Obtaining & Reporting Quality: Preventive Measures

Welcome

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Agenda

1. Introductions2. Housekeeping3. Presentation 4. Q & A5. Follow-up

• Final Webinar in Series: January 8• NAACOS’ Spring 2014 Conference will be on one of the

following dates, check back for more details soon • April 2-4 in Washington, DC or• April 23-25 in Baltimore

Housekeeping

1. Panelists will present for approximately 40 minutes2. Q&As will take the remainder of the hour

• Submit anonymous written questions using the Q/A tab (not chat) on dashboard

3. Webinar is being recorded• Slides and recording will be available at

www.NAACOS.com/webinars.

Today’s Presenters

Carrie Hagan, Coastal Carolina Health Care

Carrie Hagan is the associate administrator for Coastal Carolina Health Care and the associate executive director for CCQC. Ms. Hagan’s responsibilities include support of the work of the organization’s CEO focusing on the establishment and optimization of day-to-day operations in the organization. She plays active leadership role with senior leadership and management team. Ms. Hagan is responsible for establishing a measure of performance, quality improvement, cost controls and efficient utilization of resources.

Today’s Presenters

Sara Falkiewicz, ProHealth Solutions

Sara Falkiewicz is the director of performance excellence for ProHealth Care (health system) and ProHealth Solutions (ACO). Her responsibilities include measurement and monitoring and performance improvement functions for both organizations. Their departments provide all regulatory-required, publicly-reported and payor-driven data for the two organizations including areas like Core Measures, PQRI/PQRS and Meaningful Use, for over 450 physicians and 100 leaders. Ms. Falkiewicz develops key organizational metric sets and serves in a leadership role to drive the development and management of key data assets and business intelligence.

ACO Preventive Health Quality Measures

Carrie Hagan, MBA, CPC, CPCOCoastal Carolina Quality Care, Inc.

Introduction and Background

Carrie Hagan, MBA, CPC, CPCO, Six Sigma Green BeltAssociate Executive Director Coastal Carolina Quality Care, Inc.

• Internal Medicine• Family Practice• Emergency Medicine• Cardiology• Hematology/Oncology• Gastroenterology• Neurology• Pulmonary/CC

50+ Providers (60%

PCP)

12 Clinic Locations

• Imaging Center• Urgent Care• Sleep Lab• GI ASC

Integrated Enterprise-wide EHR

All Providers are Meaningful Users of EHR

Experience with Population Health Management and Reporting

ACO Background

• 100% Owned by Medical Practice• Reporting Period Started April 1, 2012• 11,000+ Attributed Beneficiaries• Advanced Payment Model ACO• Successfully reported 2012 ACO GPRO

Measures

ACO Preventive Health Quality Measures14. Influenza Immunization15. Pneumococcal Vaccination for Patients 65 Years and Older16. Body Mass Index Screening and Follow-up17. Tobacco Use: Screening and Cessation Intervention18. Screening for Clinical Depression and Follow-Up Plan19. Colorectal Cancer Screening20. Breast Cancer Screening21. Screening for High Blood Pressure and Follow-Up Documented

Quality Points and Weighting By DomainDomain Number of

Individual Measures

Total Measures for Scoring Purposes

Total Possible

Points Per Domain

Domain Weight

Patient/Caregiver Experience

7 1 measure with 6 survey module measures combined, plus 1 individual measure

4 25%

Care Coordination/Patient Safety

6 6 measures, plus the electronic health records measure double-weighted (4 pts.)

14 25%

Preventive Health 8 8 measures 16 25%

At-Risk Population 12 7 measures, including 5-component diabetes composite measure and 2-component coronary artery disease composite measure

14 25%

Total 33 23 48 100%

Quality Scoring Sliding ScaleACO Performance

LevelQuality Points (all measures except

EHR)

EHR Measure Quality Points

90+ percentile FFS/MA or 90+percent

2 points 4 points

80+ percentile FFS/MA or 80+percent

1.85 points 3.7 points

70+ percentile FFS/MA or 70+percent

1.7 points 3.4 points

60+ percentile FFS/MA or 60+percent

1.55 points 3.1 points

50+ percentile FFS/MA or 50+percent

1.4 points 2.8 points

40+ percentile FFS/MA or 40+percent

1.25 points 2.5 points

30+ percentile FFS/MA or 30+percent

1.10 points 2.2 points

<30 percentile FFS/MA or <30 percent

No points No points

Challenges of ACO GPRO Reporting• Competing Priorities• Dynamic Metrics• Patient Empanelment• Capabilities

Best Practices- What is the best way to eat an Elephant?

