Accountable Care Quality Measures Subgroup

October 28, 2013

Office of the National Coordinator for Health Information Technology

2

Initial Charge to ACQM Subgroup

• Develop recommendations for the next generation of e-measure constructs that are patient-centered, longitudinal, cross settings of care where appropriate and address efficiency of care delivery. – Focus will be on the domains, concepts, and

infrastructure that can be applied to Accountable Care Organizations (ACOs).

Office of the National Coordinator for Health Information Technology

3

Expanded Charge

Overarching Charge to QM WG and ACQM Subgroup:• Develop recommendations for how electronic clinical quality measure

concepts and specific measures could be used in place of MU objective measures to “deem” eligible providers (EPs) and eligible hospitals (EHs) as meaningful users through their ability to perform on quality outcomes.

• HIT-sensitive outcome measures for EPs and EHs– What are the criteria and the potential framework for deeming?– Which measures that currently exist in CMS programs are appropriate to use for

deeming? • Eligible professionals and group reporting (still to be discussed)

– What parameters should be used for a group reporting option for MU overall (including deeming).

– If there is a group reporting option, how do you attribute a provider's membership in a group and his/her ability to receive incentives (or avoid penalties)?

Office of the National Coordinator for Health Information Technology

4

Goals for this Call

• Discuss and refine draft criteria developed by Quality Measure Workgroup and this subgroup

• Develop draft recommendations on the criteria and exemplars and any specific questions for HIT Policy Committee meeting on November 6

Office of the National Coordinator for Health Information Technology

5

Overarching Thoughts on Deeming

• Approach to deeming: – HIT-sensitive, outcome-oriented – Population focused (i.e., Million Hearts, disparities,

frail elderly)• Framework would support:– High or improved performance – Reduction in disparities– Encompass the aspects of the MU Stage 2 objectives

but does not need to map one-to-one– Patient-reported outcome measures

Office of the National Coordinator for Health Information Technology

6

Overarching Thoughts on Deeming cont.

• Health is the primary outcome• Several factors influence how the criteria are applied to a given

measure within ACOs:– Ability to define the population of focus– Accountability vs. reporting for organization– Operationalization of the measure– For example, some criteria may be more important or prioritized when

a measure is applied at a population level or for accountability purposes within an organization

• Currently exploring: – whether the criteria applies or is weighted equally – how to indicate that low ratings of some criteria reflect work that must

be accomplished to achieve the measure concept and overall goal

Office of the National Coordinator for Health Information Technology

7

Overarching Thoughts on Deeming cont.

• Infrastructure requirements to ensure successful implementation:– Will ensure success if pathway is developed– Determine if data exists today– If yes, develop into measures that best leverage

the data (may be from different data sets and not solely EHRs)

– If no, first develop data fields and followed by measures

Office of the National Coordinator for Health Information Technology

8

DRAFT ACO Framework

OVE

RALL

MEA

SURE

S

Office of the National Coordinator for Health Information Technology

9

Reframing our thinking

Currently Healthcare is the primary area of focus and where measures are available. In the future, it is hoped that there will be an increasing focus and availability of measures on Health.

Office of the National Coordinator for Health Information Technology

10

Accountable Care Population

(Total Patient Population)

Office of the National Coordinator for Health Information Technology

11

Criteria Discussion

• Criteria were discussed in parallel at the ACQM subgroup and the QM workgroup

• Attempts to reconcile criteria were limited by differences in level of analysis (population, ACO, EH, EP) and focus on accountability v. reporting.

• There is no expectation that all measures considered for deeming would meet all proposed criteria.

• Further efforts at prioritization/weighting will be required after input from the HIT Policy Committee.

Office of the National Coordinator for Health Information Technology

12

Current Iteration of the Combined Draft Criteria

Applies across EP, EH, and Populations:• Preference for eCQMs or measures that leverage data

from HIT systems (e.g., clinical decision support) • Enables patient-focused view of longitudinal care:

enables assessment of care over time from the patient’s perspective

• Supports health risk status assessment and outcomes: supports assessment of patient health risks that can be used for risk adjusting other measures and assessing change in outcomes to drive improvement

Office of the National Coordinator for Health Information Technology

13

Current Iteration of the Combined Draft Criteria cont.

May be more applicable at the population level or for accountability purposes:• Preference for reporting once across programs that

aggregate data reporting (e.g., PCMH, MSSP, HRRP, CAHPS)

• Applicable to populations: preference for measures that can be used to assess population health

• Benefit Outweighs Burden: Benefits of measuring & improving population health outweighs the burden of organizational data collection and implementation

14

Frail Elderly Exemplar with a Population Focus

Measure Prefer eCQM/Levera

ges HIT

Patient-focused View of

Longitudinal Care

Health Risk/Outcomes &

Improvement

Prefer Report Once

Applicable to Populations

Benefit Outweighs

Burden

PRO on Coordi-nation by System

High High High Low High Medium

Re-admission High High High Medium High High

Falls Rate Medium Medium Medium High Medium High

Pressure Ulcer Rate

Medium High Medium High High High

# Days Living in Com-munity

Medium High Medium Low High Medium

Total Cost of Care

High High High Medium High High

15

Frail Elderly Exemplar with an EP Focus

Measure Prefer eCQM/Levera

ges HIT

Patient-focused View of

Longitudinal Care

Health Risk/Outcomes &

Improvement

Prefer Report Once

Applicable to Populations

Benefit Outweighs

Burden

Screening for Future Fall Risk

High High Medium High Medium High

Use of High-risk Meds in the Elderly

High High High High Low High

CG-CAHPS Medium High Medium Medium High High

Closing the referral loop

High High Medium Medium High Medium

Re-admissions Low High High Low High High

Total Cost of Care

High High Medium Medium High High

Office of the National Coordinator for Health Information Technology

16

Questions for Discussion

– Are the draft criteria appropriate as outlined?– What addition or changes should be made?– Are the exemplars included appropriate and

aligned with the criteria?– Are there specific questions that should be posed

to the HIT Policy Committee?