Applying Performance Measures to Improve Quality and ...

Applying Performance Measures to Improve Quality and ...

Applying PerformanceMeasures to ImproveQuality andDemonstrate ValueBurn Quality ConsensusConferenceFebruary 7, 2012Tom Valuck, MD, JDSenior Vice President,Strategic PartnershipsThis material is for individual learning purposes only and is not to bereproduced or distributed in any way.

Strategies for Reforming Health Care• Public Reporting: engaging consumers and othersstakeholders• Health Information Technology: enablingimprovement• Value‐Based Payment: rewarding achievement• Clinically‐Integrated Delivery Systems: achievingpatient‐centered, coordinated care2

Quality Measurement Enterprise• Priorities and Goals• Standardized Measures• Electronic Data Platform• Alignment of Environmental Drivers• Public reporting• Performance‐based payment• Evaluation and Feedback3

Quality Measurement EnterprisePriorities andGoalsStandardizedMeasuresElectronicDataPlatformMeasure Use inImplementationEvaluationandFeedbackNational QualityStrategyNational PrioritiesPartnershipHigh‐ImpactConditionsMeasure StewardsNQF Endorsementand MaintenanceProcessQuality DataModeleMeasureFormatMeasureAuthoring ToolMeasureApplicationsPartnershipMeasure DatabaseMeasure AlignmentToolMeasure UseEvaluation4

National Quality Forum’s MissionTo improve the quality of American healthcare by:• Building consensus on national priorities and goals forperformance improvement and working in partnershipto achieve them;• Endorsing national consensus standards for measuringand publicly reporting on performance; and• Promoting the attainment of national goals througheducation and outreach programs.5

NQF’s Primary Roles• Standard setting organization• Performance measures, serious reportable events, andpreferred practices• Neutral convener• National Priorities Partnership• Measure Applications Partnership6

Quality Measurement EnterprisePriorities andGoalsStandardizedMeasuresElectronicDataPlatformMeasure Use inImplementationEvaluationandFeedbackNational QualityStrategyNational PrioritiesPartnershipHigh‐ImpactConditionsMeasure StewardsNQF Endorsementand MaintenanceProcessQuality DataModeleMeasureFormatMeasureAuthoring ToolMeasureApplicationsPartnershipMeasure DatabaseMeasure AlignmentToolMeasure UseEvaluation7

What is the National Priorities Partnership?• Convened by the NQF –viewed as objective, neutral and experienced inbuilding consensus• 51 leaders across every key health and healthcare sector• Consumers• Purchasers• Quality alliances• Health professionals/providers• State‐based associations• Community collaboratives & regional alliances• Accreditation/certification groups• Health plans• Industry• Federal agencies (AHRQ, CDC, CMS, FDA, HRSA, NIH, OMH, SAMHSA, VA)• Co‐ChairsHelen Darling, National Business Group on HealthBernie Rosof, Physician Consortium for Performance Improvement8

Priorities Make A DifferenceNATIONAL PRIORITIES PARTNERSHIPCan get usthere faster…WHERE WE ARE GOINGBetter Care, Affordable Care, and Healthy People/Healthy Communities9

NPP’s Input into the National Quality StrategyACA requires HHS to seek NPP’s counsel:•October 2010: NPP provides input to HHS to inform thedevelopment of the NQS•March 2011: HHS issues NQS with three aims and six priorities•September 2011: NPP input to HHS helps to make NQS moreactionable:• Identification of goals and measures• Recommendation of strategic opportunities• Consensus across key leaders about where to drive their organizations© National Priorities Partnership10

HHS’ National Quality Strategy Aims andPriorities11

National Priorities• Work with communities to promote wiseuse of best practices to enable healthyliving and well‐being.• Promote the most effective prevention,treatment, and intervention practices for theleading causes of mortality, starting withcardiovascular disease.• Ensure person‐ and family‐centeredcare.12

National Priorities• Make care safer.• Promote effective communication andcare coordination.• Make quality care affordable forpeople, families, employers, andgovernments.13

