Quality Reporting in the New Payment Models

Carol L. Henwood, DO, FACOFP dist.

Iowa Osteopathic Association 33rd Annual Winter Update

December 2014

COPD

CHF

SIADH

ESRD

HNPCCRA

NAFLD

HTNPVD

CAD

CMPY

GERD

BPHIBD

IBS

PE

PCMH

AHRQCMMI

PCPCC

MRANCQA

ACO

HEDISCG-CAHPS

5-STAR

Outcomes and Evaluations• Stating the Facts: Cost, Quality and Outcomes in the Medical Neighborhood

• PCMH Initiatives• 172 at onset

• 118 evaluated as had external payment reform support• 85% NCQA recognition• NO initiatives in MI, MS, UT, HI

• 56% Payment FFS + PMPM + P4P• Of 56%, shared savings 38%

• Multi-payor Initiatives2009 2013

• Min PMPM $0.50 $3.94• Max PMPM $9 $11.25

The Triple Aim• Improved Health•Enhanced Patient Experience of Care•Reduced Cost

[+1: Improved Productivity]

TEAM•Timely

•Evidence-based and Effective

•Accessible

•Measureable

HEDIS: Healthcare Effectiveness Data and Information Set

HEDIS Percentiles 2007 HEDIS Percentiles 2012

Breast Cancer Screening 49.1-69.9 66-79

Cervical Cancer Screening 65.7-81 73-79

Diabetes Care (HgbA1c<7) 30.2-45.8

Diabetes Care (HgbA1c>9) 35-23

BP Control (<140/90mmHg) 53.1-59.7 55-68

Pay for Performance (P4P)

•BETTER CARE FOR INDIVIDUALS Patient/Caregiver Experience

Care Coordination and Safety

•BETTER HEALTH FOR POPULATIONS Preventative Health

At Risk Population – Diabetes

At Risk Population – Hypertension

At Risk Population – Ischemic Vascular Disease

At Risk Population – Heart Failure

At Risk Population – Coronary Artery Disease

P4P phase in from reporting to performance

Methods of Reporting ClaimsSurvey

EHR Incentive Program Reporting

PQRS Web Interface

CAHPS Clinician and Group Surveys (CG-CAHPS)

Visit SurveyPCMH Item Set

Health Information Technology Item Set

Version 2.0• Items refer to “this provider” VS “this doctor”

• Items about access to care (urgent/non urgent) modified to ask could they get an appointment as soon as they needed VS as soon as they THOUGHT they needed

• Item asking about getting easy to understand instructions were modified from taking of health problems to health questions

• Item whether patient had seen a doctor of other health care provider 3 or more times for the same health condition was simplified to ask whether they got health care 3 or more times for the same health problem

Link to CAHPS Overview of Questions

• Rating of provider•Would recommend provider to family and friends•Demographics• Provider showed concern for patient’s physical comfort• Patient and provider talked about the cost of the prescription• Provider interrupted patient when patient was talking• Provider asked the patient what patient thought was best for patient

https://cahps.ahrq.gov/surveys-guidance/cg/instructions/index.html

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Moving ForwardPayment = FFS + P4P +

PCMH

ACOFP

ACOFP is proud to introduce ACOFP Quality Markers program!

Diabetes: Quality Reporting

Quality Improvement Reporting:All Diabetes Measures

Diabetes: LDL ReportingCare Opportunities: LDL Patients

Coronary Artery Disease: Quality Reporting

Quality Improvement Reporting:CAD: All Measures

Hypertension: Quality Reporting

Quality Improvement Reporting

Patient Care Summary