Doing What is Best for

Their Patients

Financial Incentives

Competitive Spirit

Sentinel Effect

What Motivates Physicians?

• While not Required, it is Extremely ImportantImplement Integrated Full Feature EHR

• Problems, Medications, Allergies, Labs, History, Etc.

Need Discrete Data Populated

• Need to Determine Who is AccountableAttribute Patients to Provider

• Medicare QIO• Measure Up Pressure Down

Begin Reporting Quality Measures

• What gets Measured get s ImprovedReport Measures Monthly

• Utilize Medicare Wellness Visit and Transition Care Management Payments to Fund Team Expansion

Utilize Team Approach

• It will Never be CompleteDon’t wait until Everything is Done

Operational Changes and Preparations

Develop Strategy and Structure for Reporting Quality Measures• Develop Purpose• Get Physician Leaders Involved• Establish Clear Measurable Objectives• Create Appropriate Incentives• Make Objectives Easy to Accomplish • Provide Doctors with Resources• Have Staff do as Much as Possible• Educate Everyone on Staff• Celebrate Small Successes and Praise Champions

Develop Strategy and Structure for Reporting Quality Measures• Elaborate systems and HIE are not required• Utilize team approach-Leverage IT, clinical Staff and coders• Use CMS provided Excel templates • Structured data in EHR helps• Some clinical data will need to be abstracted from unstructured notes• Claims data is very useful to determine where preventive services are

being performed to request reports and “backfill” data in to the EHR or paper record

• Be ready to start data collection January 13th, 2014 when CMS will provide your GPRO patient list

• Decide ahead of time whether you will be using XML upload or manually entry into GPRO WI tool

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EHR and Reporting Tools• Allscripts Enterprise E H R• Allscripts Clinical Quality• Actionable at Point-of-care (For all

contracts and populations) • Saves provider and staff time searching

thru chart• Easy to use and train• EHR serves as the main data repository

for the data• Can integrate with multiple EMRs

Allscripts CQS Patient Dashboard

CCQC Mammography Screening

IM 1 IM 2 FP 1 IM 3 FP 20.0%

20.0%

40.0%

60.0%

80.0%

100.0%

Apr 2012Nov 2013

Practice

Perc

enta

ge

CCQC CRC Screening

IM 1 IM 2 FP 1 IM 3 FP 20.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Apr 2012Nov 2013

Practice

Perc

enta

ge

CCQC Pneumococcal Vaccination

IM 1 IM 2 FP 1 IM 3 FP 20.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Apr 2012Nov 2013

Practice

Perc

enta

ge

CCQC Influenza Vaccination

IM 1 IM 2 FP 1 IM 3 FP 20.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

CCQC Influenza Vaccination

Apr 2012Nov 2013

Practice

Perc

enta

ge

Best Practices• Provide clinical and system resources

• Communication

• Train and educate everyone in the medical group on Quality Measures; key to success

• Provide hands on training to help staff input, review and coordinate measure reporting

• Promote Annual Wellness Visits for ACO patients

• Develop and Present monthly “scorecards” to create healthy competition among providers and staff

• Share best practices and lessons learned across clinical locations

• Decide ahead of time whether you are focusing on completion rates or measure performance- Oversampling Counts!

• Module Completion rates are calculated by successfully completing data on at least 411 patients

• Measure performance is calculated on data completed for all patients- Oversampling may increase measure rates

• 2013 GPRO is Pay for Reporting

Contact Information

Carrie Haganchagan@cchealthcare.com

Measurement and Improvement of Preventive Health Within an ACO

Sara Falkiewicz

Background• 475 Physicians, 121 Allied Health in ACO

– PCPs 31 percent (33% independent)– Specialists 69 percent (83% independent)– Independent 66 percent– Employed 34 percent– Allied Health Members 121

