clinical quality measures (cqms) cop · 2016. 4. 6. · november 5, 2015 2:00 pm eastern time...

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

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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


mailto:[email protected]



Agenda

1. CMS Updates

2. CQM Project Development Considerations

3. eCQM Use Cases - MITRE

4. Upcoming Schedule

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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

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See Clinical Quality Measure discussion on page 62767 of Federal Register Vol.80, No. 200

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CQM Project Development

Considerations

CQM Project Development Considerations

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•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

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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

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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

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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]


Agenda

1. Introduction to eCQMs and QRDA Files

2. eCQM Use Cases

3. Questions / Discussion

4. Poll Questions

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Introduction to eCQMs and QRDA files

13


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!

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“Triple Aim”


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

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What exactly are eCQMs?, cont’d

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Each eCQM is

calculated from

EHR information

that identifies

patients who

should receive

care

(denominator) and

the patients who

did receive care

(numerator)


QRDA category 1, 2, and 3 files

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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


How QRDA files are calculated

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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


Data available through QRDA Cat 1 files

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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

http://projectpophealth.org/screen_shots.html





Data available through QRDA Cat 1 files, cont.

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Cat 1 files

include provider

and practice

information.

As a result,

quality measures

can be calculated

at the practice, or

MCO, level as

well.







Data available through eCQM Cat 3 files

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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.







eCQM Use Cases

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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**

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http://www.medicaidhitechta.org/ResourceLibrary/MITAHITECHToolkit/HITECHUseCases.aspx


What can an SMA do with eCQMs?

It depends on the type of files.

Here are few examples …

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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


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


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


Population health: QRDA Cat 1 use cases

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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


Population health: QRDA Cat 1 use case

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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.


Pros & cons of Cat 1 and Cat 3 files

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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


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

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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

http://www.medicaidhitechta.org/ResourceLibrary/StateeCQMInfrastructureToolkit.aspx

http://www.medicaidhitechta.org/ResourceLibrary/StateeCQMInfrastructureToolkit.aspx

http://www.medicaidhitechta.org/DesktopModules/Bring2mind/DMX/Download.aspx?EntryId=6460&Command=Core_Download&PortalId=0&TabId=432




https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/eCQM_Library.html

https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/eCQM_Library.html

https://ecqi.healthit.gov/ecqm

https://ecqi.healthit.gov/ecqm

https://www.osehra.org/popHealth


Follow-up Opportunity

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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.


Questions??

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Upcoming Schedule

CQM Learning Opportunities Schedule

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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.

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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





clinical quality measures (cqms) cop · 2016. 4. 6. · november 5, 2015 2:00 pm eastern time...

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