Archive for the ‘Healthcare Quality Ratings’ Category

Infographic: Connecting the Triple Aim and Supply Chain Management

August 17th, 2016 by Melanie Matthews

Supply chain processes that support caregivers as well as the products that are selected and sourced directly and indirectly impact patient safety and patient satisfaction, according to a new infographic by the Association for Healthcare Resource and Materials Management.

The infographic examines how supply chain management aligns with the Institute of Healthcare Improvement's Triple Aim.

Pursuing the Triple Aim: Seven Innovators Show the Way to Better Care, Better Health, and Lower CostsWritten by the President and CEO of the Institute for Healthcare Improvement (IHI) and a leading healthcare journalist, this groundbreaking book examines how leading organizations in the United States are pursuing the "Triple Aim": improving the individual experience of care, improving the health of populations, and reducing the per capita cost of care.

Pursuing the Triple Aim: Seven Innovators Show the Way to Better Care, Better Health, and Lower Costs shares compelling stories that are emerging in locations ranging from Pittsburgh to Seattle, from Boston to Oakland, focused on topics including improving quality and lowering costs in primary care; setting challenging goals to control chronic disease with notable outcomes; leveraging employer buying power to improve quality, reduce waste, and drive down cost; paying for care under an innovative contract that compensates for quality rather than quantity; and much more. The authors describe these innovations in detail, and show the way toward a healthcare system for the nation that improves the experience and quality of care while at the same time controlling costs.

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Appointment Data Opens Door to Population Health Management of Rising Risk Patients

August 9th, 2016 by Patricia Donovan

The rising risk population represents a healthcare organization's "low-hanging fruit," says Dr. Adrian Zai, clinical director of population informatics at Massachusetts General Hospital.

Sometimes the most powerful population health management intervention is simply to convince a patient to make an appointment.

This is the first step Dr. Adrian Zai, clinical director of population informatics at Massachusetts General Hospital (MGH), would recommend to any organization hoping to better manage its rising risk population, a group the physician describes as "low-hanging fruit."

"The appointment does not require significant investment in any health IT or other resources," said Dr. Zai during Targeting High-Risk and Rising-Risk Patients: A Multi-Pronged Strategy, an August 2016 webinar now available for replay. "All you need is appointment data. The key is to identify existing data you already have in your organization and start there, so that you impact outcomes."

Dr. Zai, whose hospital has been ranked number one in the nation by U.S. News & World Report, likened the notion of an organization acquiring a sophisticated health data analytics system prior to identifying clinical outcomes to "building a house without an architect."

However, having done its due data diligence, MGH's population health management approach embraces technology. The MGH approach, which targets rising- and high-risk patients, has moved far beyond appointment-setting, constructing a safety net program with the goal of improving clinical outcomes for 300,000 patients in its entire primary care network— a network spanning MGH and Brigham and Women's Hospital.

To this end, MGH developed a new set of clinically meaningful measures, but not before soliciting physician feedback on its existing set. In response, doctors identified more than 200 challenges to the old measures that MGH addressed in its new decision support system.

With new measures in place, MGH then created central population health coordinator teams to support primary care physicians in population health management, freeing clinicians to care for patients.

The selection of technology to support MGH's primary care safety net presented its own challenges. "Frequently, the tools you end up with—for data aggregation, analytics, care coordination, and patient outreach—don't actually talk to each other. You need a system to pull all of these functionalities together. That's the strategy we took," said Dr. Zai.

The new MGH population health management system enables clinicians to identify and share gaps in care with MGH care coordinators and population health managers, so they can intervene and try and close those gaps, he continued.

The system also tracks outcomes. After using the system for only six months, MGH reported improvement in every one of its newly developed performance framework measures. Not only is the ability to review outcomes appealing to payors, but 85 percent of MGH physicians surveyed also expressed satisfaction with the system—as well as its concurrent financial incentives.

In closing, Dr. Zai reiterated the need for collaboration: between staffers doing the work and the informatics tying those efforts neatly together. "One cannot work without the other. That technology is just a tool. Just as you cannot give a hammer to someone and expect them to build a house, you need the talents working together with technology to make that happen."

