Accountable Care Clinical Quality Measures Subgroup

1. Accountable Care Clinical Quality Measures Subgroup August 20, 2013

2. Subgroup Members • Co-chairs: • Terry Cullen, Veteran’s Administration • Joe Kimura, Atrius Health • Members: • Helen Burstin, National Quality Forum • David Kendrick, Greater Tulsa Health Access Network • Ted von Glahn, Pacific Business Group on Health • Marc Overhage, Siemens Healthcare • Eva Powell, Evolent Health • Paul Tang, Palo Alto Medical Foundation • Sam VanNorman, Park Nicollet Health Services Office of the National Coordinator for Health Information Technology

3. Agenda 9:00 AM Introductions and overview of subgroup charge 9:10 AM Presentation of Potential Framework Janet Corrigan 9:25 AM Discussion by subgroup 10:00 AM Presentation on CMS Medicare Shared Savings Program John Pilotte 10:15 AM Subgroup member experiences 10:30 AM Discussion by subgroup 10:55 AM Public Comment 11:00 AM Adjourn Office of the National Coordinator for Health Information Technology

4. Charge • Within the next three to four months for the October/November HIT Policy Committee, 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. • These measures should be feasible to develop and implement in the next 2-3 years. In order to represent the various models by which patients currently receive care, a use case of Accountable Care Organizations (ACOs) will be developed showing how the recommendations on the domains, concepts, and infrastructure can be applied. Office of the National Coordinator for Health Information Technology

5. Charge cont. • Within the next 3-4 months, develop recommendations for how electronic clinical quality measure concepts and specific measures could be used in place of MU objective measures. The goal is to “deem” eligible providers (EPs) and eligible hospitals (EHs) as meaningful users through their ability to perform on quality outcomes. The HITPC would like this work group to give recommendations on specific quality measures that will demonstrate meaningful use of HIT. Office of the National Coordinator for Health Information Technology

6. Goals for this Call • Overview of potential frameworks and previous experiences with ACOs and Medicare Shared Savings Program • Develop preliminary framework for “high stakes” e-quality measurement for ACOs • Begin to identify known gaps in measurement for accountable care • Begin discussion on identifying measures for “deeming” (described in next slide) Office of the National Coordinator for Health Information Technology

7. Questions Specific to Deeming Charge • HIT-sensitive measures are ideal for deeming. • Which measures that currently exist in CMS programs are appropriate to use for deeming? (charge to QMWG) • Which measures in the pipeline for MU3 time frame are appropriate to use for deeming? (charge to ACO CQM WG) • What measure gaps exist, that could be filled in time for MU3, that are exemplars of HIT sensitive measures for deeming? (charge to ACO CQM WG) • Eligible professionals and group reporting (charge to ACO CQM WG) • 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

8. Presentation of Potential Framework Janet Corrigan Office of the National Coordinator for Health Information Technology

9. * Table 1 from A Framework For Accountable CareMeasures. Posted in Health Affairs blog by Richard Bankowitz, Christine Bechtel, Janet Corrigan, Susan D. DeVore, Elliott Fisher, and Gene Nelson on May 9, 2013.

10. Overview of Two Frameworks Office of the National Coordinator for Health Information Technology

11. Questions for Discussion • Accountable Care Framework • Are all the domains and subdomains of interest identified and appropriately named? • Would this framework be appropriate for a variety of population and value-based payment arrangements? • Does it get at longitudinal measures across settings and time? Office of the National Coordinator for Health Information Technology

12. Presentation on CMS Medicare Shared Savings Program (MSSP) John pilotte Office of the National Coordinator for Health Information Technology

13. Pioneer ACO Experience Performance Measurement Joe Kimura Office of the National Coordinator for Health Information Technology

14. Overview • Review of Pioneer Metrics • Patient Experience Metrics • Quality Metrics • Financial & Utilization Metrics • Summary of Metric Feedback • Operational Challenges of e-Metrics Office of the National Coordinator for Health Information Technology

15. Patient Experience Office of the National Coordinator for Health Information Technology

16. Quality Metrics Office of the National Coordinator for Health Information Technology

17. Quality Metrics Office of the National Coordinator for Health Information Technology

18. Financial & Utilization

19. Summary of Measure Feedback • General Issues Identified in High Stakes Measurement: • How metrics applied to assess improvement • Relative change to various benchmark and reference groups • Adjustment of PMPM & Utilization by Clinical Risk • Role of Fixed Cohort Measurement over Time • Operational Issues: • Measurement Specification Feedback • Variation in e-Metric from EMR implementation variation Office of the National Coordinator for Health Information Technology

20. E-Metric Specifications • eMetrics require detailed specifications • Encounter Type (Face to Face, Telephone, Email) • Provider Type (Billing Providers vs Team Members) • Problem Lists (Active vs Inactive) • Medication Lists (Historical vs Active) • Results (Patient vs Clinician vs Automated Results) • Differences in operational implementation leads to substantial variation in metric results – threat to the fairness of the metric in high stakes use. Office of the National Coordinator for Health Information Technology

21. E-Metrics example: Falls Assessment Office of the National Coordinator for Health Information Technology

22. Integration of Claims + EMR Data for Measurement (Diagnoses & Medications)

23. Questions for Discussion • For ACOs: • How can the experiences with MSSP and Pioneer ACOs inform a potential framework? • How can the framework be refined or interpreted to facilitate identification of e-measure concepts that matter and drive improvements in quality and efficiency? Office of the National Coordinator for Health Information Technology

24. Next Call • Finalize potential framework for ACOs • Presentation from CMS on current and future measure development work • Begin discussion on measure concepts needed to move forward • For ACOs • For “deeming” of eligible hospitals and providers Office of the National Coordinator for Health Information Technology