Provider Perspective of Quality Measurement

Provider Perspective of Quality Measurement

The American Medical Group Association supports its members in enhancing population health and care for patients through integrated systems of care

Improve patient experience Reduce per capita cost Improve health of populations

Move to Provider Risk Fee for Service Episode Bundled Payments Global Budget Medical Home P4P ACO with shared savings/losses Provider Risk Health Plan/Employer Risk

A Patient with Heart Failure PCP PCP PCP Medical Home P4P PCP Januar y Lab Meds Rad Global Payment Meds Meds Meds Cardiologist Echo ED visit Hospital Admission Lab Cardiologist Procedure Rad Meds Episode Bundle Payment Hospital Admission Home Health December

Percent of Total Cost Source: Centers for Medicare and Medicaid Services. Chronic Conditions among Medicare Beneficiaries, Chart book: 2012 Edition Baltimore, MD. 2012.

Improve patient experience Reduce per capita cost Improve health of populations

Quality Hurdle

Pioneer ACO Quality Measures Patient & Caregiver Experience 1. Timely care, appointments, and information 2. How well your doctor communicates 3. Patients rating of doctor 4. Access to specialists 5. Health promotion and education 6. Shared decision making 7. Health status/functional status Preventative Health 14. Influenza immunization 15. Pneumoccal vaccination 16. Adult weight screening and follow-up 17. Tobacco use assessment and tobacco cessation intervention 18. Depression screening 19. Colorectal cancer screening 20. Mammography screening 21. Proportion of adults 18+ who had blood pressure measured in preceding 2 years Care Coordination & Patient Safety 8. Risk standardized, all cause readmission 9. Ambulatory Care Sensitive Admissions COPD 10. Ambulatory Care Sensitive Admissions--CHF 11. Percent of PCPs who qualify for EHR incentive 12. Medication reconciliation after discharge 13. Screening for falls risk At Risk Populations 22. Diabetes Composite A1C< 8 23. Diabetes Composite LDL < 100 24. Diabetes Composite BP<140/90 25. Diabetes Composite Tobacco non-use 26. Diabetes Composite ASA Use 27. Diabetes A1C poor control (>9) 28. HTN blood pressure control 29. Ischemic Vascular Disease (IVD) LDL<100 30. IVD use of ASA or other antithrombotic 31. Heart failure beta blocker for LVSD 32. Coronary artery disease composite--drug therapy for lowering LDL 33. Coronary artery disease composite--ace or ARB for CAD patient with diabetes and/or LVSD

Blue Cross Blue Shield of Massachusetts Depression Acute-phase Rx Continuation-phase Rx Diabetes HbA1c testing Eye exams Nephropathy screening Cholesterol management Diabetes LDL-C screening Cardiovascular LDL-C screening Preventive screening/treatment Breast cancer screening Cervical cancer screening Colorectal cancer screening Chlamydia screening Adult respiratory testing/treatment Acute bronchitis Medication adherence Digoxin monitoring Pediatric testing/treatment Upper respiratory infection Pharyngitis. Pediatric well-care visits <15 months 3 6 years Adolescent well-care visits Outcomes Diabetes HbA1c poor control LDL-C control (<100 mg) Blood pressure control (130/80) Hypertension Controlling high blood pressure Cardiovascular disease LDL-C control (<100 mg) Patient Experience Patient experience Adults (CG CAHPS/ACES) Communication quality Knowledge of patients Integration of care Access to care Patient experience Pediatric (CG CAHPS/ACES) Communication quality Knowledge of patients Integration of care Access to care

Medicare Stars Quality Measures Staying Healthy: Screenings, Tests and Vaccines Breast Cancer Screening Colorectal Cancer Screening Cardiovascular Care Cholesterol Screening Diabetes Care Cholesterol Screening Glaucoma Testing Annual Flu Vaccine Improving or Maintaining Physical Health Measure: Improving or Maintaining Mental Health Monitoring Physical Activity Adult BMI Assessment. Member Complaints, Problems Getting Services, and Improvement in the Health Plan's Performance Complaints about the Health Plan Beneficiary Access and Performance Problems Members Choosing to Leave the Plan Improvement Health Plan Customer Service Plan Makes Timely Decisions about Appeals Measure: C35 - Reviewing Appeals Decisions Call Center Foreign Language Interpreter and TTY/TDD Availability Enrollment Timeliness Member Experience with Health Plan Getting Needed Care Getting Appointments and Care Quickly Customer Service Overall Rating of Health Care Quality Overall Rating of Plan Care Coordination Managing Chronic (Long Term) Conditions Care for Older Adults Medication Review Care for Older Adults Functional Status Assessment Care for Older Adults Pain Screening Osteoporosis Management in Women who had a Fracture Diabetes Care Eye Exam Diabetes Care Kidney Disease Monitoring Diabetes Care Blood Sugar Controlled Diabetes Care Cholesterol Controlled Controlling Blood Pressure Rheumatoid Arthritis Management Improving Bladder Control Reducing the Risk of Falling Plan All-Cause Readmissions

Role of Medications Quality measures Outcomes Potential cost savings Avoidance of harm Patient experience

Challenges with Quality Measures Harmonization Longitudinal outcomes Benchmarks Data sources Safeguards for high cost services

Improve patient experience Reduce per capita cost Improve health of populations