pcqr april record of learning
DESCRIPTION
April Record of LearningTRANSCRIPT
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Primary Care Quality Reporting Collaborative Project Design Team
April 9, 2013 Work Session Record of Learning
Longaberger Alumni House, Columbus, Ohio Participating
Design Team: Michael Anthony, Susan Butler, Sarah Durfee, Lisa Kaiser, Christine Lester, Michelle Love, Diana Riggsby Gardner, Bruce Wall MD, Beth Weinstock MD Access HealthColumbus: Jeff Biehl, Carol Deibel, John Leite
Objectives
1- Discuss Project Design Team participation principles, review local rapid prototype design. 2- Determine how project should proceed in light of Ohio receiving a State Innovation Model design grant. 3- Provide clarity on actions for rapid 2013 prototype: invitation, participation agreement, measures.
TOPIC NOTES ACTION ITEMS
Objectives, Design Team Principles, Project Review
Purpose: o Review project current design and path draft
Carol reviewed slides and content of design and path for 2013 Carol described prototype and six measure focus to be detailed
later in the work session o Create understanding of design team collaborative and individual
contribution principles (first meeting of design team) Carol reviewed design team principles (below)
Work Session A – Local quality reporting in light of State Innovation Model grant
Purpose: o Determine: In light of Ohio receiving a State Innovation Model design
grant, how should our local Primary Care Quality Reporting project proceed with rapid prototyping? Jeff updated the Design team on the Southwest Ohio
Comprehensive Primary Care initiative with quality reporting imbedded, the Office of Health Transformation’s receipt of a State Innovation Model design grant focused on expanding qualified medical homes and episode based acute medical payments with specific plans to be determined by October, and the medical home current spread in Central Ohio and lack of transparent local quality reporting here.
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TOPIC NOTES ACTION ITEMS
Table work groups were asked to discuss the question and then all were asked to give thumbs up or down. ‘Up’ would indicate proceeding with the local prototype quality reporting project, ‘down’ would indicate preference to not proceed or need to discuss additional concerns. All indicated up.
Table discussion highlights were provided including: o ‘No reason to wait to build reporting for easy common
measures, keeping patient needs in mind’ o ‘Let’s not wait to obtain lessons on demonstrating the
value of primary care and engaging practices in using quality reporting’
o ‘Let’s overcome Central Ohio’s hesitancy’ Handout provided to capture written reflections (below).
Based on the consensus of the Design Team, AHC will proceed with Primary Care Quality Reporting 2013 prototype project coordination.
Work Session B – Review Drafts of Project Roadmap and Three Project Action Pieces
Purpose: Obtain Design Team input into 2013 Project Roadmap (monthly milestones) and three project action pieces (Primary Care Practice Invitation, Collaborative Agreement of Participation, Measures). Do the roadmap and the action documents provide clarity on the proposed approach?
Carol and Jeff reviewed the four pieces with the Design Team, describing their intended use and messages.
1. Project Roadmap – 2013 monthly plan with design team, primary care practices, data, and other breakouts
2. Primary Care Practice Invitation – Overview invitation displaying why, what, how, hosting committee, and Carol as contact. Invitation will primarily be conducted with system level outreach.
3. Collaborative Agreement of Participation – Agreement for participants emphasizing prototype for reporting readiness and quality improvement.
4. Measures – Six Electronic Medical Record (EMR) National Quality Forum measures for the prototype and future measures’ options for composite diabetes and access to care non-EMR measures.
Table work groups were asked to discuss the pieces and respond to the question. Each table was asked to share with the entire Design Team their table’s discussion highlights and additional team wide reflections were made on a variety of points.
• Invitations and attachments
AHC will proceed on a two pronged invitation approach. 1. Meet with local health care systems’ leaders to invite their system to participate 2. Outreach to independent practices and all physician members of Central Ohio physician associations Invitation packages will be prepared using input from the Design Team and will include:
o Outreach “Why and What” page o Q/A page with descriptions and links
− Sharing/transparency (30 day window for preview, collaborative organizations ‘Terms of Use’)
− Measures (5 for adult practices, 2 for pediatric practices)
− Frequency (quarterly through 2014)
− Crosswalk to other requirements − Practice/Site level reporting (not
provider) − Data specifics (non-detailed, non-
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TOPIC NOTES ACTION ITEMS
o Suggest adding invitation clarity on ‘how is this different than the other reporting I do?’
