Better Healthcare, Better Health, Lower Cost for ImprovementJean D Moody-Williams, RN, MPP
Director, Quality Improvement Program
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
Applies to all slides in this deck
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Transforming Care through the Affordable Care Act
3011 National Quality Strategy – CMS Quality Strategy
3021 Center for Medicare and Medicaid Innovations
3001 Hospital Value Based Purchasing
3005 Cancer Hospital Reporting
3007 Physician Value Modifier
3008 Hospital Acquired Condition Reduction Program
3401 Psychiatric Quality Reporting Program
3025 Readmission Reduction Program
3026 Community Based Care Transitions Programs
Trade Bill Revisions to the Quality Improvement Organizations Program
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Delivery system and payment transformation
Future State – People-Centered
Outcomes Driven Sustainable
Coordinated Care
New Payment Systems (and many more)Value-based purchasingACOs, Shared SavingsEpisode-based paymentsMedical Homes and care mgmtData Transparency
Passing State – Producer-Centered Volume Driven
Unsustainable
Fragmented Care
FFS Payment Systems
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Partnership for Patients Million Hearts National Quality Strategy Data.gov
Coverage of servicesPhysician Feedback report Quality Resource Utilization ReportPhysician Value ModifierReadmissions
ESRD QIPHospital VBPPlans for Skilled Nursing Facility and Home Health Agencies, Ambulatory Surgical Centers
QIOsESRD Networks
HITECH Hospital Inpatient Quality Reporting Programs
ACOsCommunity Based Transitions Care ProgramDual Eligibles
Hospitals, Home Health Agencies, Hospices, ESRD facilities
Demonstration ProjectsPilots
Target surveysQuality Assessment
Performance Improvement
Fraud & Abuse Enforcement
Implementation Levers at CMS
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Moving toward Safety
Supporting providers and families in achieving a system that provides high quality, safe and affordable care:
• Implementing a framework for improvement• Creating Learning systems supported by change
agents throughout the country to spread evidenced based practices
• Decreasing waste in the system• Focusing on the patient through engagement and
transparency• Linking quality to payment
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The QIO Program’s Approach to Clinical Quality
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INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
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Areas of Focus for CMS OMHAreas of Focus for CMS OMH
• Aligning CMS programs and policies to reduce disparities
• Improving coverage and access to care for minority populations
• Reducing disparities in health care quality
• Increasing and improving data to measure health disparities
• Improving resources for people with limited English proficiency
• Building the business case for reducing disparities
• Working with providers to reduce disparities
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CMS OMH Data and Policy Analytics Projects
CMS OMH Data and Policy Analytics Projects
• Census Data Project
• Electronic Health Records (EHR)
• Building the Business Case
• Culturally & Linguistically Appropriate Services (CLAS) Measurement Project
• CMS Demographic Data Collection Forms Inventory Project
• HEDIS/CAHPS Health Plan Quality Measure Reporting
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Moving toward Safety
Supporting providers and families in achieving a system that provides high quality, safe and affordable care:
• Implementing a framework for improvement• Creating Learning systems supported by change
agents throughout the country to spread evidenced based practices
• Decreasing waste in the system• Focusing on the patient through engagement and
transparency• Linking quality to payment
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Partnership for Patients: Better Care, Lower Costs
Secretary Sibelius launched a nationwide public-private partnership to tackle
all forms of harm to patients. Our goals are:– Reduce harm caused to patients in hospitals. By the end of 2013, preventable
hospital-acquired conditions would decrease by 40% compared to 2010.Achieving this goal would mean approximately 1.8 million fewer injuries to patients with more than 60,000 lives saved over the next three years.
– Improve care transitions.- By the end of 2013, preventable complications during a transition from one care setting to another would be decreased such that all hospital readmissions would be reduced by 20% compared to 2010. Achieving this goal would mean more than 1.6 million patients would recover from illness without suffering a preventable complication requiring re-hospitalization within 30 days of discharge.