MACRA Mantra for Physician Practices: “Chase the Quality, and the Dollars Will Follow”

July 19th, 2016 by Patricia Donovan

Physician practices should position themselves to be paid for volume now and value in the future, McKesson's Eric Levin advised webinar participants.


If provider discontent doesn't prompt a delay, the controversial MACRA legislation will become reality in just six months, shaking up traditional physician reporting and reimbursement as healthcare knows it.

And while the proposed MACRA rule is still in flux, the bones of the law aren't expected to change, notes Eric Levin, McKesson's director of strategic services. From this point forward, he says, care coordination will be the ticket to success in eventual MACRA value- and performance-based healthcare models.

"As clinical alignment and care coordination increase, if you are not participating in some type of value-based care program, most likely you're not being reimbursed or rewarded for that work," Levin told participants in The New Physician Quality Reporting: Positioning Your Practice for MACRA's Merit-Based Incentive Payment System, a July 2016 webinar now available for replay.

In outlining MACRA's intent, Levin chiefly focused on the Merit-Based Incentive Payment Systems (MIPS) rather than the second reimbursement path, alternative payment systems (APMs), since the majority—88 percent—of physicians is expected to qualify under MIPS rather than APMs.

Zeroing in on MIPS, Levin reviewed eligibility, performance categories and data submission options, among other points. He then detailed the plethora of current and planned technical assistance options from CMS—including eventual practice transformation networks to provide peer-level support to physicians—before offering practical ways physician practices can prepare now for MACRA.

His six immediate action steps for practices included dipping a toe into analytics and data aggregation. "Look at the data. Learn how to risk-stratify. See the gaps in care you currently have and where those can be filled in so you're not just measuring but actually improving quality," Levin advised. The CMS Quality and Resource Use Report is useful for estimating a practice's MIPS score, he added.

In offering six additional tactics to become MACRA-ready, Levin recommended physician practices acquaint themselves with national benchmarks as a primer in quality measurement.

And on Levin's accompanying five-point MACRA implementation checklist is a reminder to stay current on CMS's proposed and final MACRA rulings. Fostering relationships with technology vendors wouldn't hurt either, he added.

His final points covered additional MACRA implementation resources, including education from provider associations, as well as the benefits of Patient-Centered Medical Home recognition and engagement in CMS's Chronic Care Management initiative in MACRA preparation.

"These programs will really help you begin the value-based journey if you have not started."

Levin emphasized providers should not wait for the final rule. Rather, physician practices should "learn how to focus on quality outcomes and costs, helping focus on the patient as well as that patient-provider relationship. Look at how you can identify ways to increase inexpensive patient encounters."

Before concluding, Levin answered participants' questions on how MACRA and MIPS will impact specialty providers; lessons practices can take from participation in the Physician Quality Reporting System, Meaningful Use and other value-based initiatives to enhance MACRA success; recommendations for small and solo practices; and other key concerns.

Learn more about Levin's presentation.

CMS to Physicians: 3 Things You Really Need to Know About MACRA

June 20th, 2016 by Patricia Donovan

It is expected that most physician practices will opt for the Merit-based Incentive Payment System (MIPS) under new MACRA-mandated reimbursement strategies.

It is expected that most physician practices will opt for the Merit-based Incentive Payment System (MIPS) under new MACRA-mandated reimbursement strategies.

While digesting the implications of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) can be an understandable distraction for physicians, the goal of the MACRA program is to return the focus to patient care, not spend time learning a new program, emphasized CMS Acting Administrator Andy Slavitt to members of the American Medical Association during the AMA's annual meeting in Chicago last week.

Early in Slavitt's comments, available in their entirety in a June 2016 post in the CMS blog, he posed the following two questions to physicians: What do you really need to know about the MACRA program? And what new sets of requirements are there to participate?

At the outset of his explanation, Slavitt emphasized Medicare will still pay for services as it always has, but every physician and other participating clinicians will have the opportunity to be paid more for better care and for making investments that support patients—like having a staff member follow up with patients at home.

