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Better Healthcare, Better Health, Lower Cost for Improvement Jean D Moody-Williams, RN, MPP Director, Quality Improvement Program INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law. Applies to all slides in this deck

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Page 1: Better Healthcare, Better Health, Lower Cost for Improvement Jean D Moody-Williams, RN, MPP Director, Quality Improvement Program INFORMATION NOT RELEASABLE

Better Healthcare, Better Health, Lower Cost for ImprovementJean D Moody-Williams, RN, MPP

Director, Quality Improvement Program

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

Applies to all slides in this deck

Page 2: Better Healthcare, Better Health, Lower Cost for Improvement Jean D Moody-Williams, RN, MPP Director, Quality Improvement Program INFORMATION NOT RELEASABLE

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Page 3: Better Healthcare, Better Health, Lower Cost for Improvement Jean D Moody-Williams, RN, MPP Director, Quality Improvement Program INFORMATION NOT RELEASABLE

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Transforming Care through the Affordable Care Act

3011 National Quality Strategy – CMS Quality Strategy

3021 Center for Medicare and Medicaid Innovations

3001 Hospital Value Based Purchasing

3005 Cancer Hospital Reporting

3007 Physician Value Modifier

3008 Hospital Acquired Condition Reduction Program

3401 Psychiatric Quality Reporting Program

3025 Readmission Reduction Program

3026 Community Based Care Transitions Programs

Trade Bill Revisions to the Quality Improvement Organizations Program

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Delivery system and payment transformation

Future State – People-Centered

Outcomes Driven Sustainable

Coordinated Care

New Payment Systems (and many more)Value-based purchasingACOs, Shared SavingsEpisode-based paymentsMedical Homes and care mgmtData Transparency

Passing State – Producer-Centered Volume Driven

Unsustainable

Fragmented Care

FFS Payment Systems

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Partnership for Patients Million Hearts National Quality Strategy Data.gov

Coverage of servicesPhysician Feedback report Quality Resource Utilization ReportPhysician Value ModifierReadmissions

ESRD QIPHospital VBPPlans for Skilled Nursing Facility and Home Health Agencies, Ambulatory Surgical Centers

QIOsESRD Networks

HITECH Hospital Inpatient Quality Reporting Programs

ACOsCommunity Based Transitions Care ProgramDual Eligibles

Hospitals, Home Health Agencies, Hospices, ESRD facilities

Demonstration ProjectsPilots

Target surveysQuality Assessment

Performance Improvement

Fraud & Abuse Enforcement

Implementation Levers at CMS

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Moving toward Safety

Supporting providers and families in achieving a system that provides high quality, safe and affordable care:

• Implementing a framework for improvement• Creating Learning systems supported by change

agents throughout the country to spread evidenced based practices

• Decreasing waste in the system• Focusing on the patient through engagement and

transparency• Linking quality to payment

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The QIO Program’s Approach to Clinical Quality

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INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

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Areas of Focus for CMS OMHAreas of Focus for CMS OMH

• Aligning CMS programs and policies to reduce disparities

• Improving coverage and access to care for minority populations

• Reducing disparities in health care quality

• Increasing and improving data to measure health disparities

• Improving resources for people with limited English proficiency

• Building the business case for reducing disparities

• Working with providers to reduce disparities

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CMS OMH Data and Policy Analytics Projects

CMS OMH Data and Policy Analytics Projects

• Census Data Project

• Electronic Health Records (EHR)

• Building the Business Case

• Culturally & Linguistically Appropriate Services (CLAS) Measurement Project

• CMS Demographic Data Collection Forms Inventory Project

• HEDIS/CAHPS Health Plan Quality Measure Reporting

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Moving toward Safety

Supporting providers and families in achieving a system that provides high quality, safe and affordable care:

• Implementing a framework for improvement• Creating Learning systems supported by change

agents throughout the country to spread evidenced based practices

• Decreasing waste in the system• Focusing on the patient through engagement and

transparency• Linking quality to payment

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Partnership for Patients: Better Care, Lower Costs

Secretary Sibelius launched a nationwide public-private partnership to tackle

all forms of harm to patients. Our goals are:– Reduce harm caused to patients in hospitals. By the end of 2013, preventable

hospital-acquired conditions would decrease by 40% compared to 2010.Achieving this goal would mean approximately 1.8 million fewer injuries to patients with more than 60,000 lives saved over the next three years.

– Improve care transitions.- By the end of 2013, preventable complications during a transition from one care setting to another would be decreased such that all hospital readmissions would be reduced by 20% compared to 2010. Achieving this goal would mean more than 1.6 million patients would recover from illness without suffering a preventable complication requiring re-hospitalization within 30 days of discharge.