o Suggest adding invitation clarity on the evolution of transparency, who and when will see reports
o For included measures, recommend cross-walking them to other requirements (e.g. PQRS, PCMH, ACO)
o Suggest including some physician champions in hosting o Suggest additional clarity on use of the reporting in the
invitation o Value, with data provided, reporting comes back o Consider and specify timing frequency, quarterly or even
monthly, practices can build into capabilities o Consider allowing for release timing to practice first o Offer additional learning with invitation, like webinar,
FAQs o Keep transparent only the site level reporting, physician
attribution even with EMR can be problematic • Measures
o Consider sharing the measures details with the invitation o Questions on Asthma detail definitions o Flu immunization, from other sources can pose difficulties
even if noted in EMR, sometimes not auto-retrievable, not always considered primary care improvement priority.
o Flu immunization measure can encourage pediatric practice participation
o Remember patient satisfaction in future measures • Other
o Can we encourage this with desired payer streamlining of required reporting?
o For quality improvement, more frequent timing keeps projects in view
Handout provided to capture written reflections (below).
PHI) o Live webinars and recorded webinar links
AHC will share Asthma e-measures specifications with design team
Closing and Next Steps
Future design team work sessions are tentatively scheduled for 6/4, 8/6, 10/8, and 12/10. General collaborative updates will also be provided.
AHC will share work session Record of Learning, revise action pieces, and proceed with project coordination.
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Design Team Principles –
1- Respecting all perspectives and grateful for team members’ time provided. 2- Project is getting team members’ perspective, not necessarily that of his or her organization. 3- Regardless of a team member’s primary care organization’s decision to share data with the project, team member is welcome to stay on the
design team.
Work Session A Handouts In light of Ohio receiving a State Innovation Model design grant, how should our local Primary Care Quality Reporting project
proceed with rapid prototyping? Reflections
Basic common measures are essential. CCF Area and Cincinnati but not Central Ohio? Really. Diabetes Don’t need to wait. Easy, common measures. For state, we believe this will help/better position for future success/application of additional grants. For the community, it will be valuable, whatever measures are selected, to see care variations vs. CLE and CIN. For those practices willing to participate, this can be a powerful feedback mechanism. Keep it simple to get it off the ground. Lessons learned will be in engaging PCPs to contribute to reporting not in deciding upon measures. Make it easy and reasonable. Must be focused on how this will get us to:
1. Continuous quality improvement. 2. Consistency among payers to financially reward/incentivize quality goals.
Need to start on small basic measures. Even the most basic measure has the potential to be done very differently from practice to practice. No need to wait for other areas to “perfect” this project. No reason to wait when others in the state have already started. PCMHs or transforming practices will have transparency-in-reporting capability, so system is already in place. Rapid prototyping model makes sense in light of future expansion of CMMI (possibility) similar to what is happening in Cincinnati. We should be ready for that. Think of how “we” as patients would want it. We will need to demonstrate the value of PCMHs and reporting is important in that regard. “You don’t know what you don’t know.”
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Work Session B Handouts
Do the roadmap and the action documents provide clarity on the proposed approach? Topic Reflections
1- Invitation explanation of plans, level Practice level reporting. 1- Invitation explanation of plans, level Will data be practice or physician level?
• Would practice be de-id in reports? • Is the project valuable if no one is identified?
1- Invitation explanation of plans, other Benchmarking data 1- Invitation explanation of plans, other Give the details
• What is being measured? • Flu shots in particular may be a problem.
1- Invitation explanation of plans, other Include “quality measures” page? Asthma measure—RX of appropriate meds—not use of appropriate meds.
1- Invitation explanation of plans, other Include metrics in the invite. 1- Invitation explanation of plans, other Probably need FAQs along with the introduction letter. 1- Invitation explanation of plans, other Will metric details be included with invitation—so PCPs know and can make decision to participate
or not. 1- Invitation explanation of plans, sharing De-ID the site? Physicians should be de-identified. 1- Invitation explanation of plans, sharing Do we need to ensure PCP—specific reporting is revealed to the PCP only, de-indentified to others
(maybe beta test and concept first) may not be feasible given SIM grant timeframe. 1- Invitation explanation of plans, sharing Does expectation of not sharing have to be managed? 1- Invitation explanation of plans, sharing How transparent will this be?
• By practice or by physician • Site or practice level easier to obtain than physician level.
