NAIIS Quality and Performance Measures Working Group Update
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1 NAIIS Quality and Performance Measures Working Group Update 2015 National Adult and Influenza Immunization Summit May 13, 2015 Working Group Members Alemu, Girma HRSA Alexander, Alison Oregon State Health Department Arthur, Phyllis BIO Baskin, Andrew AHIP Bricco, Angie Sanofi Pasteur Bridges, Carolyn CDC Byron, Sepheen NCQA Capppio, Kelly BIO Carrillo, Jorge D. DoD Chi, Alison AIRA Correa-De-Araujo, Rosaly NIH Dean, Anna K. CDC ORISE Fellow Dunlap, Mary Anne Sanofi Pasteur Farrall, Susan CDC Fortuna, Joseph PRISM Gandhi, Nisha CA Department of Public Health Garcia, Nancy TX Department of State Health Serv Geevarughese, Anita NYC Department of Health Gehring, Rebecca ACP Gellin, Bruce NVPO Graitcer, Sam CDC Groom, Amy* IHS Hall, Cynthia Emory Healthcare Hance, Mary Beth E. CMS Hirsch, Pamela VA Hopkins, Robert ACP Kalayil, Elizabeth CDC Kelman, Jeffrey CMS Kennedy, Erin CDC Kim, David* CDC Knighton, Troy VA Lance, Trang VA Lantos, Paul Duke University Lesher, Michele GSK Lindley, Megan CDC Luta, Martin DE Health and Social Services Moy, Ernest* AHRQ Pittman, Kathleen VA Reavey, Tara DoD Rodríguez, Andrés IDSA Shurtliff, Carlie UT Department of Health Slaughter, Natalie AHIP Snow, Vincenza (Vinnie) Pfizer Sommer, Sandra VA Department of Health Sprenger, Sharon Joint Commission Stolpe, Samuel PQA Southerland, Shiree CMS Tan, Litjen IAC Vassell, Barbara TX Department of State Health Serv Weiser, Thomas IHS Winkler, Reva NQF Woods, LaDora Carter Consulting - CDC *Co-chair 2 Natl Adult and Influenza Immunization Summit 5/13/2015 1
2 Outline Primer on quality measures Priorities Activities Updates on composite measure work by IHS Updates on maternal and end-stage renal disease immunization composite measure development Future activities and plans 3 Why are measures important? Serve as qualitative tool Inform improvements to patient experience Inform purchaser and consumer decisions Element of accreditation and/or certification Public reporting reaching more provider segments Increasing payment impact (private and public) Pay for reporting Pay for performance 4 Natl Adult and Influenza Immunization Summit 5/13/2015 2
3 Why are measures challenging? Various public and private quality reporting programs are not fully integrated Data collection difficult due to variety of immunization administration settings Findings on impact of quality measurement and reporting on outcomes sometimes unclear Few outcomes measures available, often measuring structure or process Quality measurement and reporting remain administratively burdensome Difficult for smaller providers Payment impact reaching different provider segments at different times 5 Working Group Priorities and Activities Presented at NAIIS Meeting, May Support and advise HHS in the mapping of adult immunization measurement processes and practices, including the pre-rulemaking and MAP (Measure Applications Partnership) process 2. Provide Summit Quality WG partners information to act on immunization quality engagement opportunities 3. Support and advise HHS and other stakeholders on harmonization and alignment of adult immunization measures across various public and private initiatives 4. Developed adult immunization dashboard to track and use to improve vaccination rates WG briefed by members involved in MAP, and invited to provide input to MAP process WG facilitated improved interaction and communication among adult immunization and national quality organization stakeholder communities WG participation by wide breadth of stakeholders ensured group consensus decisions had strong base of support Several WG members recruited to participate in providing input to current NQF project to address performance measure gaps in adult immunization IHS and VA project to test feasibility of implementing an adult immunization composite measure HHS agencies collaborating to design and implement a dashboard for tracking of adult vaccination rates 7 Natl Adult and Influenza Immunization Summit 5/13/2015 3