NPP’s Role as an Action Catalyst• In addition to setting national priorities and goals, NPPrecommends and monitors the implementation of strategicopportunities to achieve the priorities and goals• NPP provides a unique opportunity for stakeholders to alignand take action, to engage others to advance the priorities andgoals, and to accelerate change• Recognizing stakeholders need a portfolio of options toaddress priorities and promote fundamental systems change,NPP’s most recent report to HHS laid out three sets of strategicopportunities14

NPP’s Report: Three Sets of Strategies• One: A national strategy for data collection, measurement andreporting that supports measurement‐based improvement sowe know “how we are doing” against the NQS• Two: Community infrastructure (public‐private) responsiblefor improvement efforts, resources for benchmarking andcomparing performance, and mechanisms to identify, shareand evaluate progress• Three: Payment and delivery system reform—emphasizingprimary care—that rewards value over volume and promotespatient‐centered outcomes, efficiency, and appropriate carewhile reducing waste15

NPP’s Support of HHS’ Partnership for Patients• Focus on safety, particularly healthcare‐acquired conditionsand readmissions• Quarterly NPP‐PfP meetings to identify public‐private sectoropportunities for collaboration• Affinity groups and action pathways• Patient Safety Webinar Series16

Quality Measurement EnterprisePriorities andGoalsStandardizedMeasuresElectronicDataPlatformMeasure Use inImplementationEvaluationandFeedbackNational QualityStrategyNational PrioritiesPartnershipHigh‐ImpactConditionsMeasure StewardsNQF Endorsementand MaintenanceProcessQuality DataModeleMeasureFormatMeasureAuthoring ToolMeasureApplicationsPartnershipMeasure DatabaseMeasure AlignmentToolMeasure UseEvaluation17

Measurement Facilitates Improvement• Measurement is necessary, but insufficient toachieve quality• Provides information about performance useful forselecting providers with high quality (consumers,purchasers, health plans)• Provides information about outcomes andprocesses useful to providers for identifying areasthat need improvement and changes in caredelivery systems18

Quality Measurement in Evolution• Patient‐level outcomes (better health)• Morbidity and mortality• Functional status• Health‐related quality of life• Patient experience of care• Processes of care (better care)• Clinical processes tightly linked to outcomes• Care coordination and transitions• Patient engagement and alignment with patient preferences• Cost/resource use (affordability)• Per capita cost• Total cost of care• Patient out‐of‐pocket cost19

Endorsement Topic Areas1. Cancer 12. Mental health2. Cardiovascular 13. Musculoskeletal3. Care coordination 14. Neurology4. Disparities 15. Palliative & end‐of‐life care5. Endocrine 16. Patient experience/engagement6. Functional Status 17. Perinatal7. Gastrointestinal 18. Prevention8. GU/GYN 19. Pulmonary/Critical Care9. Healthcare Infrastructure 20. Renal10. HEENT 21. Safety11. Infectious disease 22. Surgery20

Measure Endorsement ProcessQF 9-Step Consensus Development Process:Call for Intent to Submit Candidate StandardsCall for Nominations for Steering Committee and Technical ExpertPanelsCall for Candidate StandardsCandidate Consensus Standard ReviewNQF Member and Public CommentNQF Member VotingConsensus Standards Advisory Committee (CSAC) DecisionNQF Board of Directors EndorsementAppeals Process21

NQF Endorsement Evaluation Criteria• Importance to measure and report• What is the level of evidence for the measure?• Is there an opportunity for improvement?• Relation to a priority area or high impact area of care?• Scientific acceptability of the measurement properties• What is the reliability and validity of the measure?• Usability• Can the intended audiences understand and use the results for decisionmaking?• Feasibility• Can the measure be implemented without undue burden, capture withelectronic data/EHRs?• Assess competing and related measures22

The Measurement ImperativeNot everything that counts can be counted, and noteverything that can be counted counts.~Albert EinsteinBUT…You cannot improve what you do notmeasure.23

Quality Measurement EnterprisePriorities andGoalsStandardizedMeasuresElectronicDataPlatformMeasure Use inImplementationEvaluationandFeedbackNational QualityStrategyNational PrioritiesPartnershipHigh‐ImpactConditionsMeasure StewardsNQF Endorsementand MaintenanceProcessQuality DataModeleMeasureFormatMeasureAuthoring ToolMeasureApplicationsPartnershipMeasure DatabaseMeasure AlignmentToolMeasure UseEvaluation24