1- Invitation explanation of plans, sharing Last meeting group felt strongly that info initially should only be reported back to the practices, not to other groups. Agreement would indicate otherwise, which could be threatening to participation. Maybe should indicate that non-providers would initially only get trend data (% for example, not provider-identified results)
1- Invitation explanation of plans, timing 45-60 day rolling window 1- Invitation explanation of plans, timing At a site level, avoids patient attribution. 1- Invitation explanation of plans, timing Frequency of data upload
• Yearly? • Monthly with quarterly refresh?
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1- Invitation explanation of plans, timing How frequent will you report? Quarterly may be most beneficial. 1- Invitation explanation of plans, timing How often will data need to be submitted? (monthly, quarterly, annually? Biannually?) 1- Invitation explanation of plans, timing Lag/Frequency 1- Invitation explanation of plans, timing Monthly or quarterly data frequency, 60 days past service date 1- Invitation explanation of plans, timing Potential for quarterly refresh. 1- Invitation explanation of plans, timing Timing
• Quarterly good • One private review would be good—call beta—may slow it, but keeps trust going (not as
slow as CIN 2 years) 1a- Invitation intros Add next steps: you can influence, CLE and CIN doing it. 1a- Invitation intros Appeal to ego—“Do you want to know how you stack up?” 1a- Invitation intros Could communicate you have an opportunity to help shape quality reporting. 1a- Invitation intros FAQ add to invite more context setting
• Webinar/video for added learning • Leadership discussion (some leaders would do both) • Should we have “release only after review” process for practices? (not 2 year delay) • Practice level or physician level… attribution issue. Only share with collaborative.
1a- Invitation intros Ground floor? Beta? 1a- Invitation intros Have additional learning opportunity (webinar) 1a- Invitation intros Have physician’s names on invitation. 1a- Invitation intros Is there a need to provide more context in invitation?
• MDs may not see unique value of project. • Include FAQs in invite.
1a- Invitation intros Play on MD’s competitive nature in the intro, almost marketing, “Do you know how you compare to your peers?”
1a- Invitation intros Webinar 1a- Invitation intros Would help to have MD leaders on the Quality Reporting Hosting Committee—PCMHs will recognize
those leaders vs MD associations. 1b- Invitation rationales Begin to use the data to support accurate benchmarking. 1b- Invitation rationales Focused reporting to promote meaningful evaluation to take to payer and show care improvement. 1b- Invitation rationales Make clear that this will be required in near future. 1b- Invitation rationales Need the WHY 1b- Invitation rationales Need to clarify why and how the info plays into ACO, meaningful use, NCQA PCMH report
requests—make it relevant.
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1b- Invitation rationales Need to make it clear the info can be used to improve the quality of care. 1b- Invitation rationales Payer consistency intent should be stressed 1b- Invitation rationales Peers – give that focus/make a wedge(sp) 1b- Invitation rationales Provide continual medium to evaluate care delivery. 1b- Invitation rationales Provider question—Why?
• How is this reporting any different than what I’m already doing? What is the added value? • Peer group, 2-way communication (not just one-way like other reporting already being
done) 1b- Invitation rationales Show how this lines up with other initiatives (crosswalk)
• Meaningful use, NCQF, PCMH, PQRS, CMS, ACOs • Need to be completed by 2015 to avoid penalties. • Build crosswalk to show we are not trying to create something new—this data will need to
be reported elsewhere in 2015. • This will help them be ahead of the game. • Take advantage of the help.
1b- Invitation rationales Used to promote more consistency of quality reporting measures across payers. 1b- Invitation rationales What gets measured gets done 1b- Invitation rationales Will create one report rather than one per health plan.
2- Participation Agreement Clarify the “will not use reports content to promote or publicize physician practices.” 2- Participation Agreement Named or masked? 2- Participation Agreement Was there a need to manage the no-advertising clause?
• Create a safe space without having to wait and build trust. • Have a timeline for release to broader group.
3- Measures Asthma meds—more details needed for docs? Can this be tied to avoiding ER usage?
3- Measures Consider rolled up measure reporting from systems 3- Measures Immunization measure needs additional review. 3- Measures Is flu shot a deal breaker?
Primary Care Quality Reporting Collaborative Project Design Team
Work Session
April 9, 2013
8:00-10:00 AM Longaberger Alumni House
Lead Support Major Support Additional Support
100% Access HealthColumbus
Board & Staff
Individual & Corporate Donations
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1. Discuss Project Design Team participation
principles, review local rapid prototype design. 2. Determine how project should proceed in light
of Ohio receiving a State Innovation Model design grant.