Potential to save up to $35 billion over 3 years
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Hospital Acquired Condition (HAC) Rates Show Improvement
Ventilator-Associated Pneumonia
(VAP)
Early Elective Delivery
(EED)
Obstetric Trauma
Rate (OB)
Venous thromboembolic complications
(VTE)
Falls and Trauma
Pressure Ulcers
55.3% ↓ 52.3% ↓ 12.3% ↓ 12.0% ↓ 11.2% ↓ 11.2% ↓
2010 – 2012 - Preliminary data show a 9% reduction in HACs across all measures
Many areas of harm dropping dramatically (2010 to 2013 for these leading indicators)
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QIO 10th SoW ResultsQIO 10th SoW Results
• Over the course of the current 10th SoW QIOs have worked with providers, patients, families, nursing homes, home health agencies, pharmacist and many more in the community to increase coordination of care and improve patient safety. These efforts have resulted in the following improvements:
– 34% relative improvement in the reduction on pressure ulcer for nursing home
– 85,149 fewer days with urinary catheters for beneficiaries– 53% relative improvement in reduced Central Line Associated
Blood Stream Infections (CLABSI– 44,640 potential adverse drug events avoided– Over 27,000 people avoided being readmitted and over 95,000
avoided admission to the hospital resulting in improved coordination of care and millions of dollars in savings
– Resolve more than 180,000 cases of care concerns or requests for appeals received from beneficiaries and their families
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11th SoW Activities11th SoW Activities
CMS made the following changes to the QIO program:– Separated case review (including patient generated quality of
care concerns) from quality improvement activities to avoid the perception of conflict of interest – BFCC QIO
– Developed Quality Innovation Networks (QIN) QIOs– Redefined the geographic boundaries of the QIOs to create a
multi-state structure will maintaining the requirement for locally based quality activities
– Expanded the pool of organizations eligible to bid on the contracts by removing the requirement that the QIO be physician sponsored. The organization may use a multidisciplinary approach to improvement.
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Four key roles of the CMS Quality Improvement Organizations
QIOs work on behalf of CMS to:
Champion local-level, results-oriented change • Data driven• Active engagement of providers, patients and other partners• Proactive, intentional innovation spread that improves and “sticks”
Facilitate learning and action networks• Democratizing clinical QI expertise so “all teach, all learn”• Placing impetus for improvement at the community and bedside levelTeach and advise as technical experts• Consultation, education and technical assistance in quality improvement• Knowledge management so learning is never lost
Communicate effectively• Optimal learning, patient activation, and sustained behavior change
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Cardiac Health Special Innovation Projects
• 3 State Projects in Arkansas, California, Michigan focusing on
Beneficiaries that are of Hispanics ethnicity along with African
Americans, and Asian Pacific Island patients in rural and urban areas
• Heart attack and stroke prevention projects focused on the A B C S:
Aspirin Therapy- Appropriate Use; Blood Pressure Control;
Cholesterol Management; and Smoking Cessation
• Aligns with the HHS Secretary’s Million Hearts initiative found at
www.millionhearts.hhs.gov
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20,000+ Patients Impacted to Date Through:
Health fairs in community centers, malls, other locations
Churches - utilizing the Bless Your Heart Health Ministry Toolkit (Spanish & English version) found at https://www.afmc.org/HealthCareProfessionals/OrderInterventionTools/tabid/386/ProdID/230/Default.aspx
Patient education classes on the ABCS
All activities and events conducted with consideration for language, culture, and literacy level of the participants
Additional information and resources available at www.cmspulse.org
Cardiac Health Special Innovation Projects
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IPRO (NY QIO) Everyone with Diabetes Counts (EDC) 10th SOW Goals
Enroll : 6,000 participants in DSMEGraduate: 2,500 Hispanic/Latino Medicare
Beneficiaries in DSME ClassesCurriculum: Bi-lingual classes Stanford’s Diabetes
Self-Management Program (DSMP)Where: Senior centers, hospitals, parks,
basements, churches, housing buildings, clinics, others
When: 1 Workshop (sessions) = 6 weekly classes of 2.5 hours per class
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Addressing the Diabetes Burden in New Jersey through a Community of Promotoras: Dulce New Jersey
Created a community-based education, compliance program incorporating nurse-managed care
Recruited and trained promotoras (peer educators) to lead 8-week education courses that address barriers to patient project participation and diabetes self-management goals
Piloted program in three sites (grew to four) over two years
Led by the New Jersey Hospital Association and Health Research & Education Trust of NJ
Results:
90% increase in patient knowledge of diabetes care
64% improvement in patient exercise, 22% improvement in nutrition
16% decrease in HbA1c, 18% decrease in Fasting Blood Glucose, 17% decrease in Triglycerides
Created patient education and outreach materials in English and Spanish
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Latino/Hispanic Family Advisory Board Guides Children’s Mercy Hospital Improvements
El Consejo de Familias Latinas/Hispanas is a Family Council comprised of Spanish-speaking families
Developed to more formally include the voice of Spanish-speaking families in hospital quality and improvement efforts
Led by a parent leader and a bilingual staff member
Results:
Expanded patient and family engagement to Spanish-speaking families and meets monthly
Developed new family orientation materials in Spanish
Created new nurse-family communication materials (bilingual, pictorial, video)
Developed and implemented bilingual signage, Spanish radio health messaging, and Spanish videos to help orient patients and families to the hospitals