Linking HIT and MeasurementDataSourcesData SourcesPerformanceMeasuresEHRs andHIT ToolsE‐Infrastructure25

Linking HIT and MeasurementPerformance measurement•700 + Measures•Dozens of stewardsHealth IT Advisory Committee•Translate (QDM)•Harmonize measure standardsand HIT standardsHealth IT•Vendors•Standard Development Orgs26


Comprehensive Data Needed to GeneratePerformance InformationLaboratoriesPharmaciesQualityImprovementCareEvaluationMedicalClaimsConsumerActivationPay forPerformanceEHRsRegistriesData AggregationHospitals/InstitutionsRWJF Aligning Forces for Quality 28

Data Platforms for Measurement• Measures work on multiple data platforms:• Level 1: Single source of claims• Level 2: Aggregation of multiple sources of claims (e.g.,diagnosis plus pharmacy claims)• Level 3: Clinically enriched sources (e.g., claims plusclinical laboratory results)• Level 4: Electronic health record data• Retooling effort underway for electronic data collection29

Migration of Measures to Electronic DataPlatform• Immediate Strategy• Over 100 measures have been retooled• Preferred Approach• Establish a comprehensive data platform to supportperformance measurement and improvement• Develop performance measures that take advantage ofavailable data and are “turnkey”30


Quality Measurement EnterprisePriorities andGoalsStandardizedMeasuresElectronicDataPlatformMeasure Use inImplementationEvaluationandFeedbackNational QualityStrategyNational PrioritiesPartnershipHigh‐ImpactConditionsMeasure StewardsNQF Endorsementand MaintenanceProcessQuality DataModeleMeasureFormatMeasureAuthoring ToolMeasureApplicationsPartnershipMeasure DatabaseMeasure AlignmentToolMeasure UseEvaluation32

Applying Performance MeasurementInformationAccountabilityQualityimprovementQualityimprovement withbenchmarkingPublichealth/diseasesurveillanceCertificationAccreditationand regulationHIT incentivepaymentsPerformancebasedpaymentConsumerchoiceImproveCareTransparency33

Payment Reform ModelsPayment for servicePayment for episode orprocedurePayment for care of apopulationFee‐forserviceAugmentedfee‐forservice(e.g., P4P)Bundledpayment(singleprovider)Bundledpayment(multipleproviders)PartialcapitationFullcapitationIncreasing aggregation of services into a unit of payment34

Organization of Delivery and Payment:Selection of Performance Measures35

Measurement Implications• Measurement role• Pay differentially based on performance• Promote evidence‐based care• Avoid inappropriate care• Better coordinate care• Focus on the patient• Protect against unintended consequences of paymentincentives• Support performance improvement36

Measure Applications PartnershipStatutory AuthorityHealth reform legislation, the Affordable Care Act(ACA), requires HHS to contract with the consensusbasedentity (i.e., NQF) to “convene multistakeholdergroups to provide input on theselection of quality measures” for public reporting,payment, and other programs.37

Purpose of MAP• Provide input to HHS on the selection of performancemeasures for use in public reporting, performance‐basedpayment, and other programs• Identify gaps for measure development, testing, andendorsement• Encourage alignment of public and private sectorprograms• Harmonize measurement across levels of analysis andsettings to:• Promote coordination of care delivery• Reduce data collection burden38

MAP Two‐Tiered StructureAd Hoc Safety WorkgroupMore than 60 major stakeholder organizations, 40 individual experts, and 9federal agencies are represented on the MAP39

MAP Coordinating Committee Membership40

Measure Applications PartnershipInitial TasksPerformance Measurement Coordination StrategiesCoordination Strategy for Clinician Performance MeasurementReadmissions and Healthcare‐Acquired Conditions Performance Measurement StrategyAcross Public and Private PayersStrategic Approach to Performance Measurement for Dual Eligible Beneficiaries InterimReportPerformance Measurement Coordination Strategy for Post‐Acute Care and Long‐Term CareReports submittedOctober 1, 2011Report submittedFebruary 1, 2012Reports can be found on the NQF website41