As the AMA, AAFP and other physician support organizations have done, CMS will provide comprehensive MACRA documentation, Slavitt assured the association. "We will, of course, provide information in as much or as little detail as is helpful. For those who like to read computer manuals end-to-end, there is of course the 900-page proposed rule complete with every detail about how the regulation and the law is proposed to work. But, for most people, who do not need to see every scenario and how each element of the formula works, there are webinars, in-person meetings, fact sheets, and web portals that will bring all the information to suit various needs."

Slavitt then outlined three immediate features of the program designed as improvements over Medicare's existing payment system:

  • First, MACRA sunsets three disjointed programs. If you participate in the Physician Quality Reporting System, the Value Modifier, and the Meaningful Use program, your life just got simpler, as they are replaced with a single, aligned Quality Payment Program, which will reduce reporting requirements, eliminate duplication, and reduce the number of measures. For those who participate in MACRA Alternative Payment Models, those requirements are reduced further or eliminated.
  • Second, it also reduces the combined possible downward adjustment of 9 percent that is occurring today from the three programs to a maximum of 4 percent in the first year of the Quality Payment Program. The program is designed to build up over the course of several years, with more modest financial impacts in the first year when the vast majority of physicians are expected to be in the MIPS part of the program.
  • Third, while the Merit-Based Incentive portion of the law is designed to be budget neutral in general, there are new opportunities for additional bonuses. In MIPS, in addition to the 4 percent positive payment adjustment, there is the potential for much higher payments through $500 million in funding over six years. Physicians earn a 5 percent lump sum bonus for participating in an Advanced Alternative Payment Model.

Under the current proposed timing, the first physician reporting isn’t due until early 2018 for the first performance period in 2017, Slavitt said. Off-the-shelf tools like Certified EHRs and clinical data registries can provide complete capabilities, but other options exist as well, including most types of reporting that a physician is doing today.

If CMS can get data automatically or through another source, it will do so, he stated, before moving on to MACRA implementation and priorities.

Editor's Note: To briefly outline MACRA and advise on physician practice focus for the remainder of 2016 to avoid reimbursement penalties in 2017 based on the MACRA proposed rule, the Healthcare Intelligence Network will hold a 45-minute webinar on July 14, 2016: The New Physician Quality Reporting: Positioning Your Practice for MACRA's Merit-Based Incentive Payment System.

Are You MACRA-Ready? Physician Groups Prep Members for Medicare Payment Modernization

May 16th, 2016 by Patricia Donovan

Physician groups digested the 962-page MACRA notice of proposed rule-making in order to distill the notice for their members.

As they digest the HHS's momentous proposal to modernize how Medicare provider payments are tied to the cost and quality of patient care, physician organizations are assembling arsenals of educational tools to de-mystify MACRA.

The federal government's first step in implementing certain provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was detailed in an April 2016 announcement.

Just nine days after that bulletin, the AAFP arranged a town hall meeting for its members with two high-ranking CMS officials to discuss the law that will greatly influence how physicians are paid. Comments provided by CMS Acting Administrator Andy Slavitt via conference call are detailed here.

While the HHS window to receive feedback on the proposal remains open through June 27, 2016, the AMA has created an extensive set of online resources to support physician preparations for a post-MACRA Medicare. The resources include a guide to physician-focused payment models, key points of the Merit-based Incentive Payment System (MIPS), and five things providers can do now to prepare for the legislation, among other resources, according to a May 2016 press release.

“The core policy elements in MACRA are surfacing in other public and private insurance programs, so understanding these policies will be essential for most physician practices,” said AMA President Steven J. Stack, MD.

The AMA's MACRA support tools were announced in conjunction with the release of its new interactive module on practicing value-based care authored by Grace Terrell, MD, an internal medicine physician and president of Cornerstone Health Care, who shares the proven steps her clinic used to focus on patients at the center of care.

The value-based care module is the latest in the AMA’s STEPS Forward™ collection of physician-developed practice improvement strategies.

