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Quality Reporting in the New Payment Models
Carol L. Henwood, DO, FACOFP dist.
Iowa Osteopathic Association 33rd Annual Winter Update
December 2014
COPD
CHF
SIADH
ESRD
HNPCCRA
NAFLD
HTNPVD
CAD
CMPY
GERD
BPHIBD
IBS
PE
PCMH
AHRQCMMI
PCPCC
MRANCQA
ACO
HEDISCG-CAHPS
5-STAR
Outcomes and Evaluations• Stating the Facts: Cost, Quality and Outcomes in the Medical Neighborhood
• PCMH Initiatives• 172 at onset
• 118 evaluated as had external payment reform support• 85% NCQA recognition• NO initiatives in MI, MS, UT, HI
• 56% Payment FFS + PMPM + P4P• Of 56%, shared savings 38%
• Multi-payor Initiatives2009 2013
• Min PMPM $0.50 $3.94• Max PMPM $9 $11.25
The Triple Aim• Improved Health•Enhanced Patient Experience of Care•Reduced Cost
[+1: Improved Productivity]
TEAM•Timely
•Evidence-based and Effective
•Accessible
•Measureable
HEDIS: Healthcare Effectiveness Data and Information Set
HEDIS Percentiles 2007 HEDIS Percentiles 2012
Breast Cancer Screening 49.1-69.9 66-79
Cervical Cancer Screening 65.7-81 73-79
Diabetes Care (HgbA1c<7) 30.2-45.8
Diabetes Care (HgbA1c>9) 35-23
BP Control (<140/90mmHg) 53.1-59.7 55-68
Pay for Performance (P4P)
•BETTER CARE FOR INDIVIDUALS Patient/Caregiver Experience
Care Coordination and Safety
•BETTER HEALTH FOR POPULATIONS Preventative Health
At Risk Population – Diabetes
At Risk Population – Hypertension
At Risk Population – Ischemic Vascular Disease
At Risk Population – Heart Failure
At Risk Population – Coronary Artery Disease
P4P phase in from reporting to performance
Methods of Reporting ClaimsSurvey
EHR Incentive Program Reporting
PQRS Web Interface
CAHPS Clinician and Group Surveys (CG-CAHPS)
Visit SurveyPCMH Item Set
Health Information Technology Item Set
Version 2.0• Items refer to “this provider” VS “this doctor”
• Items about access to care (urgent/non urgent) modified to ask could they get an appointment as soon as they needed VS as soon as they THOUGHT they needed
• Item asking about getting easy to understand instructions were modified from taking of health problems to health questions
• Item whether patient had seen a doctor of other health care provider 3 or more times for the same health condition was simplified to ask whether they got health care 3 or more times for the same health problem
Link to CAHPS Overview of Questions
• Rating of provider•Would recommend provider to family and friends•Demographics• Provider showed concern for patient’s physical comfort• Patient and provider talked about the cost of the prescription• Provider interrupted patient when patient was talking• Provider asked the patient what patient thought was best for patient
https://cahps.ahrq.gov/surveys-guidance/cg/instructions/index.html
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Moving ForwardPayment = FFS + P4P +
PCMH
ACOFP
ACOFP is proud to introduce ACOFP Quality Markers program!
Diabetes: Quality Reporting
Quality Improvement Reporting:All Diabetes Measures
Diabetes: LDL ReportingCare Opportunities: LDL Patients
Coronary Artery Disease: Quality Reporting
Quality Improvement Reporting:CAD: All Measures
Hypertension: Quality Reporting
Quality Improvement Reporting
Patient Care Summary