Potential to save up to $35 billion over 3 years

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Hospital Acquired Condition (HAC) Rates Show Improvement

Ventilator-Associated Pneumonia

(VAP)

Early Elective Delivery

(EED)

Obstetric Trauma

Rate (OB)

Venous thromboembolic complications

(VTE)

Falls and Trauma

Pressure Ulcers

55.3% ↓ 52.3% ↓ 12.3% ↓ 12.0% ↓ 11.2% ↓ 11.2% ↓

2010 – 2012 - Preliminary data show a 9% reduction in HACs across all measures

Many areas of harm dropping dramatically (2010 to 2013 for these leading indicators)

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QIO 10th SoW ResultsQIO 10th SoW Results

• Over the course of the current 10th SoW QIOs have worked with providers, patients, families, nursing homes, home health agencies, pharmacist and many more in the community to increase coordination of care and improve patient safety. These efforts have resulted in the following improvements:

– 34% relative improvement in the reduction on pressure ulcer for nursing home

– 85,149 fewer days with urinary catheters for beneficiaries– 53% relative improvement in reduced Central Line Associated

Blood Stream Infections (CLABSI– 44,640 potential adverse drug events avoided– Over 27,000 people avoided being readmitted and over 95,000

avoided admission to the hospital resulting in improved coordination of care and millions of dollars in savings

– Resolve more than 180,000 cases of care concerns or requests for appeals received from beneficiaries and their families

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11th SoW Activities11th SoW Activities

CMS made the following changes to the QIO program:– Separated case review (including patient generated quality of

care concerns) from quality improvement activities to avoid the perception of conflict of interest – BFCC QIO

– Developed Quality Innovation Networks (QIN) QIOs– Redefined the geographic boundaries of the QIOs to create a

multi-state structure will maintaining the requirement for locally based quality activities

– Expanded the pool of organizations eligible to bid on the contracts by removing the requirement that the QIO be physician sponsored. The organization may use a multidisciplinary approach to improvement.

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Four key roles of the CMS Quality Improvement Organizations

QIOs work on behalf of CMS to:

Champion local-level, results-oriented change • Data driven• Active engagement of providers, patients and other partners• Proactive, intentional innovation spread that improves and “sticks”

Facilitate learning and action networks• Democratizing clinical QI expertise so “all teach, all learn”• Placing impetus for improvement at the community and bedside levelTeach and advise as technical experts• Consultation, education and technical assistance in quality improvement• Knowledge management so learning is never lost

Communicate effectively• Optimal learning, patient activation, and sustained behavior change

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Cardiac Health Special Innovation Projects

• 3 State Projects in Arkansas, California, Michigan focusing on

Beneficiaries that are of Hispanics ethnicity along with African

Americans, and Asian Pacific Island patients in rural and urban areas

• Heart attack and stroke prevention projects focused on the A B C S:

Aspirin Therapy- Appropriate Use; Blood Pressure Control;

Cholesterol Management; and Smoking Cessation

• Aligns with the HHS Secretary’s Million Hearts initiative found at

www.millionhearts.hhs.gov

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20,000+ Patients Impacted to Date Through:

 

Health fairs in community centers, malls, other locations

Churches - utilizing the Bless Your Heart Health Ministry Toolkit (Spanish & English version) found at https://www.afmc.org/HealthCareProfessionals/OrderInterventionTools/tabid/386/ProdID/230/Default.aspx

Patient education classes on the ABCS

All activities and events conducted with consideration for language, culture, and literacy level of the participants

 

Additional information and resources available at www.cmspulse.org

Cardiac Health Special Innovation Projects

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IPRO (NY QIO) Everyone with Diabetes Counts (EDC) 10th SOW Goals

Enroll : 6,000 participants in DSMEGraduate: 2,500 Hispanic/Latino Medicare

Beneficiaries in DSME ClassesCurriculum: Bi-lingual classes Stanford’s Diabetes

Self-Management Program (DSMP)Where: Senior centers, hospitals, parks,

basements, churches, housing buildings, clinics, others

When: 1 Workshop (sessions) = 6 weekly classes of 2.5 hours per class

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Addressing the Diabetes Burden in New Jersey through a Community of Promotoras: Dulce New Jersey

Created a community-based education, compliance program incorporating nurse-managed care

Recruited and trained promotoras (peer educators) to lead 8-week education courses that address barriers to patient project participation and diabetes self-management goals

Piloted program in three sites (grew to four) over two years

Led by the New Jersey Hospital Association and Health Research & Education Trust of NJ