MAP Clinician Coordination StrategyRecommendations for coordinating clinician performancemeasurement across federal programs:•Alignment of measures and data sources to reduceduplication and burden•Characteristics of an ideal measure set to promote commongoals across programs•Standardized data elements42

MAP Safety Coordination StrategyRecommendations for coordinating efforts to reducehealthcare‐acquired conditions and readmissions acrosspublic and private payers:•National core set of safety measures applicable to allpatients•Data element library for core measure set•Public and private coordination of efforts, beginning withincentive structures43

Strategic Approach to PerformanceMeasurement for Dual Eligible BeneficiariesVision: In order to promote a system that is both sustainable and personandfamily‐centered, individuals eligible for both Medicare and Medicaidshould have timely access to appropriate, coordinated healthcare servicesand community resources that enable them to attain or maintain personalhealth goals.•Elements of Strategic Approach:• Guiding Principles• High‐Need Subgroups• High‐Leverage Opportunities• Illustrative Measures• Data Sources• Program Alignment44

MAP PAC/LTC Coordination StrategyRecommendations for coordinating performancemeasurement across federal programs for nursing homes,home health, inpatient rehabilitation facilities, and long‐termcare hospitals:•Promote common measurement goals across providers by using theidentified priorities and measurement goals•Encourage uniform data sources and use of health IT so data can becollected once, in the least burdensome way, and be used for multiplepatient‐centric purposes•Improve the use of measures for PAC/LTC settings by filling prioritymeasure gap, developing standardized planning tools, and monitoring forunintended consequences45

Measure Applications PartnershipInitial TasksAnnual Pre‐rulemaking Input to HHSMAP Pre‐Rulemaking ReportReportsubmittedFebruary 1,2012Report can be found on the NQF website46

HHS National Quality Strategy Aims and Priorities• Working with communities to promotewide use of best practices to enablehealthy living• Promoting the most effective preventionand treatment practices for the leadingcauses of mortality, starting withcardiovascular disease• Ensuring that each person and family areengaged as partners in their care• Making care safer by reducing harmcaused in the delivery of care• Promoting effective communication andcoordination of care• Making quality care more affordable forindividuals, families, employers, andgovernments by developing and spreadingnew health care delivery models47

Person‐ and Family‐Centered MeasurementMeasuring what isimportant topatients andconstruction ofmeasures specific topatient populationsrather than providersettings or diseases48

Measures Across Multiple Levels in the HealthcareSystemNational Priority: Promote the most effective prevention, treatment, and intervention practices for the leading causes ofmortality, starting with cardiovascular disease.Promote cardiovascular health through community interventions thatresult in improvement of social, economic, and environmental factors.Promote cardiovascular health through interventions that result inadoption of the most important healthy lifestyle behaviors across thelifespan.Promote cardiovascular health through receipt of effective clinicalpreventive services across the lifespan in clinical and communitysettings.Access to healthy foodsAccess to recreational facilitiesUse of tobacco products by adults and adolescentsConsumption of calories from fats and sugarsControl of high blood pressureControl of high cholesterol49

MAP Measure Selection Criteria1. Measures within the program measure set are NQF‐endorsedor meet the requirements for expedited review2. Program measure set adequately addresses each of theNational Quality Strategy (NQS) priorities3. Program measure set adequately addresses high‐impactconditions relevant to the program’s intended population(s)(e.g., children, adult non‐Medicare, older adults, dual eligiblebeneficiaries)4. Program measure set promotes alignment with specific programattributes, as well as alignment across programs50

MAP Measure Selection Criteria5. Program measure set includes an appropriate mix of measuretypes6. Program measure set enables measurement across the personcenteredepisode of care7. Program measure set includes considerations for healthcaredisparities8. Program measure set promotes parsimony51

