Uses electronic systems to order and retrieve
tests and flag duplicate tests
Pts7
6
13
Standard 7: Referral Tracking A. Tracks referrals using paper-based or
electronic system**
PT4
4
Standard 8: Performance Reporting and Improvement
A. Measures clinical and/or service performance by physician or across the practice**
B. Survey of patients’ care experience C. Reports performance across the practice
or by physician **D. Sets goals and takes action to improve
performance E. Produces reports using standardized
measures F. Transmits reports with standardized measures
electronically to external entities
Pts
3
33
3
21
15
Standard 9: Advanced Electronic Communications A. Availability of Interactive Website B. Electronic Patient Identification C. Electronic Care Management Support
Pts121
4
**Must Pass Elements
© 2008 National Committee for Quality Assurance
PCMH Must Pass Elements1. PPC1A: Written standards for patient access and patient
communication
2. PPC1B: Use of data to show meeting this standard
3. PPC2D: Use of paper or electronic-based charting tools to organize clinical information
4. PPC2E: Use of data to identify important diagnoses and conditions in practice
5. PPC3A: Adoption and implementation of evidence-based guidelines for three conditions
6. PPC4B: Active support of patient self-management
7. PPC6A: Tracking system to test and identify abnormal results
8. PPC7A: Tracking referrals with paper-based or electronic system
9. PPC8A: Measurement of clinical and/or service performance
10. PPC8C: Performance reporting by physician or across the practice
© 2008 National Committee for Quality Assurance
Priorities
• Composite measures– Prenatal and postpartum care– Child well care
• Coordination/Continuity– Transitions across settings – Primary and specialty care– Medication reconciliation
• Overuse• Disparities
© 2008 National Committee for Quality Assurance
Gender Disparities Notably Absent in Blood Pressure, Diabetes Control
Measures
CVD: Cholesterol
Control
White Males
African-American Males
African-American Females
White Females Blood Pressure Control
White MalesWhite Females
African-American Males
African-American Females
Diabetes: Poor A1c Control
(Lower is better)
White MalesWhite Females
African-American Males
African-American Females
10
20
30
40
50
60
70
Un
ad
jus
ted
Rat
e (
%)
© 2008 National Committee for Quality Assurance
Voluntary Accreditation Standards on Culturally and Linguistically Appropriate
Services (CLAS)• Project designed to develop consensus-based
standards for addressing cultural competence, language needs and disparities for health plans, DMOs and MBHOs
• Activities include – Analysis of current state and federal rules – Assessment of market opportunities– Development of draft standards with input from
stakeholder advisory panel– Testing of standards
• Goal is to have standards ready for public comment by December 2008 with final standards by April 2009
• Supported by The California Endowment