Also readying its membership for MACRA is the AAFP, which last week launched a comprehensive member communication and education effort related to the proposed legislation. The AAFP's MACRA Ready site is a one-stop shop filled with resources family physicians can use right now such as the following:

  • A timeline of important MACRA dates;
  • A list of acronyms to help digest the alphabet soup associated with MACRA's complicated regulations;
  • A "MACRA in a Minute" 60-second overview video;
  • A deep-dive review of what value-based payment means to family physicians;
  • and much more.

In announcing the MACRA tools, AAFP President Wanda Filer, MD, MB, told family physicians that the academy's MACRA communication plan "is designed to help simplify the transition and provide the guidance that you will need to realize the benefits of MACRA and value-based payments."

A recent AAFP survey indicated that some 40 percent of family physicians already were involved in some kind of value-based payment system, she noted.

As she related the history of MACRA, Dr. Filer reminded members that the legislation not only repealed the sustainable growth rate (SGR) but also established an annual positive or flat-fee payment for the next 10 years as well as a two-track program (the MIPS, and Alternative Payment Models, referred to as APMs) for calculating Medicare payments beginning in 2019.

MACRA Transition Bolstered by CMS Quality Measure Development Plan

May 9th, 2016 by Patricia Donovan

payment bundling shared savings

Partnerships are key to the final Quality Measure Development Plan by CMS.

The final Quality Measure Development Plan by CMS is an essential aspect of its transition to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), according to last week's blog post by Kate Goodrich, MD, MHS, director of CMS's Center for Clinical Standards & Quality.

The Quality Measure Development Plan is a strategic framework for clinician quality measurement development to support the new Merit-based Incentive Payment System (MIPS) and advanced alternative payment models (APMs), stated Dr. Goodrich.

CMS recently rolled out a proposed rule outlining MACRA's payment incentives for physicians and other clinicians based on quality rather than quantity of care.

The final Quality Measure Development Plan will provide the foundation for building and implementing a measure portfolio to support the quality payment programs under MACRA, Dr. Goodrich said.

After considering comments and suggestions for the plan, CMS finalized the Quality Measure Development Plan to include the following:

  • Identification of known measurement and performance gaps and prioritization of approaches to close those gaps by developing, adopting and refining quality measures, including measures in each of the six quality domains:
    • Clinical care;

    • Safety;

    • Care coordination;

    • Patient and caregiver experience;

    • Population health and prevention;

    • Affordable care.
  • CMS actions to promote and improve alignment of measures, including the Core Quality Measures Collaborative, a work group convened by America’s Health Insurance Plans (AHIP). On February 16, 2016, CMS and the collaborative announced the selection of seven core measure sets that will support multi-payor and cross-setting quality improvement and reporting across our nation’s healthcare systems.
  • Partnering with frontline clinicians and professional societies as a key consideration to reduce the administrative burden of quality measurement and ensure its relevance to clinical practices.
  • Partnering with patients and caregivers as a key consideration for having the voice of the patient, family, and/or caregiver incorporated throughout measure development.
  • Increased focus and coordination with federal agencies and other stakeholders to lessen duplication of effort and promote person-centered healthcare.

Infographic: Comparison of Physician Quality Measures

March 14th, 2016 by Melanie Matthews

The new Physician Quality Metric Consensus Set, released by the Centers for Medicare & Medicaid Services (CMS) and America's Health Insurance Plans (AHIP), is a common set of quality measures from several current measurement sets. These sets were identified by healthcare systems participating in the federal Core Quality Measures Collaborative. Many healthcare providers are already collecting most of these measures, though there are modifications to several, according to a new infographic by Oliver Wyman.

While there is substantial overlap between the Consensus Set and existing STARS and QRS measure sets, providers also need to take heed that the next few years will be a time of flux for physicians as additional Consensus measures are developed and STARS and QRS migrate toward these. The infographic, researched by Oliver Wyman's Health & Life Sciences Provider team, shows the degree of overlap between the proposed and current measure sets.

