Ensuring A Person-Centered Approach to Quality MeasurementEmma KopleffSenior Policy Advisor

NCCS Cancer Policy Advocate Training November 14, 2014

About us

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National Partnership for Women & Families

Non-profit, consumer organization with 40 years’ experience on issues related to healthcare, workforce, and anti-discrimination

Consumer-Purchaser Alliance (C-P Alliance)

Collaboration of leading consumer and employer organizations

Vision is a high quality, affordable, person-centered healthcare system

Since 2002, C-P Alliance has shaped delivery and payment reform through the use of meaningful quality measures

What is health care quality and what does it mean to patients?

What are quality measures and how are they used?

What are priority areas of cancer care where quality measurement could better support patient, family and caregiver needs?

Today’s Goal: Answering Key Questions

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Defining Health Care Quality and What it Means to

Patients

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Quality in the U.S. Healthcare System Is Not What It Should Be

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Variation in mammogram rates in female patients aged 65-69:

58% in Oklahoma 76 % in Massachusetts 65.4 % nationally

Patients Are Not Consistently Receiving Recommended Care

55 % of adults 47 % of children

Quality Within the U.S. System:Variation and Inadequacy

6Sources: Dartmouth Institute for Health Policy and Clinical Change, 2013; McGlynn et. al., 2003; Mangione-Smith et. al., 2007

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Many of us can relate to the notion that:We are forced to navigate a complex and

uncoordinated system

We do not feel fully informed or engaged in decisions about our care

We cannot access the information we need in a way that is easy to understand

Patients, Families, and Caregivers’ Needs Are Not Being Met

What Quality Means to Us

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The Right Care

At the Right Time

For the Right Reason

What Is Quality Measurement?

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Quality Measures 101

Quality measures:

A way to evaluate and improve care provided by hospitals, doctors, health plans and other health care entities based on accepted national guidelines or evidence

Defining Quality Measurement

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Quality Has Been Measured For a Long Time

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1850s: Florence Nightingale measured infection rates

Early 1900s: Earnest Codman tracked patient outcomes and documented errors

Over the last 20-25 years:

demand for standardized, “apples to apples” quality information

data availability

willingness to integrate into public policy

Sources: Mainz J, 2004; Berenson, Pronovost and Krumholz, 2013.

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Types of Measures*

*See appendix for additional detail 12

Process Outcome

Patient Experience Structure

Measurement Math: The Simple Version

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Numerator (ex: Patients within the denominator population who received one or more mammograms during the measurement year)

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Denominator (ex: Women 42–69 years of age)

The Measurement Development Process

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Identifying quality issue and evidence

Identifying numerator, denominator, exclusions, time window, data source, and other specifications

Identifying appropriate use and implementing measure

Collecting, verifying and refining data

Endorsement from national standards entity 3+

years

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Uses of Measures to Improve Value

CONSUMER CHOICE PAYMENT

QUALITY IMPROVEMENT

VALUE

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Quality Measurement for Cancer Care

Coordinating care is complex

Increases in survivorship introduce challenges across course of illness and recovery

Current state of cancer care quality measurement is limited

Cancer Care Has A Unique Set of Quality Challenges

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The majority of cancer care quality measures that currently exist are:

Focused on discrete processes of care

Particular to one cancer type Not specific to cancer patients but

still relevant (e.g., rates of hospital infections)

The Current Landscape Misses the Target

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The Desired State

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The future of measure development and implementation should be:

Understandable, meaningful, and usable by consumers

Outcomes-focused Based on patient and/or

family/caregiver-generated health data

Patient-Reported Outcome Measures (PROMs) Are High-Priority

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PROMs promote a more person-centered approach to quality improvement by:

Providing valuable information otherwise not available

Asking patients for information and engaging with them on the results and interventions

Institute of Medicine committee identified key quality gaps for cancer (e.g., patient-reported outcomes, costs of care)

American Society of Clinical Oncology developing PROMs addressing pain and symptom management

MD Anderson Inventory used in clinical practice and research

Promising Endeavors Underway To Fill Gaps in Person-Centered Measures

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How Would You Rate the Highest-Priority Gaps?

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1. Care planning2. Coordination of care3. Cross-cutting patient-reported

issues4. Cancer- and stage-specific

survival rates5. Costs of care

Ensure the consumer voice is heard:CMS and CMMI National Quality Forum Cancer Experience RegistryThe International Consortium for Health

Outcomes Measurement

Be At the Table

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Visit consumerpurchaser.org and sign-up for the Consumer-Purchaser Alliance newsletter:

Stay up to date on opportunities to serve on committees or comment on quality efforts

Sign-on to comment letters and/or write your own

Join educational webinars and conference calls

Collaboration is Key

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Questions?

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For more information

Find us:

www.nationalpartnership.orgwww.consumerpurchaser.org

Contact me:

Emma Kopleff, MPHSenior Policy Advisor, Consumer-Purchaser Allianceekopleff@nationalpartnership.org

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APPENDIX

Process Measure Examples

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Doing the right thing at the right time for patients Examples

Completed mammogram to screen for breast cancer

Recording that vital signs are being monitored

Outcome Measure Examples

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Having an effect on the patient’s health and well-being Examples

Survival rate Rate of infections or complications Quality of life

Patient Experience Measure Examples

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The patient’s own rating of the care received

Examples

The doctor spent enough time with me and answered all of my questions

The hospital gave me information about what to do to manage my care at home

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Structural Measure Examples

Assessing features of delivery organizations, including characteristics of care setting, personnel, and/or policies related to care delivery

Examples Do patients have access to their health

information through an electronic interface? Does an intensive care unit (ICU) have a

critical care specialist on staff at all times?

Name Role

National Quality Forum (NQF) Serves as the national measurement endorsement entity and the primary forum for setting measurement priorities and recommending measures for use in federal programs

National Committee for Quality Assurance (NCQA) Accredits health plans; certifies programs; measure development

The Joint Commission Accredits hospitals; measure development and implementation

Medical specialty societies Ongoing certification requirements; measure development

Centers for Medicare & Medicaid Services (CMS) Payer for Medicare and Medicaid, sponsors measure development, implementation and data aggregation

Agency for Healthcare Research and Quality (AHRQ) Measure developer (e.g. patient experience measures)

Leapfrog Translates hospital quality information to be easily understood by consumers

Key Organizations in the Measurement Enterprise

Berenson RA, Pronovost PJ, Krumholz HM. Achieving the Potential of Health Care Performance Measures: Timely Analysis of Immediate Health Policy Issues, May 2013.

Mainz, Jan. Quality Indicators: Essential for Quality Improvement. Int J Qual Health Care,E 2004; Volume 16, Supplement.

McGlynn EA, Asch SM, Adams J, et. al. The Quality of Health Care Delivered to Adults in the United States. N Engl J Med, 2003; 348:2635-2645.

Mangione-Smith R, DeCristofaro A, Setodji C, et. al. The Quality of Ambulatory Care Delivered to Children in the United States. N Engl J Med, 2007; 357:1515-1523

The Dartmouth Institute for Health Policy and Clinical Practice, 2013, Selected Measures of Primary Care Access and Quality—State Level 2010. Available at www.dartmouthatlas.org/downloads/tables/PC_State_rates_2010.xls.

References

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