Care Coordination Performance Measures Across SettingsClinician Hospital Post‐Acute Care/Long‐Term CareCareTransitionsSupport CTM‐3 (NQF#0228) if successfullydeveloped, tested, andendorsed at the clinicianlevelSupport immediateinclusion of CTM‐3measure and urge for it tobe included in the existingHCAHPS surveySupport several dischargeplanning measures (i.e.,NQF #0338, 0557, 0558)Support CTM‐3 if successfullydeveloped, tested, and endorsedin PAC‐LTC settingsIdentified specific measure forfurther exploration for its use inPAC/LTC settings (i.e., NQF#0326, 0647)ReadmissionsReadmission measures area priority measure gap andserve as a proxy for carecoordinationSupport the inclusion ofboth a readmissionmeasure that crossesconditions andreadmission measuresthat are condition‐specificIdentified avoidableadmissions/readmissions (bothhospital and ED) as prioritymeasure gapsMedicationReconciliationSupport inclusion ofmeasures that can beutilized in an HITenvironment includingmedication reconciliationmeasure (i.e., NQF #0097)Recognize the importanceof medicationreconciliation upon bothadmission and discharge,particularly with the dualeligible beneficiaries andpsychiatric populationsIdentified potential measures forfurther exploration for useacross all PAC/LTC settings (i.e.,NQF #0097)52

Dual Eligible Beneficiaries• HHS has identified the dual eligible beneficiary population as apriorityconsideration for all MAP tasks• One of many populations that could greatly benefit from a purposeful andperson‐centered approach to care and related quality measurement• Many of the poorest and sickest individuals in the health system are dualeligible beneficiaries. The group is disproportionately expensive and providesan important opportunity to address the affordability aspect of NationalQuality Strategy• Dual eligible beneficiaries are served in every part of the health and long‐termcare systems, but they do not have their own Federal measurement program• To expand the use of measures that are relevant to duals’ unique needs,those types of measures must be added to existing programs53

Contribution to Strategic AlignmentDual Eligible Beneficiaries• To make measures more relevant to the needs of vulnerable populationssuch as dual eligible beneficiaries, MAP recommendations:▫ Take a cross‐cutting approach, emphasizing outcome and compositemeasures» Broaden denominators as much as clinical evidence allows, but allow for exclusions so as notto diminish patient choice» More precise measure arrays can be used for targeted internal quality improvement efforts▫ Explore stratification of measures to reveal and reduce disparities▫ Push measurement forward in the areas of care coordination and sharedaccountability, while keeping the individual and his/her goals at thecenter▫ Increase emphasis on behavioral health issues throughout the system• MAP supported for inclusion all measures under consideration that had beenidentified as core concepts for dual eligible beneficiaries54

Pre‐Rulemaking Report –General Themes• The National Quality Strategy (NQS) provides the guiding framework forMAP decision making and is reflected as a key component of the MAPMeasure Selection Criteria• MAP adopted a person‐centered approach to measure selection,encouraging broader use of patient‐reported measures such as theClinician Group‐Consumer Assessment of Healthcare Providers (CG‐CAHPS)• Many high priority measurement gaps were identified, including measuresof patient experience, functional status, shared decision making, carecoordination, cost, appropriateness of care, and mental health• Measures used in federal programs should promote team‐based care andshared accountability through population‐level measurement, asexemplified by the Medicare Shared Savings Program55

Pre‐Rulemaking Report –Measures• Provided input on over 350 measures under consideration by HHSfor nearly 20 Federal performance measurement programs:▫ Support the measure – MAP supports the measure for inclusion in theassociated federal program during the next rulemaking cycle for thatprogram» Approximately 40% of the measures under consideration▫ Support the direction of the measure – MAP supports the measureconcept, however, further development, testing, or implementationfeasibility must be addressed before inclusion» Approximately 15% of the measures under consideration▫ Do not support the measure – Measure is not recommended forinclusion in the association federal program» Approximately 45% of the measures under consideration• For nearly 70% of the measures within the do not support category, MAPdid not have enough information to complete its evaluation, so could notsupport those measures at this time56