4 National Quality Forum Report Priority setting for healthcare performance Measurement: Addressing Performance Measure Gaps for Adult Immunizations August NQF Adult Immunization Measurements HHS contract with NQF, multistakeholder committee Identify, prioritize measure gaps for adult immunization Provide recommendations on priorities for performance measurement Agreed on 10 measure gap priorities 8 Natl Adult and Influenza Immunization Summit 5/13/2015 4
5 Priorities for Measure Development 9 Composite Measure Priorities Composite including immunization with other preventive care services as recommended by age and gender Composite (Tdap, influenza vaccination) for pregnant women Composite (influenza, pneumococcal, hepatitis B vaccination) for diabetes Composite (influenza, pneumococcal, hepatitis B vaccinations) for end-stage renal disease (ESRD) Composite (hepatitis A and B vaccinations) for chronic liver disease Composite of all ACIP-recommended vaccinations for healthcare personnel 10 Natl Adult and Influenza Immunization Summit 5/13/2015 5
6 Composite Measures NQF Committee s overarching recommendations to development of composite measures Single score to help drive performance Often are easier for policymakers to understand Should be able to extrapolate data from each component of composite measure Measure should be actionable to component level by creating a feedback loop Harmonization of existing measures a crucial first step NQF provided priorities, but did not define measures Working group identified 2 composite measures to develop 11 Composite Measure Teams Maternal Immunization Short-Term NQF Priority ESRD Immunization Identified by NQF as Priority Measurement 2 for 1 Long-term with little change in enrollment Data source, end user - ACOG, AAFP - IHS - Maternal care payers Members - Girma Alemu, HRSA - Carolyn Aoyama, IHS - Carolyn Bridges, CDC - Anita Geevarughese, NYC HD - Cheyenne Jim, IHS - David Kim, CDC - Megan Lindley*, CDC - Len Silverstein, GSK - Sandra Sommer*, VA HD - LJ Tan*, IAC Data source, end user - CMS - Dialysis service providers Members - David Kim, CDC - Ernest Moy*, AHRQ - Shiree Southerland, CMS - Sam Stolpe*, PQA - Andrew Trofa, GSK *Member of the Adult Immunization Committee, Priority Setting for Healthcare Performance Measurement: Addressing Performance Measure Gaps for Adult Immunizations, Final Report, August 15, 2014, National Quality Forum 12 Natl Adult and Influenza Immunization Summit 5/13/2015 6
7 Developing Composite Measures: IHS 2014 Developed and validated logic for an adult composite measure Implemented as developmental performance measure 2015 Evaluation of usefulness of adult composite measure as a QI tool Development of maternal immunization performance indicator Proportion of pregnant women who received influenza, Tdap, and influenza+tdap vaccines Implementation slated for FY2016 Challenges Identifying pregnant women Identifying administration of vaccine(s) during pregnancy 13 Identifying trimester Developing Composite Measures ESRD Immunization Composite Measure Team Reach out to renal physicians/organizations, dialysis service providers, parts of CMS that manage quality metrics and data on dialysis facilities Collect information on existing measures Gauge interest in developing composite measure Maternal Immunization Composite Measure Team Reach out to ob/gyn s/acog, AAFP, maternal care payers Learn about existing measures Gauge interest in developing composite measure 14 Natl Adult and Influenza Immunization Summit 5/13/2015 7
8 Composite Measure Team Activities Maternal Immunization Identify existing measures - Coverage - Useful/meaningful - Actionable feedback Identify sources of data - Completeness - Gaps and disparities - Data access (proprietary or not) Identify end-user - Level: provider, practice, system - Accountability Who else is working on developing composite measure? - IHS ESRD Immunization Identify existing measures - Coverage - Useful/meaningful - Actionable feedback Identify sources of data - Completeness - Gaps and disparities - Data access (proprietary or not) Identify end-user - Level: provider, practice, system - Accountability Who else is working on developing composite measure? -?? 15 Natl Adult and Influenza Immunization Summit 5/13/2015 8
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