3. Provide clarity on actions for rapid 2013 prototype:
• Invitation • Participation agreement • Measures
Today’s objectives
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Today’s agenda
8:00 Welcome 8:10 Objectives, Design Team Principles, Project Review 8:20 Work Session A –
Consider local quality reporting in light of State Innovation Model grant
9:05 Work Session B – Project Roadmap Taking Action on the Rapid Prototype
•Primary Care Practice invitation •Collaborative Agreement of Participation •Measures
9:50 Next Steps, Closing
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1. Respecting all perspectives and grateful for team members’ time provided.
2. Project is getting team members’ perspective, not necessarily that of his or her organization.
3. Regardless of a team member’s primary care organization’s decision to share data with the project, team member is welcome to stay on the design team.
Design Team Principles
• Build a local rapid prototype in 2013
• Begin with an invitation to all Primary Care practices, include choice of determined measures
• Collect data and report semi-annually on National Quality Forum measures
• Use measures that reflect Central Ohio priorities that are aligned with the SW Ohio region’s Comprehensive Primary Care Initiative
• Measures – Participating practices can provide EMR data for six measures, Diabetes(3) , Asthma(1), Blood Pressure Control (1), Influenza Immunization(1) 4/9/2013
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Primary Care Quality Reporting 2013 Rapid Prototype Design
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11/9/2012 WHY & WHAT Begin Shaping Project Design (version 1.0)
2/1/2013 DESIGN
Finalize Project Prototype Design
(version 1.0)
2nd Qtr 2013 INVITE & ENROLL
Primary Care Practices invited to
share their data
3rd & 4th Qtrs 2013 BUILD & SHARE Local Prototype
Primary Care Quality Reporting built
Primary Care Quality Reporting Proposed Local Project Path
Work Session A – Consider local quality reporting in light of State Innovation Model grant
CMMI: Comprehensive Primary Care Initiative (CPCI)
Ohio & Kentucky: Cincinnati-Dayton Region • 75 Primary Care Practices • 261 Providers • 10 Payers • Estimated 44,500 Beneficiaries Served • Aetna CareSource (Ohio only), Centene Corporation (Ohio only),
Amerigroup (Ohio only), Anthem Blue Cross Blue Shield of Ohio, Humana, HealthSpan, Medical Mutual, Ohio Medicaid, UnitedHealthcare
7 regions • 500 primary care practices • 2,144 providers • 313,000 Medicare beneficiaries
Testing two models simultaneously: a service delivery model and a payment model
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1. Patient Experience-CG-CAHPS 2. Health/Functional Status 3. Prevention-Colorectal Screening 4. Prevention-Influenza
Immunization 5. Prevention-Tobacco
Assessment/Cessation Intervention
6. Prevention-Glaucoma Screening 7. Prevention-Mammography
Screening 8. Diabetes HbA1c Poor Control 9. Diabetes LDL Control 10. Diabetes Blood Pressure Control 11. Ischemic Vascular-Lipid Profile &
LDL Control 12. Hypertension-Blood Pressure
Control
13. Coronary Artery Disease-ACE or ARB for CAD+Diabetes and/or LVSD
14. Heart Failure-Beta Blocker Therapy for LVSD
15. Asthma-Use of Appropriate Asthma Medications
16. Children-Appropriate Treatment for Upper Respiratory Infections
17. Care Coordination-Risk-Std, All condition readmission
18. Care Coordination-COPD Admission Rate
19. Care Coordination-CHF Admission Rate
20. Future-Depression Screening 21. Future-Screening for fall risk
NATIONAL: brief list of the 21 adopted SW Ohio quality measures (from the National Quality Forum measures set)
CMMI: 2013 State Innovation Models Initiative nearly $300 million to support the development and testing
of state based models for multi-payer payment and health care delivery system transformation with the aim of improving health system performance
Testing (6) Pre-testing (3) Design (16)
1. Expand the capacity and availability of qualified medical homes to most Ohioans across Medicaid, Medicare, and commercially insured patients in a 3-5 year timeframe
2. Define and administer episode-based payments for a majority of acute medical events across Medicaid, Medicare, and commercially insured patients in a 3-5 year timeframe
SOURCE: State Innovation Model Design Grant Application, Ohio Office of Health Transformation, September 21, 2012.
