Accountable Care Clinical Quality Measures Subgroup

August 26, 2013

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Agenda

10:00 AMIntroductions and overview of previous call

10:10 AMPresentation of CMS eMeasure DevelopmentKate Goodrich

10:30 AMReview and discussion of preliminary analysis of example measures against the ACO Framework

10:45 AMDevelop preliminary framework and underlying principles for ACOs

11:15 AMBegin to discuss measure concepts needed

11:25 AM Public Comment

11:30 AM Adjourn

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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.

– focus will be on the domains, concepts, and infrastructure that can be applied to Accountable Care Organizations (ACOs).

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Charge cont.

• 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 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 ACQM Subgroup)– What measure gaps exist, that could be filled in time for MU3, that are exemplars of HIT

sensitive measures for deeming? (charge to ACQM Subgroup)

• Eligible professionals and group reporting (charge to ACQM Subgroup)– 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)?

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Goals for this Call

• Presentation from CMS on current and future eMeasure development work

• Finalize potential framework for ACOs• Begin discussion on measure

concepts needed to move forward– For ACOs– For “deeming” of eligible hospitals and

providers

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Summary of Last Call

• Presentations on potential ACO framework and experiences with Pioneer ACO and MSSP

• Received an overview of “deeming” and discussed reporting of the measures

• Began discussion on potential framework • Requested either examples of the MU measures or the full

list of the MU and ACO Pioneer measures under each domain and subdomain

• Agreed that the framework will also be examined to see how social determinants or other population-relevant factors could be seen as HIT-sensitive and ready for the MU program

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Summary of Last Call Cont.

• Measures should be:– Patient-centered – Population-centered– Community-centered

• From the operational perspective: – eMeasures must be able to pass the clinical "sniff test" at the

measure specification level. The titles of many metrics appear appropriate, but the specification does not capture reality well.

– eMeasures with specifications that do not pass the 'sniff-test' are challenging to operationalize at the PCP or microsystem level

– eMeasures with specifications that do not pass the 'sniff-test' and rely on significant organizational subjectivity are problematic when applied for high stakes comparisons.

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KATE GOODRICH

Presentation of CMS eMeasure Development

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PRELIMINARY ANALYSIS OF EMEASURES

Preliminary Analysis of eMeasures against the ACO Framework

Patient-Centered Measures of Value

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

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Questions for Discussion

• Accountable Care Framework–Would this framework be appropriate for

high stakes measurement?– Does it get at longitudinal measures

across settings and time?– Are all the domains and subdomains of

interest identified and appropriately named?

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Questions for Discussion cont.

• Accountable Care Framework– Are there underlying principles that

could be developed to ensure measures that are included in the framework are:• Parsimonious• Balanced across the domains• HIT-sensitive• Minimize operational burden• Others?

MEASURE CONCEPTS NEEDED TO MOVE FORWARD

Measure Concepts Needed to Move Forward

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NQF Report on Identifying Potential eMeasures

Defined measure criteria and a rating scheme to identify potential eMeasures for future implementation:

1. State of readiness: state of measure development and pipeline/endorsement status at NQF.

2. HIT-sensitive: evidence that measures built into EHR-systems with implementation of relevant HIT functions (e.g., clinical decision support) result in improved outcomes and/or clinical performance.

3. Promotes parsimony: measures applicable across multiple types of providers, care settings and conditions.

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NQF Report on Identifying Potential eMeasures Criteria Cont.

4. Preventable burden: evidence that measurement could support potential improvements in population health and reduce burden of illness.

5. Supports health risk status and outcomes assessment – supports assessment of patient health risks that can be used for risk adjusting other measures and assessing change in outcomes, including general cross-cutting measures of risk status and functional status and condition-specific measures.

6. Enables longitudinal measurement –enables assessment of a longitudinal condition- specific patient-focused episode of care.

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Questions for Discussion

– In which domains and subdomains should be measure development be prioritized?

–What criteria should be used to determine if a measure should be included for:• ACOs?• “Deeming” of eligible hospitals and

providers

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