Results:

90% increase in patient knowledge of diabetes care

64% improvement in patient exercise, 22% improvement in nutrition

16% decrease in HbA1c, 18% decrease in Fasting Blood Glucose, 17% decrease in Triglycerides

Created patient education and outreach materials in English and Spanish

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Latino/Hispanic Family Advisory Board Guides Children’s Mercy Hospital Improvements

El Consejo de Familias Latinas/Hispanas is a Family Council comprised of Spanish-speaking families

Developed to more formally include the voice of Spanish-speaking families in hospital quality and improvement efforts

Led by a parent leader and a bilingual staff member

Results:

Expanded patient and family engagement to Spanish-speaking families and meets monthly

Developed new family orientation materials in Spanish

Created new nurse-family communication materials (bilingual, pictorial, video)

Developed and implemented bilingual signage, Spanish radio health messaging, and Spanish videos to help orient patients and families to the hospitals

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City of Hope Cancer Center Engages Spanish-Speaking Community

Created El Concilio, a Spanish-speaking patient and family advisory council

Informs linguistically and culturally appropriate educational and supportive care programs for Spanish-speaking patients/caregivers

Results:

Developed materials in Spanish and other languages

Revamped Spanish language version of hospital website

Created Healthy Hispanic Living, a website to educate the Hispanic community

Established process to identify Spanish-speaking volunteers

Expanded educational programs and classes to be taught in Spanish

Promoted phone interpreter services and on-site interpreters to staff

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Massachusetts General Hospital Launches Multicultural Advisory Committee

Established Committee on Racial and Ethnic Disparities in Health and Health Care

Recommended the creation of a multicultural advisory committee (MAC) to advise the hospital on patient experience at MGH, minority communities’ perceptions of hospital, and review programs/initiatives addressing minority patient or community issues

Results:

MAC consists of 15-18 individuals and reflects the racial and ethnic demographics of Boston and the Mass General health center communities

Launched “The Service Matters Series,” an 8-hour program that trains frontline staff about providing a welcoming experience for patients and families

Continues to identify barriers to improving the health of minorities and makes recommendations, such as a the need for a health literacy campaign

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Providers are Driving TransformationProviders are Driving Transformation

More than 50,000 providers are or will be soon providing care to beneficiaries as part of the Innovation Center’s current initiatives

Over 250 organizations are participating in Medicare ACOs

More than 4 million Medicare FFS beneficiaries are receiving care from ACOs

More than 1 million Medicare FFS beneficiaries are participating in primary care initiatives

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http://innovation.cms.gov/initiatives/Transforming-Clinical-Practices/

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Core Competencies of Practice Transformation

Engaged leadership; quality improvement strategyEmpanelment (linking each patient with a responsible primary

care provider)Continuous and team-based relationships among providers

(specialty, primary care, others)Organized, evidence-based care; patient-centered interactionsIntentional approach to patient and family engagement Enhanced access; progression toward population –based care

management and reduction of disparitiesSystematic efforts to reduce un-necessary diagnostic testing and

procedures with little or no benefitState-of-the-art, results-linked, care coordination Financial acumen in the various payment alternatives

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Moving toward Safety

Supporting providers and families in achieving a system that provides high quality, safe and affordable care:

• Implementing a framework for improvement• Creating Learning systems supported by change

agents throughout the country to spread evidenced based practices

• Decreasing waste in the system• Focusing on the patient through engagement and

transparency• Linking quality to payment

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Decreasing Waste

• Spreading lean techniques and developing lean coaches

• New culture focused on the truth and improvement

• Continuously plan, do, study, and act

• Decreasing administrative waste

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Development Time Current Process Jan 2013 – 3 to 5 years

Electronic Clinical Quality Measure (eCQM) Development Kaizen Future & Current States

Development Time Future Process – 1 year

Major Changes Future vs. Current: -Single Piece “Continuous” Flow vs. Batch Flow Processing-Upfront vs. During Stakeholder Engagement-Streamlined vs. Redundant Approval Loops-QA throughout the process vs. only the end

=

=

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Moving toward Safety

Supporting providers and families in achieving a system that provides high quality, safe and affordable care:

• Implementing a framework for improvement

• Creating Learning systems supported by change agents throughout the country to spread evidenced based practices

• Decreasing waste in the system

• Improved transparency and patient engagement

• Linking quality to payment

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Public Reporting TimelinePublic Reporting Timeline