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City of Hope Cancer Center Engages Spanish-Speaking Community
Created El Concilio, a Spanish-speaking patient and family advisory council
Informs linguistically and culturally appropriate educational and supportive care programs for Spanish-speaking patients/caregivers
Results:
Developed materials in Spanish and other languages
Revamped Spanish language version of hospital website
Created Healthy Hispanic Living, a website to educate the Hispanic community
Established process to identify Spanish-speaking volunteers
Expanded educational programs and classes to be taught in Spanish
Promoted phone interpreter services and on-site interpreters to staff
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Massachusetts General Hospital Launches Multicultural Advisory Committee
Established Committee on Racial and Ethnic Disparities in Health and Health Care
Recommended the creation of a multicultural advisory committee (MAC) to advise the hospital on patient experience at MGH, minority communities’ perceptions of hospital, and review programs/initiatives addressing minority patient or community issues
Results:
MAC consists of 15-18 individuals and reflects the racial and ethnic demographics of Boston and the Mass General health center communities
Launched “The Service Matters Series,” an 8-hour program that trains frontline staff about providing a welcoming experience for patients and families
Continues to identify barriers to improving the health of minorities and makes recommendations, such as a the need for a health literacy campaign
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Providers are Driving TransformationProviders are Driving Transformation
More than 50,000 providers are or will be soon providing care to beneficiaries as part of the Innovation Center’s current initiatives
Over 250 organizations are participating in Medicare ACOs
More than 4 million Medicare FFS beneficiaries are receiving care from ACOs
More than 1 million Medicare FFS beneficiaries are participating in primary care initiatives
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http://innovation.cms.gov/initiatives/Transforming-Clinical-Practices/
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Core Competencies of Practice Transformation
Engaged leadership; quality improvement strategyEmpanelment (linking each patient with a responsible primary
care provider)Continuous and team-based relationships among providers
(specialty, primary care, others)Organized, evidence-based care; patient-centered interactionsIntentional approach to patient and family engagement Enhanced access; progression toward population –based care
management and reduction of disparitiesSystematic efforts to reduce un-necessary diagnostic testing and
procedures with little or no benefitState-of-the-art, results-linked, care coordination Financial acumen in the various payment alternatives
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Moving toward Safety
Supporting providers and families in achieving a system that provides high quality, safe and affordable care:
• Implementing a framework for improvement• Creating Learning systems supported by change
agents throughout the country to spread evidenced based practices
• Decreasing waste in the system• Focusing on the patient through engagement and
transparency• Linking quality to payment
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Decreasing Waste
• Spreading lean techniques and developing lean coaches
• New culture focused on the truth and improvement
• Continuously plan, do, study, and act
• Decreasing administrative waste
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Development Time Current Process Jan 2013 – 3 to 5 years
Electronic Clinical Quality Measure (eCQM) Development Kaizen Future & Current States
Development Time Future Process – 1 year
Major Changes Future vs. Current: -Single Piece “Continuous” Flow vs. Batch Flow Processing-Upfront vs. During Stakeholder Engagement-Streamlined vs. Redundant Approval Loops-QA throughout the process vs. only the end
=
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Moving toward Safety
Supporting providers and families in achieving a system that provides high quality, safe and affordable care:
• Implementing a framework for improvement
• Creating Learning systems supported by change agents throughout the country to spread evidenced based practices
• Decreasing waste in the system
• Improved transparency and patient engagement
• Linking quality to payment
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Public Reporting TimelinePublic Reporting Timeline
• 2011 PQRS, GPRO, eRx &EHR Incentive Program Participation
• 2012 PQRS, GPRO, eRx, & EHR Incentive Program Participation
• Information on ABMS board certification
• 2014 PQRS, GPRO, EHR, Incentive Program Participation
• 2014 Maintenance of Certification Incentive
• 2014 PQRS GPRO & ACO measures
• 2014 CG-CAHPS data for GPROs, ACOs, and other groups
• 2014 Individual PQRS Quality Measures
• Measures from the 2014 Cardiovascular Prevention measures group in support of Million Hearts Initiative
• Specialty Society Measures (beyond 2015)
• 2013 PQRS, GPRO, & EHR Incentive Program Participation
• 2013 PQRS Maintenance of Certification Incentive
• 2012 PQRS GPRO & ACO measures (early 2014)
• 2013 PQRS GPRO & ACO measures (late 2014)
• GPRO Composite Measures (DM & CAD) (late 2014)
• CG-CAHPS data for PQRS GPROs and ACOs (late 2014)
• Successful reporting of the 2013 Cardiovascular Prevention measures group in support of Million Hearts Initiative
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Moving toward Safety
Supporting providers and families in achieving a system that provides high quality, safe and affordable care:
• Implementing a framework for improvement• Creating Learning systems supported by change
agents throughout the country to spread evidenced based practices
• Decreasing waste in the system• Focusing on the patient through engagement and
transparency• Linking quality to payment
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• Goal is to reward providers and health systems that deliver better outcomes in health and health care at lower cost to the beneficiaries and communities they serve.