Ohio’s State Innovation Model Design (4/13-10/13)
In coordination with Access HealthColumbus: Recognized PCMHs Emerging PCMHs Coordinated by others: Recognized PCMHs
SPREAD: Patient-Centered Medical Homes (PCMH)
230
175
1,205
0
200
400
600
800
1000
1200
RecognizedPCMH
Practitioners*
Total PrimaryCare
Practitioners(PCPs)**
Total PCPs
EmergingPCMHsRecognizedPCMHs
SPREAD: Patient-Centered Medical Homes (PCMH)
Sources * National Committee for Quality Assurance (NCQA) ** Practicing PCPs in Franklin County provided by Columbus Medical Association
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
450,000
500,000
Estimated Patients Served byPCMHs
Recognized PCMHs
Emerging PCMHs
In light of Ohio receiving a State Innovation Model design grant, how should our local Primary Care Quality Reporting project proceed with rapid prototyping?
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Work Session B – Project Roadmap Taking Action on the Rapid Prototype
• Primary Care Practice invitation • Collaborative Agreement of Participation • Measures
Taking Action on the Rapid Prototype – Primary Care Practice Invitation
Taking Action on the Rapid Prototype – Collaborative Agreement of Participation
Taking Action on the Rapid Prototype –Measures
Primary Care Quality Reporting – 2013 Rapid Prototype EMR Measures – A good place to start DRAFT
Domain NQF# Quality Measure Steward Clinical Process/Effectiveness
0059 Diabetes: Hemoglobin A1c Poor Control. Description: Percentage of patients 18-75 years of age with diabetes (type 1 or type 2) who had hemoglobin A1c > 9.0 %.
NCQA
Clinical Process/Effectiveness
0064
Diabetes: Low Density Lipoprotein (LDL) Management. Description: Percentage of patients 18–75 years of age with diabetes whose LDL-C was adequately controlled (<100 mg/dL) during the measurement period.
NCQA
Clinical Process/Effectiveness
0061
Diabetes: Blood Pressure Management. Description: Percentage of patients 18-75 years of age with diabetes (type 1 or 2) who had a blood pressure < 140/90.
NCQA
Clinical Process/Effectiveness
0036 Use of Appropriate Medications for Asthma. Description: Percentage of patients 5-50 years of age who were identified as having persistent asthma and were appropriately prescribed medication during the measurement period.
NCQA
Clinical Process/Effectiveness
0018 Controlling High Blood Pressure. Description: Percentage of patients 18-85 years of age who had a diagnosis of hypertension and whose blood pressure was adequately controlled (<140/90 mmHg) during the measurement period.
NCQA
Population/Public Health
0041 Preventive Care and Screening: Influenza Immunization. Description: Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization.
AMA-PCPI
Taking Action on the Rapid Prototype –Measures
Primary Care Quality Reporting – Parking Lot for Future Additional Measures DRAFT
Domain NQF# Quality Measure Steward
Composite Diabetes Options No eMeasure Available
0729 Composite Diabetes. Optimal Diabetes Care – five measures MN Comm Msmt
No eMeasure Available
0731 Composite Diabetes. Comprehensive Diabetes Care – ten measures NCQA
Will this be eMeasureable?
Not Composite Diabetes. PCQR 3a – A1c<8.0 (NQF#0575),LDL<100,BP<140/90 [note the A1c is from an additional measure]
na
Will this be eMeasureable?
Not Composite Diabetes. PCQR3b – Patients receiving all three tests (A1c, LDL, BP)
na
Access to Care Options Not from EMR Not Access to Care. Same Day Appointments -- Average percent of
appointments available at the beginning of each work day.
Not from EMR Not Access to Care. Continuity of Care – Percent of appointments in which patients were seen by their Physician/Clinician of Record.
Not from EMR Not NQF, IHI
Access to Care. Third Next Available – Average time between patient appointment request and the third available appointment for a physician (eliminates chance open occurrences)
IHI
Not from EMR Not NQF, IHI
Access to Care. Future Capacity – Percent of appointment slots that are open and available for booking over the next four weeks
IHI
Do the roadmap and the action documents provide clarity on the proposed approach?
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Primary Care Quality Reporting Collaborative Project Design Team
Work Session
April 9, 2013
8:00-10:00 AM Longaberger Alumni House
THANK YOU!
Lead Support Major Support Additional Support
100% Access HealthColumbus
Board & Staff
Individual & Corporate Donations
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