• 2011 PQRS, GPRO, eRx &EHR Incentive Program Participation

• 2012 PQRS, GPRO, eRx, & EHR Incentive Program Participation

• Information on ABMS board certification

• 2014 PQRS, GPRO, EHR, Incentive Program Participation

• 2014 Maintenance of Certification Incentive

• 2014 PQRS GPRO & ACO measures

• 2014 CG-CAHPS data for GPROs, ACOs, and other groups

• 2014 Individual PQRS Quality Measures

• Measures from the 2014 Cardiovascular Prevention measures group in support of Million Hearts Initiative

• Specialty Society Measures (beyond 2015)

• 2013 PQRS, GPRO, & EHR Incentive Program Participation

• 2013 PQRS Maintenance of Certification Incentive

• 2012 PQRS GPRO & ACO measures (early 2014)

• 2013 PQRS GPRO & ACO measures (late 2014)

• GPRO Composite Measures (DM & CAD) (late 2014)

• CG-CAHPS data for PQRS GPROs and ACOs (late 2014)

• Successful reporting of the 2013 Cardiovascular Prevention measures group in support of Million Hearts Initiative

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Moving toward Safety

Supporting providers and families in achieving a system that provides high quality, safe and affordable care:

• Implementing a framework for improvement• Creating Learning systems supported by change

agents throughout the country to spread evidenced based practices

• Decreasing waste in the system• Focusing on the patient through engagement and

transparency• Linking quality to payment

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• Goal is to reward providers and health systems that deliver better outcomes in health and health care at lower cost to the beneficiaries and communities they serve.

• Hospital value-based purchasing program shifts approximately $1 billion based on performance

• Five Principles

- Define the end goal, not the process for achieving it

- All providers’ incentives must be aligned

- Right measure must be developed and implemented in rapid cycle

- CMS must actively support quality improvement

- Clinical community and patients must be actively engaged

VanLare JM, Conway PH. Value-Based Purchasing – National Programs to Move from Volume to Value. NEJM July 26, 2012

• Goal is to reward providers and health systems that deliver better outcomes in health and health care at lower cost to the beneficiaries and communities they serve.

• Hospital value-based purchasing program shifts approximately $1 billion based on performance

• Five Principles

- Define the end goal, not the process for achieving it

- All providers’ incentives must be aligned

- Right measure must be developed and implemented in rapid cycle

- CMS must actively support quality improvement

- Clinical community and patients must be actively engaged

VanLare JM, Conway PH. Value-Based Purchasing – National Programs to Move from Volume to Value. NEJM July 26, 2012

Value-Based Purchasing

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• Hospital:

• Value-based purchasing, readmissions, healthcare acquired conditions, EHR Incentive Program and Inpatient Quality Reporting

• Physician/clinician

• Physician value-based modifier, physician quality reporting system, EHR incentive program

• End stage renal disease bundle and quality incentive program

• Hospital:

• Value-based purchasing, readmissions, healthcare acquired conditions, EHR Incentive Program and Inpatient Quality Reporting

• Physician/clinician

• Physician value-based modifier, physician quality reporting system, EHR incentive program

• End stage renal disease bundle and quality incentive program

Value-Based Purchasing

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Physician Value Modifier

• VM assesses both quality of care furnished and the cost of that care under the Medicare Physician Fee Schedule.

• The VM is a new per-claim adjustment under the Medicare Physician Fee Schedule that is applied at the group (Taxpayer Identification Number “TIN”) level to physicians billing under the TIN.

• CY 2015 – CMS will apply the VM to groups of physicians with 100 or more eligible professionals (EPs) based on 2013 performance.

• CY 2016 - CMS will apply the VM to groups of physicians with 10 ore more EPs based on 2014 performance.

• CMS is required to apply the VM to all physicians and groups of physicians starting in 2017.

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From Coverage to CareFrom Coverage to Care

An initiative designed to help the newly insured understand:

– What it means to have health insurance;– How to find the right provider;– When and Where to seek health services;

and– Why prevention and partnering with a provider

is important for achieving optimal health.

To equip health care providers and staff with information and resources to help them better understand and connect with newly insured patients.

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http://marketplace.cms.gov/training/get-training.htmlhttp://marketplace.cms.gov/training/get-training.html

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Get Engaged and Stay Informed!Get Engaged and Stay Informed!

http://marketplace.cms.gov

[email protected]

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Learn, Act, Improve, Spread, Sustain

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• How can CMS continue to facilitate and spread best practices in quality improvement initiatives?

• How can CMS best engage with the National Hispanic Medical Association to support clinical practice transformation efforts ?

• What are the most important considerations as CMS prepares to expand the availability of clinician information on public reporting sites?

• How can CMS ensure that providers understand the Value Modifier Program?

QuestionsQuestions