• Represent approximately 20 specialties– No Behavioral Health, Anesthesiology

• 50%/50% between Health System, IPA

Background• Health System

– 19 primary care and specialty clinics– 2 hospitals

• One medium size teaching hospital• One small community hospital

– Joint Ventures• Ambulatory Surgery Center• Rehabilitation Hospital of Wisconsin

– Continuum• Home Health, Hospice, Senior Center

Background• ProHealth Solutions

– Formed January 1, 2011– MSSP Program July 1, 2012– 15,000+ Attributed Beneficiaries

Preventive Metrics• Influenza• Pneumococcal• BMI and Blood Pressure

Screening/Follow Up• Tobacco Screening/Intervention• Colorectal and Breast Cancer • Depression Screening

Strategy and Structure to Report• Strong history of clinical reporting

– Health System Medical Group• Voluntarily submitting electronically gathered patient

level data to state collaborative (WCHQ) since 2006– Currently at 32 measures

• Immunization, tobacco, cancer screening

– Independent Physician Association• Measuring at a physician level since late 90’s in a manual

fashion– As of 2012 had been running almost 200 metrics

• Immunization, tobacco, cancer screening

PHS Information Technology Timeline

Secure electronic capabilities for each member practice

Secure comprehensive electronic capture of clinical and administrative data

Epic EMR, Patient Registries, Data Warehouse

Electronically connect members for population management and organization performance

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ObtainingData

• Started With:– Multiple EMR’s– 20+ Individual Billing Systems

• End With:– One monster warehouse– 83% of providers on Epic– Balance on other EMR or SharePoint

How to Report: Technical

How to Report: Literal

• Studied each measure specification• Identified impacted clinical workflows, and if

discrete data was available (or not)• Prioritized EMR documentation build projects

based on metric needs• Validation and test process for each metric• Engage physicians in reporting manually if

needed

Reporting Challenges• Immunizations

– Capturing out-of-clinic administrations– WIR – Wisconsin Immunization Registry

• BMI and Blood Pressure Screening/Follow Up– Doing the screening, couldn’t discretely capture the

follow up– SmartText in Epic

Reporting Challenges

• Colorectal and Breast Cancer Screening– Capturing out-of-ACO procedures– Accurate documentation of exclusions

• Mastectomies, Colostomies

• Depression Screening– Had to identify a single tool– Rolling out in primary care, adding to rooming

process

Reporting Challenges

• Physician assignment– Specialty versus primary care: “actionable”– Movement of physicians in and out of ACO

• Resources and Organizational “Breadth”– Preparation for ICD-10– Meaningful Use quality measures– Increase in commercial payor metrics– Pressure from specialists for metrics more applicable

to their practice

Strategy and Structure to Improve

• Develop a shared vision– Education

• Measure definitions• Documentation requirements• Supporting clinical evidence

Strategy and Structure to Improve• Mobilize

– During visit activity• Utilize medical record decision support

– Due date calendar– Easy-to-access orders

• Scheduling of testing outlined in care plan and next steps for patient

– Outside of visit activity• Searching charts for old or incorrectly documented testing• Telephone, letter, and patient portal outreach

communication

Strategy and Structure to Improve• Monitor

– Monthly data provided to leaders and clinicians

• Overall rate, numerator and denominator• Patient-level detail on patients missing care or

documentation

Monitoring Tool: Visual Reports

Thank You For Your Time!

Questions?

Submit anonymous written questions using the Q/A tab (not chat) on dashboard

If you did not have a chance to ask a question today or have new questions, please send to info@naacos.com.

Speaker Emails

Carrie Hagan, Coastal Carolina Health CareEmail: chagan@cchealthcare.com

Sara Falkiewicz, ProHealth SolutionsEmail: sara.falkiewicz@phci.org

Upcoming

• The final webinar in this series is Wednesday, January 8 at 1:00pm ET. The title for the next webinar is: Obtaining & Reporting Quality, At-Risk Measures. The speakers are Jeff Farber and Jill Kalman, Mount Sinai Medical Center.

• Slides and recording of today’s webinar will be posted on our website, www.NAACOS.com/webinar by tomorrow.

• Watch our website for information about the 2014 Spring Conference and our next webinar series coming soon!

Thank You!

Thank you for attending today’s webinar!

Consider joining NAACOS

The ACO and Business Partner applications can be found at www.NAACOS.com