Physician Value-Based Reimbursement: Quality Rewards for Population Health With more than a quarter-century of experience with value-based reimbursement models, Humana is ideally positioned to help physician practices navigate the transition from fee for service to fee for value. The payor's multi-level Accountable Care Continuum rewards physician practices for care coordination of Medicare beneficiaries along the population health spectrum.

Physician Value-Based Reimbursement: Quality Rewards for Population Health describes the four tiers of Humana's Physician Quality Rewards program as well as the support, training, technologies and outcomes associated with these pay-for-value relationships.

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CHS on Data Analytics in Accountable Care: “No Matter What Happens, This Change is Coming”

February 11th, 2016 by Patricia Donovan

Collaborative Health Systems, the largest sponsor of Medicare ACOs in the United States, recently rolled out an analytics and dashboard portal for its 3,200 providers.

Attention, please. Two aggressive milestones to migrate Medicare providers to value-based healthcare are on the horizon:

  • In 2016, CMS expects 30 percent of Medicare fee-for-service (FFS) reimbursement to be tied to alternative payment models such as accountable care and bundled payments.
  • Also this year, the federal payor wants 85 percent of Medicare FFS payments to be based upon quality metrics.

"If you are a provider, or working with providers who accept Medicare beneficiaries, it's really important to know these changes are coming," advises Elena Tkachev, director of ACO analytics for Collaborative Health Systems (CHS). "It will be the responsibility of physicians to participate in these payments because no matter what happens, this change is coming."

Ms. Tkachev detailed the power of data analytics to drive CHS's success in accountable care during Data Analytics in Accountable Care: Strategies and Case Studies, a January 2016 webinar from the Healthcare Intelligence Network now available for replay.

As the largest sponsor of Medicare Shared Savings Program (MSSP) ACOs in the United States, CHS has a firm handle on HHS's value-based agenda. The organization manages 24 MSSP ACOs, nine of which generated savings of nearly $27 million in 2014, and one that has been accepted as a Next Generation ACO, the newest Medicare accountable care model.

And with CMS expectations for value-based reimbursement slated to rise over the next two years, expectations for data analytics to improve care and costs related to Medicare beneficiaries have never been higher.

"Today, physicians are being measured through claims and the clinical metrics on the population they serve. We see the main responsibility of analytics as providing simple access to actionable, timely and relevant information to help clinicians make better decisions, improve quality of care and enhance the patient experience."

Despite the magnitude of its enterprise, CHS believes its future in accountable care rests upon its primary care physicians (PCPs), which it views as "quarterbacks of care" for its more than 280,000 Medicare beneficiaries.

To foster quality improvement, CHS equips PCPs with an arsenal of analytics capabilities. So that its 3,200 providers can tap into CHS's massive storehouse of CMS, claims, lab, risk stratification and care coordination data collected on its 24 Medicare Shared Savings Program (MSSP) ACOs, the health system recently rolled out an analytics and dashboard portal.

These tools enable providers to monitor the aggregate health of their populations as well as their own performance, even giving providers the ability to track their own performance over time and contrast it with other clinicians'—a capability that pleases CHS's more competitive physicians, Ms. Tkachev notes.

Frequent webinar training keeps provider analytics' use sharp, and dashboard-generated reports and scorecards help physicians to monitor and enhance quality performance and improve patient outreach, Ms. Tkachev explained.

Despite its significant success, CHS still encounters the perennial challenges of access to timely and accurate data, aggregation abilities, and the display of meaningful results. Ms. Tkachev shared some CHS tactics to resolve these issues, including soliciting feedback on the tools from providers who use them.

Listen to an interview with Elena Tkachev on data analytic's potential to drive annual wellness visits and boost beneficiary attribution.

Infographic: Top 11 Health Plans in 2015

October 12th, 2015 by Melanie Matthews

Capital District Physicians' Health Plan (HMO) and Capital District Physicians' Health Network (HMO), both of New York, were the top rated health plans by NCQA in 2015, according to a new infographic by HIMSS Media, which highlights the NCQA findings.

NCQA used combined HEDIS, CAHPS and NCQA Accreditation standards scores as of June 30, 2015 to develop the ranking. The HIMSS infographic shows the top 11 health plans, based on these scores.

