Setting National Priorities: Leveraging Our Collective Efforts

1. Setting National Priorities:Leveraging Our Collective Efforts Janet M. Corrigan, PhD, MBA President and CEO National Quality Forum

2. National Quality Forum: FASB For Healthcare • Established in 1999 • Non-profit • Multi-stakeholder membership organization • Voluntary, consensus standard setting organization

3. DRAFT: Quality Alliance Steering Committee Document National Framework for Quality and Cost Transparency for High-Value Care AHRQ Foundations Other NQF National Priorities Partners* NCQA The Joint Commission AMA PCPI Medical Societies Medical Specialty Boards CMS AHRQ Others** Set national priorities and goals to drive improvement and affordability Continuously evaluate health and health care QIOs Regional Collaboratives Providers Oversight Organizations Employers Health Plans Improve quality and reduce waste Consumer Outcomes High Quality Equitable Affordable Patient-Centered Develop and test evidence-based measures Establish effective public policies, payment policies, and consumer incentives to reward or foster better performance Fed/State Govt Health Plans Employers Consumers Providers NQF Endorse and maintain measures and incorporate specifications into EHRs Develop coordinated and streamlined implementation strategies: prioritization, timelines, and process solutions Generate public reports on quality and cost Aggregate data and pilot test and validate standard performance information QASC Quality Alliances Joint Commission NCQA Medical Specialty Boards Regional Collaboratives Fed/State Govt. Health Plans Others QASC Regional Collaboratives RHIOs/HIEs CMS States Health Data Stewards *List of all involved partners available. ** Nursing, Academic Commnities, etc.

4. Growth in the Number of Endorsed Measures

5. Not everything that counts can be counted, and not everything that can be counted counts. Albert Einstein

6. NQF New Mission Statement To improve the quality of American healthcare by • setting national priorities and goals for performance improvement, • endorsing national consensus standards for measuring and publicly reporting on performance, and • promoting the attainment of national goals through education and outreach programs.

7. Why set national priorities? • Current state of performance measurement is cacophony of well-meaning but uncoordinated signals • National priorities will help to align strategies of “multiple groups” around common goals for improvement • Drive fundamental change in delivery system!

8. NQF National Priorities Partnership:Leveraging Our Collective Efforts • 27 national organizations (see appendix) • Co-chaired: • Don Berwick, IHI • Margaret O’Kane, NCQA

9. Preliminary Priority Areas • HAIs – Peter Lee(PBGH) • System level measure of infection rates in high risk areas • Population health – George Isham(HealthPartners) • Index of key preventive services • Overuse – Bernie Rosof (PCPI) • Engage specialty societies and focus on a process for identifying overuse across all specialties. • Avoidable Harms • Hospital-level mortality rates – Carolyn Clancy (AHRQ) • Serious adverse events – Helen Darling (NBGH)

10. Preliminary Priority Areas • Continuity of Care – • Care coordination and linkages - David Stevens (NACHC) • Medication reconciliation – Linda Stierle (ANA) • Patient/family engagement – Debra Ness (NPWF) • Shared decision-making • Patient activation • End of life/palliative care - Chris Cassell (ABIM) • Cancer care & beyond (i.e. multiple chronic conditions) • Reliable and effective care management of chronic/acute episodes • Focus initially on AMI, LBP, Cancer, and Diabetes from NQF Pilots

11. Next Steps – Priority Partners • February 2008 – • Workgroups begin to fine tune priority areas and identify measurement gaps • March 2008 – • List of priority areas sent out for public comment • June 2008 – • Workgroups identify measures and practices needed for priority area action plans

12. Focusing Measurement on Extended Episodes • NQF “skunk works” Pilot Project: Comprehensive Measurement Framework for Extended Episodes

13. NQF “Skunk Works” Project • Charge: Develop a comprehensive measurement framework for extended health care episodes • Co-chaired: Elliott Fisher (Dartmouth) and Kevin Weiss (ABMS) • Generic framework adapted to specific conditions

14. Rationale: Extended Episodes of Care • Patient-focused way of thinking • Follows the natural trajectory of care • Directed at value • Quality, costs & patient preferences • Addresses care coordination • Care transitions & hand-offs • Needed to support fundamental payment reform

15. Episode Framework AppliedLow Back Pain Episode • Trajectory 1 (T1) Returning back to work & assuming normal activities of daily living • Focus on: • Quality of Life • Functional Status • Patient-generated goals • Education & prevention of future episodes Diagnosis & Initial Management

16. Episode FrameworkApplied to AMI • Post AMI Trajectory I (T1) • Relatively healthy adult • Focus on: • Quality of Life • Functional Status • 20 Prevention Strategies • Rehabilitation • Advanced care planning • Population at Risk • 10 Prevention • (no known CAD) • 20 Prevention • (CAD no prior AMI) Episode ends – 1 year post AMI

17. NQF Care Coordination Framework • Healthcare “Home” • Proactive Plan of Care and Follow-up • Communication • Information Systems • Transitions or Hand-offs

18. Shift to Composite Measures • More understandable to patients and consumers • Reflects the comprehensive nature of care and potentially more patient centric • More oriented toward outcomes improvement • Drives multi-faceted improvement strategies • Provides enhanced ability to differentiate between/among different levels of care

19. Moving Towards Outcomes Measurement • Slowly growing numbers of morbidity and mortality measures for certain conditions/procedures • Very limited set of measures that address health-related quality of life and functional status • Ongoing concerns regarding risk adjustment for outcomes

20. Additional Information Please contact: Janet Corrigan, PhD President and CEO corrigan@qualityforum.org Karen Adams, PhD Vice President, National Priorities kadams@qualityforum.org Helen Burstin, MD, MPH Senior Vice President, Performance Measures hburstin@qualityforum.org

21. APPENDIX

22. NATIONAL PRIORITIES PARTNERS PARTICIPATING ORGANIZATIONS

23. CONSUMERS • National Partnership for Women and Families • Consumers Union • AARP • AFL-CIO

24. PURCHASERS • National Business Group on Health • The Leapfrog Group • Pacific Business Group on Health • Chamber of Commerce

25. QUALITY ALLIANCES • AQA • Hospital Quality Alliance • Quality Alliance Steering Committee • Alliance for Pediatric Quality

26. HEALTH PROFESSIONALS/PROVIDERS • AMA’s Physician Consortium for Performance Improvement • American Nurses Association • American Board of Medical Specialties • National Association of Community Health Centers

27. ACCREDITATION/CERTIFICATION • Joint Commission • National Committee for Quality Assurance • Certification Commission for Healthcare Information Technology

28. PUBLIC SECTOR ORGANIZATIONS • Centers for Disease Control and Prevention • Centers for Medicare and Medicaid Services • Agency for Healthcare Research and Quality • National Institutes of Health • National Governors Association

29. INSURERS & OTHER PRIVATE SECTOR • America’s Health Insurance Plans • Institute for Healthcare Improvement • Institute of Medicine