Edward Jones, MD KCP Chairman Gail Wick, MHSA, BSN, RN, CNN Allen Nissenson, MD

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2 Re-launching KCQA Edward Jones, MD KCP Chairman Gail Wick, MHSA, BSN, RN, CNN Allen Nissenson, MD

3 ABOUT KCP Re-launching KCQA Founded in May 2003 Voice of the entire kidney care community Patients and patient advocates Dialysis facilities and providers Physicians and nurses Pharmaceutical and device manufacturers Our mission is to ensure Chronic kidney disease (CKD) patients receive optimal care; CKD patients are able to live quality lives; Dialysis care is readily accessible to all those in need; and Research and development lead to enhanced therapies and innovative products.

4 Re-launching KCQA KCP S QUALITY INITIATIVES Kidney Care Quality Alliance to develop and test performance measures for NQF endorsement Voluntary goals initiative Performance Accountability in Kidney Care (PEAK) to reduce first-year mortality: 14.5% reduction in first-year mortality as of June 2013 Strategic Blueprint to provide a roadmap on the key actions that, if undertaken through collaboration and partnership, can significantly improve kidney care quality

5 Re-launching KCQA STRATEGIC BLUEPRINT OVERVIEW Despite community-wide improvements, KCP felt kidney care quality would benefit from a strategic blueprint that identified essential areas for improvement Project launched in early 2013 and overseen by the Blueprint Steering Committee Multi-stakeholder consensus report Literature review Semi-structured interviews of KCP members In-person Blueprint Summit Internal review External review by six experts in kidney care and/or care quality

6 Re-launching KCQA OVERVIEW (cont.) KCP s vision is a comprehensive, core set of strategic recommendations Key components: Comprehensive list of domains and subdomains to improve kidney care quality nine primary domains, several with multiple subdomains Goals for kidney care quality Transformation drivers effective mechanisms that can drive change in the health care system Strategic opportunities key recommendations that can significantly improve care quality Identifying key barriers to success within each domain and driver of transformation.

7 GOALS FOR ADVANCING KIDNEY CARE QUALITY Re-launching KCQA Goals for kidney care quality are: Improved survival; Reduced hospitalizations; Improved quality of life; and Improved patient experience with care.

8 KCP Blueprint Domains and Subdomains DOMAINS FOR KIDNEY CARE QUALITY CARE COORDINATION * Care Transitions Integrated Care Medication Management Rehospitalizations DISEASE MANAGEMENT Adequacy Anemia Bone Mineral Metabolism Comorbidities Management (e.g., diabetes, PVD, CVD) Renal Replacement Modality Selection Fluid Management Immunization Nutrition Vascular Access INFRASTRUCTURE Care Models HIE/Data Coordination New Technology: HIT New Technology: Device/Machine New Technology: Pharmaceuticals Telehealth/Medicine Workforce PALLIATIVE & END-OF-LIFE CARE PATIENT ENGAGEMENT AND EDUCATION Adherence to Dialysis Rx, Medications, Diet, etc. CKD Stage 4 Pre-Dialysis Education Dialysis Patient Education Frequency and Duration of Dialysis Modality Options Selection Nutrition PATIENT SATISFACTION AND PATIENT EXPERIENCE WITH CARE PEDIATRIC-SPECIFIC ISSUES QUALITY OF LIFE Depression Functional Status Rehabilitation and Employment Transplantation Referral and Access SAFETY Adverse Events Healthcare-Associated Infections *Including care coordination for Acute Kidney Injury

9 TRANSFORMATION Re-launching DRIVERS KCQA FOR ADVANCING KIDNEY CARE QUALITY Drivers to transform care are: Quality Incentive Program (payment and public reporting) Internal quality improvement Research Policy System innovation

10 Improved survival, lower hospitalizations, improved quality of life, improved patient experience with care

11 STRATEGIC OPPORTUNITIES: QIP Re-launching KCQA KCP has supported the overall intent of the QIP, but supports improving it in four areas the measure development process; measure harmonization; inclusion of arteriovenous grafts in the QIP; and careful deployment and improvement of ICH CAHPS to make a marked difference in achieving the four goals.

12 STRATEGIC OPPORTUNITIES: IQI KCP recognizes that internal quality improvement (IQI) activities such as deploying standardized protocols, identifying and disseminating best practices, and benchmarking are highly effective drivers of improving care. KCP recommends IQI activities focus on: Vascular access Incident patients Modality choice Fluid management Nutrition management Patient comprehension Patient experience with care Care coordination and care transition Infections Co-morbidities management Depression Staff engagement Medication management End-of-life care

13 STRATEGIC OPPORTUNITIES: RESEARCH Re-launching KCQA Research is essential to improving the quality of care for patients with kidney disease. KCP recommends priority be placed on research related to: bone mineral metabolism and the QIP fluid management reducing rehospitalizations reducing sudden death patient communication tools quality of life assessment and patient engagement

14 STRATEGIC Re-launching OPPORTUNITIES: KCQA SYSTEM INNOVATION System innovation can transform quality of care. KCP recommends focusing on: integrated care alternative dialysis strategies

15 STRATEGIC OPPORTUNITIES: POLICY Re-launching KCQA Federal policy is a significant driver of health care quality, especially for kidney care. KCP recommends that federal policies: support the advancement of quality in the delivery of care to patients with kidney disease provide incentive payments be incorporated into the QIP encourage health information exchange and health information technology for dialysis care incorporate a new technology adjustment that is not budget neutral permit dialysis facilities to be reimbursed for providing education for pre-esrd patients

16 SUMMARY AND WHAT S NEXT Re-launching KCQA A Strategic Blueprint for Advancing Kidney Care Quality Multi-stakeholder, consensus document intended to provide a near-term roadmap of key actions that, if undertaken through collaboration and partnership, can significantly improve kidney care quality Strategic, not tactical, document a guidepost for public and private sector stakeholders to expand upon and/or identify their own priorities KCP s immediate implementation will focus on measure development through KCQA i.e., prioritizing the potential measurement areas and then developing, specifying, and testing 1-2 measures in one domain

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