Improving Accountable Care Measure Sets ACO Viewpoint Jonathan Nasser, MD Chief Clinical Transformation Officer Crystal Run Healthcare
Crystal Run Healthcare Physician owned MSG in NY State, founded 1996 340 providers, 17 locations Joint Venture ASC, Urgent Care, Diagnostic Imaging, Sleep Center, High Complexity Lab, Pathology Early adopter EHR (NextGen ) 1999 Accredited by Joint Commission 2006 Level 3 NCQA PCMH Recognition 2009, 2012
Crystal Run Healthcare ACO Single entity ACO April 2012: MSSP participant December 2012: NCQA ACO Accreditation 4 Commercial Contracts at Risk 35.000 attributed patients 108 Quality Measures
Outline Challenges of Current Measure Sets Cross Cutting Measures and Layered Approach Underutilization
Quality Measurement Quality Measurement Meaningful Use Exclusions CMS Denominator NQF Measurement Period HEDIS Atrribution Numerator
Goals Meaningful Measures with benchmarks Engage all Providers Simplify Measurement and Documentation Consistency Across Payers Match External and Internal Evaluation
Physician Matrix Organization wide value scorecard 40% Quality Performance, 10% of Compensation 3 Measures per Specialty Joint Commission HEDIS, MSSP, NQF Crystal Run Created: Rheumatology: Methotrexate Monitoring Neurology: Vitamin D evaluation in patients with MS Derm: TBSE yearly in patients with h/o melanoma
Measuring Quality across a Multispecialty Group DEPARTMENT JCAHO MEASURE QUALITY MEASURE 2 Allergy Medication Use of Appropriate Reconciliation Medications for Asthma (MU) 6 Cardiology Anticoagulation Controlling High Blood Pressure (MU) 2 Dermatology Time Outs Melanoma no imaging studies (NQMC) 26 Endocrinology FP/IM Medication Reconciliation Medication Reconciliation Hgb A1c >9 (MU) 1 Pneumonia Vaccination for Patients 65 and Older (MU) 3 QUALITY MEASURE 3 Asthma Assessment (MU) 7 CAD: Drug Therapy for Lowering LDL- Cholesterol (MU) 5 Melanoma complete skin exam performed and documented yearly (Gundersen) 27 Diabetes Mellitus: Urine Screening for Microalbumin or Medical Attention for Nephropathy in Diabetic Patients (MU) 13 Screening Mammography (MU) 4
Reporting Quality
Physician Engagement Quality Scorecard
Tracking Performance
Outline Challenges of Current Measure Sets Cross Cutting Measures and Layered Approach Underutilization
DISCERN Existing or Developed Cross Cutting Measure Accountable Care Measure Set Medication Adherence Types 1 and 2 Diabetes HbA1c Control Rheumatoid Arthritis DMARD Use Multiple Sclerosis Gap Condition Specific Measures Cross Cutting Gap Cross Cutting Measure Gap Timely Care Access to Specialists 14
Cross Cutting Implementation Medication Reconciliation Pain Assessment Patient Reported Outcomes and Goal Completion
Diabetes Care DISCERN External Accountability Measure Set Internal Management Measures Internal Improvement Measures HbA1c Test Blood Pressure Test Hypo Glycemic Events Composite Measure Comprehensive Diabetes Care Lipid Panel Tobacco Assessment Depression Remission Appropriate Use of Anti Depressants Depression Screening Population Level System Level Provider Level 16
Layered Approach Implementation Current State: Provider Level measures used for population reporting rting More Outcome Measures Needed Aligned with Organizational Management: Engage Providers on Front Line Stimulate best practice sharing Organizational QI
Outline Challenges of Current Measure Sets Cross Cutting Measures and Layered Approach Underutilization
Improving Quality Variation Reduction Step 1: Analyze Utilization Step 2: Compare utilization between physicians Step 3: Analyze the variation
Variation Reduction Pilot: Diabetes Charges/Patient 2010 vs. 2012
Choosing Wisely www.choosingwisely.org ABIM Foundation, Consumer Reports Choosing care that is: Supported by evidence, not duplicative, free from harm, truly needed Specialty Societies: Five Things Physicians and Patients Should Question
jnasser@crystalrunhealthcare.com