Measuring Quality and Value Keys to Reducing Disparities

1. Measuring Quality and Value Keys to Reducing Disparities Janet M. Corrigan, PhD President and CEO National Quality Forum

2. 2D Framework for Measure Development • Cross-cutting National Priorities • Population health, safety, care coordination, patient/family engagement, palliative care, overuse • Patient Focused Episodes • Top 20 Medicare Conditions • Supplemented by Conditions for <65

3. National Priorities—Key Cross Population health - Key preventive services - Healthy lifestyle behaviors Safety Hospital-level mortality rates Serious adverse events Healthcare-Acquired Infections Care Coordination Medication reconciliation Preventable hospital readmissions Preventable emergency department visits Patient/family engagement Informed decision-making Patient experience of care Patient self-management Palliative Care Relief of physical symptoms Help with psychological, social and spiritual needs Communication regarding treatment options, prognosis Access to palliative care services Overuse 9 major areas 3

4. National Priorities: Overuse Goals • Inappropriate medication use • Unnecessary lab tests • Unwarranted maternity care interventions • Unwarranted diagnostic procedures • Unwarranted procedures • Unnecessary consultations • Preventable ED visits and hospitalizations • Inappropriate end of life care • Non-beneficial preventive services

5. National Priorities Partnership

6. Prioritized Medicare Conditions • Major depression • CHF • IHD • Diabetes • Stroke/TIA • Alzheimer’s dx • Breast CA • COPD • AMI • Colorectal CA • Hip/pelvic fracture • Chronic renal dx • Prostate CA • Rheumatoid & osteoarthritis • Atrial fibrillation • Lung CA • Cataract • Osteoporosis • Glaucoma • Endometrial CA

7. Post AMI Trajectory 1 (T1) • Relatively healthy adult • Focus on: • Secondary prevention • Quality of Life • Functional Status • Advanced care planning Patient & Family Engagement Care Coordination Population Health 10 Prevention 20 Prevention (CAD with prior AMI) Post Acute/Rehabilitation Phase Acute Phase 20 Prevention • Post AMI Trajectory 2 (T2) • Adult with multiple co-morbidities • Focus on: • Palliative Care • Functional Status • Advanced Care Planning PHASE 3 PHASE 2 PHASE 4 PHASE 1 Getting Better Staying Healthy Living w/ Illness/Disability (T1) Coping w/ End of Life (T2) Population Health Palliative/End of Life Care Overuse Episode begins – onset of symptoms Episode ends – 1 year post AMI Safety 2-D Measurement Framework: AMI Episode

8. Key Measurement Domains to Get at Value • Patient-level outcomes (better health) • Morbidity and mortality • Functional status • Health-related quality of life • Patient experience of care • Processes of care (better care) • Technical • Care coordination and transitions • Alignment with patients’ preferences • Resource use (lower cost) • Total cost of care across the episode • Indirect costs • Appropriateness measures targeting “overused” services