Immunization Quality Metrics
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1 Immunization Quality Metrics Samuel Stolpe, PharmD Senior Director, Quality Strategies Discussion Objectives 1. Describe the expanding influence of quality metrics, and their connection to CMS incentive structures 2. Explore the immunization measures included throughout federal quality programs 3. Describe a performance measure-based quality program example: the CMS Star Rating System for Medicare Part C 4. Outline the connections emerging between payors and pharmacies based on Star Rating measure performance 5. Describe appointment-based medication synchronization, an emerging best practice for Star Rating performance 6. Discuss the Adult Immunization Task Force, and the measures currently under development Natl Adult and Influenza Immunization Summit 5/12/2015 1
2 The Triple Aim Affordable Care Better Care Healthy People/ Communities Federal Value-based Payment Sylvia Burwell Jan 26, 2015 HHS Announcement - NEJM Article/Meeting/Press Release New Quality Goals - FFS payments tied to quality or value - 85% by 2016, 90% by FFS payments tied to value through alternative payment models - 30% by 2016, 50% by 2018 MACRA - Quality measurement plan in place by 2016 Natl Adult and Influenza Immunization Summit 5/12/2015 2
3 IZ Metrics in Federal Programs Measure # Programs Influenza 9 Hospital Inpatient Quality Reporting; Inpatient Rehabilitation Facility; Nursing Home Compare Measures; LTCH Quality Reporting; Home Health Quality Reporting; Medicare Shared Savings Program; Medicaid Adult Core; Health Insurance Marketplaces; Medicare Part C Flu Healthcare Professionals 5 Pneumococcal 5 Hospital Inpatient Quality Reporting; Outpatient Quality Reporting; Ambulatory Surgical Center Quality Reporting; Inpatient Rehabilitation Facility; LTCH Quality Reporting Hospital Inpatient Quality Reporting; PQRS; Nursing Home Compare Measures; Home Health Quality Reporting; Medicare Shared Savings Program Adolescent IZ Status 2 PQRS; Medicaid CHIPRA Childhood IZ Status 2 PQRS; Medicaid CHIPRA HPV in females 2 Medicaid CHIPRA; Health Insurance Marketplaces Influenza Screening 2 PQRS; Home Health Quality Reporting Hepititus A 1 PQRS Pneumococcal Screening 1 Home Health Quality Reporting Registry Submission Capability 1 Medicare and Medicaid HER Incentive: Meaningful Use Stage 2 Core Natl Adult and Influenza Immunization Summit 5/12/2015 3
4 High Stakes for Part C Stars Enrollment Implications Quality Bonus Payments (MA-PD) Poor performers identified by CMS Removal from Medicare for continued poor overall performance (< 3 stars for 3 years in a row) Quality Bonus Payments The star ratings now affect payment to Medicare Advantage plans wherein higher-rated plans get higher payment Quality Bonus Payments (QBPs) are being awarded on a sliding scale according to star ratings 2015 payments will be based on 2014 ratings which are based on 2012 and 2013 data QBP opportunity for large MA-PDs (Humana, United Healthcare, Aetna/Coventry, CIGNA/HealthSpring) may exceed $100 million Natl Adult and Influenza Immunization Summit 5/12/2015 4
5 Medicare Part C Flu Metric Part C Influenza Metric Performance Average Plan Performance % 61% 67% 68% 71% 73% Health Plan Response Formularies, clinical strategies, network contracts, marketing/promotions, aligning with star measures Significant investments in drive to 5 Contract strategies for pharmacy networks - Pay for Performance (P4P) pharmacies may be eligible for bonus payment based on star performance - Preferred pharmacy network based partly on star performance of chain or stores Natl Adult and Influenza Immunization Summit 5/12/2015 5