• Hospital value-based purchasing program shifts approximately $1 billion based on performance
• Five Principles
- Define the end goal, not the process for achieving it
- All providers’ incentives must be aligned
- Right measure must be developed and implemented in rapid cycle
- CMS must actively support quality improvement
- Clinical community and patients must be actively engaged
VanLare JM, Conway PH. Value-Based Purchasing – National Programs to Move from Volume to Value. NEJM July 26, 2012
• Goal is to reward providers and health systems that deliver better outcomes in health and health care at lower cost to the beneficiaries and communities they serve.
• Hospital value-based purchasing program shifts approximately $1 billion based on performance
• Five Principles
- Define the end goal, not the process for achieving it
- All providers’ incentives must be aligned
- Right measure must be developed and implemented in rapid cycle
- CMS must actively support quality improvement
- Clinical community and patients must be actively engaged
VanLare JM, Conway PH. Value-Based Purchasing – National Programs to Move from Volume to Value. NEJM July 26, 2012
Value-Based Purchasing
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• Hospital:
• Value-based purchasing, readmissions, healthcare acquired conditions, EHR Incentive Program and Inpatient Quality Reporting
• Physician/clinician
• Physician value-based modifier, physician quality reporting system, EHR incentive program
• End stage renal disease bundle and quality incentive program
• Hospital:
• Value-based purchasing, readmissions, healthcare acquired conditions, EHR Incentive Program and Inpatient Quality Reporting
• Physician/clinician
• Physician value-based modifier, physician quality reporting system, EHR incentive program
• End stage renal disease bundle and quality incentive program
Value-Based Purchasing
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Physician Value Modifier
• VM assesses both quality of care furnished and the cost of that care under the Medicare Physician Fee Schedule.
• The VM is a new per-claim adjustment under the Medicare Physician Fee Schedule that is applied at the group (Taxpayer Identification Number “TIN”) level to physicians billing under the TIN.
• CY 2015 – CMS will apply the VM to groups of physicians with 100 or more eligible professionals (EPs) based on 2013 performance.
• CY 2016 - CMS will apply the VM to groups of physicians with 10 ore more EPs based on 2014 performance.
• CMS is required to apply the VM to all physicians and groups of physicians starting in 2017.
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From Coverage to CareFrom Coverage to Care
An initiative designed to help the newly insured understand:
– What it means to have health insurance;– How to find the right provider;– When and Where to seek health services;
and– Why prevention and partnering with a provider
is important for achieving optimal health.
To equip health care providers and staff with information and resources to help them better understand and connect with newly insured patients.
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http://marketplace.cms.gov/training/get-training.htmlhttp://marketplace.cms.gov/training/get-training.html
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Get Engaged and Stay Informed!Get Engaged and Stay Informed!
http://marketplace.cms.gov
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Learn, Act, Improve, Spread, Sustain
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• How can CMS continue to facilitate and spread best practices in quality improvement initiatives?
• How can CMS best engage with the National Hispanic Medical Association to support clinical practice transformation efforts ?
• What are the most important considerations as CMS prepares to expand the availability of clinician information on public reporting sites?
• How can CMS ensure that providers understand the Value Modifier Program?
QuestionsQuestions