Slide 1

Margaret E. OKane, NCQA PresidentPartnership to Fight Chronic DiseaseMarch 6, 2015The Future of Performance Measurement

1

Gap analysisWhat we haveWhat we wantMany structure and process measures, some intermediate outcomesOutcome measures and performance reporting across systemsUneven knowledge aboutspecialty careMeasurement that comes naturally from workflow, rather than being imposed on workflow

2

Partnership to Fight Chronic Disease

Use outcome measurement for procedures3

HipsKneesBacksCataractsHeart surgery, stentsMake sure procedures are appropriateMake sure to get patient-reported outcomes

Partnership to Fight Chronic Disease

3/6/20153

Patient-reported outcomes in quality framework4STRUCTUREPROCESS

Biology

Symptoms

Function

General health perception

Overall quality of lifePATIENT FACTORS

BehaviorsUse of careKnowledge and beliefsExpectationsAdherence to treatment

DemographicsAge, Gender, SES

Health characteristicsSeverity of conditionCo-morbid factors

HEALTH SYSTEMCHARACTERISTICSProvision of treatmentAvailability of careKnowledge and beliefs of providersProvider communication

ENVIRONMENT CHARACTERISTICSOUTCOME

Partnership to Fight Chronic Disease

4

Use patient safety measures in hospitals5Infection ratesSepsisMedication errorsIatrogenic preterm deliveriesHCAHPSEtc.

Partnership to Fight Chronic Disease

3/6/20155

Then theres the really hard stuff6CancerMultiple chronic conditions (e.g., frail elderly)Intractable illness

Partnership to Fight Chronic Disease

3/6/20156

Where do we go from here?

Partnership to Fight Chronic Disease

7

Emulate successful examples8

Cystic fibrosis benchmarking

Untzer et al. IMPACT

Partnership to Fight Chronic Disease

8

Getting to outcome measures (diabetes)9 Structure Process OutcomePre-visit planning including labs

Collection of relevant patient reported data

Team with defined roles, training

Use data (e.g., risk models like Archimedes and patient reported tools) to present information to patient and clinical teams

Elicit patient priorities

Develop shared understanding

Agree on care plan and self management goals

Decrease risk of harmful events

Decrease symptoms

Maintain or improve functioning

Who is accountable?Diabetes today:Target threshold for A1c, BP, statin use, BMI

Diabetes in the future:select patient-centered targets for clinical, functional measures

Partnership to Fight Chronic Disease

9

Diabetes complications are downSource: NEJM/CDC, 4/1410

10

Benchmarking works 11

Benchmark outcomes

Study what works

Spread best practices

Engage parents

Partnership to Fight Chronic Disease

Kids are living longer with cystic fibrosis12Source: Cystic Fibrosis Foundation

12

Building an accountability framework13

Begin with structure measures

Then focus on process measures

Build up to outcome measures

Partnership to Fight Chronic Disease

13

IMPACT is a system of care14

Primary Care Practice with Mental Health Care ManagerOutcome MeasuresTreatment ProtocolsPopulationRegistryPsychiatric Consultation

14

IMPACT doubles effectiveness of care for depression

15%Participating Organizations 50 % or greater improvement in depression at 12 monthsUntzer et al., JAMA 2002; Psych Clin NA 2004

15

Global Cardiovascular Risk (GCVR)RWJF grant to NCQA to develop measures to manage CV risk Predictive risk calculators identify, manage patient risks to improve outcomes

16

Partnership to Fight Chronic Disease

16

What is the model?Organize for successManage against process benchmarks and patient-reported outcomesUse accountability for quality improvement where benchmarking outcomes is unfair

17

Partnership to Fight Chronic Disease

17

Thank you

Partnership to Fight Chronic Disease

18

Chart122.254.513.343.520.262.311.939.523.239.232.547.926.155.624.448.5

Usual CareIMPACT

Sheet112345678Usual Care22.213.320.211.923.232.526.124.4IMPACT54.543.562.339.539.247.955.648.5