Top 11 Health Plans in 2015

A multi-layer, patient-centered approach to care coordination of Memorial Hermann's ACO covered lives is designed to cover these members under a population health umbrella spanning the entire continuum of care from wellness services to supportive services for end-of-life care.

During Care Coordination in an ACO: Managing the Population Health Continuum from Wellness to End-of-Life, a September 29th webinar, now available for replay, Mary Folladori, RN, MSN, FACM, CMAC, system director of care management at the Memorial Hermann Physician Network and ACO, provided the inside details on its care coordination strategy and results.

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Steward Medicare Pioneer ACO ‘Patient Trackers’ Boost Care Management, Improve Performance

July 14th, 2015 by Patricia Donovan

Steward Medicare Pioneer ACO

Steward's Medicare Pioneer ACO was a top performer in performance year two, with gross savings of $19.2 million.

The ability to track patients across a continuum of care sites is a perennial challenge for healthcare organizations—even a top-performing Medicare Pioneer ACO.

"We can't prevent a readmission back to the hospital or redirect unnecessary emergency department visits if we don't know the patients were in the hospital to begin with," noted Kelly Clements, Pioneer program director at Steward Healthcare Network, during Medicare Pioneer ACO: Care Management, Quality Improvement and Data Integration Yields Substantial Performance Gains, a Healthcare Intelligence Network webinar now available for replay.

But Steward's Medicare Pioneer ACO meets this challenge head-on with two tools: a home-grown patient surveillance tracker, and the "Patient Ping" service that provides real-time patient admissions and discharge notifications to providers. Both tools help Steward to identify and coordinate care for Pioneer ACO beneficiaries who seek services from both Steward and non-Steward providers.

These innovations have helped Steward's Medicare Pioneer ACO, aptly named Promise ("For our promise to do the best we can to coordinate beneficiaries' care and increase quality of care," said Ms. Clements), to emerge as one of the top CMS Medicare Pioneer ACO performers in 2013, with gross savings of $19.2 million.

Three Medicare Pioneer ACO Challenges

Care management, including the tracking of its 80,000 Promise beneficiaries, was one of three categories of Medicare Pioneer ACO challenges Ms. Clements touched on during the webinar, along with physician engagement and performance improvement.

Supporting care management, the internally developed patient surveillance tracker is Steward's in-network solution for real-time tracking of care received from Steward providers and facilities; the contracted Patient Ping service allows the Pioneer ACO to communicate with skilled nursing facilities (SNFs) outside their network that care for Steward Pioneer patients, providing the SNF is registered with Patient Ping.

"Through the Pioneer program, we've learned that a large portion of our opportunity to reduce cost and achieve savings as an ACO is in the post-acute care space, particularly in the SNFs," noted Ms. Clements.

To engage physicians in the delivery of accountable care, Steward has done everything from holding road shows for providers to creating performance improvement teams for each geographic "chapter" in the ACO to work with physician practices to improve efficiency and quality. Physician report cards measure stewardship (including attendance at chapter meetings) and other efficiency and quality indicators.

And finally, to drive performance improvement, Steward has worked aggressively on data integration, with a strong focus on the two most popular electronic health records (EHRs) its physician network, in order to feed its 'quality data warehouse.'

This focus, along with efforts by the physician practices, has generated results. Steward saw its Pioneer ACO raw quality scores rise significantly from performance year one to performance year two: a 39 percent jump in the preventive health domain, and a 42 percent improvement in the at-risk domain (care for chronic conditions such as diabetes and coronary artery disease (CAD).

There is one additional hurdle: Steward must decide which ACO program it will participate in next year: Pioneer ACO, Next Generation ACO or Medicare Shared Savings Program (MSSP), Track 3. "The more efficient we become, the harder it will be to achieve shared savings, because the benchmark will keep getting lower, so this is one of our big concerns," said Ms. Clements.

"Our leadership is fully committed to pursuing risk aggressively and it's been worthwhile being at the table with Medicare and advocating for programmatic changes that will benefit our providers and patients in a sustainable way."