6 Pharmacy P4P A few health plans have already implemented P4P for pharmacies, including - Silverscript - Health Partners - Inland Empire Health Plan - Michigan BCBS Example: Inland Empire Health Plan (IEHP) - Launched in October Pharmacies are evaluated on Star measures plus asthma and GDR - EQuIPP allows pharmacies to track their performance - Bonuses based on number of patients at each store in addition to score on each measure Natl Adult and Influenza Immunization Summit 5/12/2015 6
7 Changing Dynamics: Community Pharmacy Pharmacists need to reallocate resources - Can innovate to improve measure performance - Changes approach to provision of services (e.g. MTM) Expectation to interact with prescribers as part of virtual care team - Improvement on metrics dependent on prescriber buy in (e.g. if pneumococcal prescription required) Traditional vs. Appointmentbased Model Rx Traditional Model Patients manage own medication therapy Inefficient and hinders pharmacist s ability to provide services that improve adherence and health ABM One monthly call from pharmacy to patient, prior to appointment date Patients don t need to manage their refills Pharmacy assumes responsibility for workflow and patient engagement Natl Adult and Influenza Immunization Summit 5/12/2015 7
8 Three Key Features of ABM 1. Synchronization of chronic medications 2. Pre-appointment call 3. Appointment date Strength of the Adult IZ Records in IIS (2013) Top Performers - Minnesota: 89%, Wisconsin: 87%, North Dakota: 78%, Georgia: 77%, Oregon: 72%, Washington: 65%, Indiana: 64% Bottom Performers - Texas: 1%, New Jersey: 3%, Kentucky: 8%, New York: 9%, Hawaii: 11%, Virginia: 13% IIS with <50% of adults: 40 IIS with <25% of adults: 19 Natl Adult and Influenza Immunization Summit 5/12/2015 8
9 Adult Immunization Task Force First convened June Monthly telephonic meeting to build IZ Quality Metrics - Prioritized measures based on - NVAC recommendations - NQF Adult IZ Committee priorities Currently 35 members - Community pharmacy - Public health - Health plans - Tech vendors - MTM specialists - Pharmacy association leadership NVAC Key Priorities Performance of regular IZ Assessments Provision of vaccine or referral - CDC study: - 70% acceptance of vaccination recommendation if vaccine on hand - 40% acceptance if referral - 16% if no assessment or referral Appropriate documentation in IIS and EHR Natl Adult and Influenza Immunization Summit 5/12/2015 9
10 NQF Adult Immunization Committee NQF Priorities for Measure Development 1. HPV catch-up for ages TDaP/Pertussis vaccine for ages Zoster vaccine for ages Zoster vaccine for ages Composite with other preventative services 6. Composite TDaP and flu for pregnant women 7. Composite Influenza, pneumococcal, Hepatitis B in diabetes 8. Composite Influenza, pneumococcal, Hepatitis B in ESRD 9. Composite Hep A and B in chronic liver disease 10. Composite of all AHIP vaccines for healthcare workers Measure Development Priorities Immunization registry reporting Assessment of adult immunization status in community Pharmacy - Generalized version - Within context of MTM or CMR Adult Herpes Zoster Vaccination Natl Adult and Influenza Immunization Summit 5/12/
11 Immunization Information System Reporting Measure Measure description: The percentage of administered adult vaccinations that are submitted to Immunization Information Systems during the measurement period. Will use pharmacy and medical claims data, and IIS data. - All immunizations; not just ACIP recommended - All adults 18 years of age or older This performance measure allows payors to determine if providers are appropriately documenting vaccinations that the payor is covering. Questions? Sharon L. Sprenger Co-Lead Quality Measures Workgroup Director, Measurement Coordination and Outreach Division Healthcare Quality Evaluation The Joint Commission Samuel Stolpe, PharmD Quality Measures Workgroup Senior Director, Quality Strategies Pharmacy Quality Alliance sstolpe@pqaalliance.org ssprenger@jointcommission.org Natl Adult and Influenza Immunization Summit 5/12/
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