Federal Program for MAP Pre‐Rulemaking InputValue‐Based Payment ModifierPhysician Quality Reporting SystemMedicare and Medicaid EHR Incentive Program for Eligible ProfessionalsMedicare Shared Savings ProgramHospital Inpatient Quality ReportingHospital Value‐Based PurchasingHospital Outpatient Quality ReportingMedicare and Medicaid EHR Incentive Program for Hospitals and CAHsProspective Payment System (PPS) Exempt Cancer Hospital Quality ReportingInpatient Psychiatric Facility Quality ReportingAmbulatory Surgical Center Quality ReportingHome Health Quality ReportingNursing Home Quality Initiative and Nursing Home Compare MeasuresInpatient Rehabilitation Facility Quality ReportingLong‐Term Care Hospital Quality ReportingHospice Quality ReportingEnd Stage Renal Disease Quality ManagementMAP WorkgroupClinicianWorkgroupHospitalWorkgroupPAC/LTCWorkgroup57

Clinician Performance Measurement ProgramsClinician ProgramValue‐BasedPayment ModifierPhysician QualityReportingMedicare andMedicaid EHRIncentive Programfor EligibleProfessionalsMedicare SharedSavings ProgramMeasures UnderConsiderationSupport Do Not Support SupportDirection7 0 0 7153 17 120 1692 67 25 00 n/a n/a n/a58

Clinician Performance Measurement Programs• Federal programs should augment measure alignment between public andprivate sectors, including the utilization of existing Maintenance ofCertification (MOC) requirements in clinician performance measurementprograms• More information on specifications of measures within PQRS is needed forMAP to fully evaluate the program▫ A number of measures are still in the development and testingphase, while other measures do have finalized specifications andshould be made available to MAP for future deliberations• Over time, as HIT becomes more effective and interoperable, theMeaningful Use program should have a greater focus on HIT‐sensitivemeasures (i.e., measures that provide information on whether electronichealth records are changing care processes) and HIT‐enabled measures(i.e., measures that require data from multiple settings/providers or arelongitudinal and would require an HIT‐enabled collection platform to befully operational)59

Hospital Performance Measurement ProgramsHospital ProgramMeasures UnderConsiderationSupport Do Not Support Support DirectionHospital InpatientQuality ReportingHospital Value‐BasedPurchasingMedicare andMedicaid EHRIncentive Programfor Hospitals andCAHSHospital OutpatientQuality ReportingAmbulatory SurgicalCenter QualityReportingInpatient PsychiatricFacility QualityReportingPPS Exempt CancerHospitals22 9 3 1013 3 9 136 27 9 00 n/a n/a n/a0 n/a n/a n/a6 6 0 05 5 0 060

Hospital Performance Measurement Programs• Composite measures offer a comprehensive picture of patient care for aspecific condition or an overall institution▫Composite measures should also allow for examination of individualcomponent scores to assist providers in addressing the specific careimprovement opportunities• Measures should align across programs addressing similar settings of care,for example, encouraging greater overlap between Hospital InpatientQuality Reporting and PPS‐exempt Cancer Hospital Reporting Programmeasures▫Synchronize measures across care settings where comparable care isprovided, such as Hospital Outpatient Quality Reporting and the PhysicianQuality Reporting System.• Patient Safety is a high priority area for all stakeholder groups representedwithin MAP, and MAP strongly supported the use of NQF‐endorsed safetymeasures where available61

PAC‐LTC Performance Measurement ProgramsPAC‐LTC ProgramMeasures UnderConsiderationSupport Do Not Support Support DirectionNursing HomeCompareHome Health QualityReportingInpatientRehabilitationFacility QualityReportingLong‐Term CareHospital QualityReporting0 n/a n/a` n/a0 n/a n/a n/a8 0 0 88 0 0 8Hospice QualityReporting 6 6 0 0End Stage RenalDisease QualityManagement5 3 1 162

PAC‐LTC Performance Measurement Programs• Important measures of changes in functional status, whetherpersonalized care goals are established and attained, and patient, family,and caregiver experience are limited, if not entirely absent, from PAC/LTCprograms• Measure gaps can potentially be addressed by adapting existingperformance measures from Nursing Home Compare or Home HealthCompare, also promoting alignment• Measure set should address aspects of care beyond clinical care:▫▫Include assessment of health‐related quality of life measureExplore available depression screening measures63

Overall Prioritized Gaps• Many high priority measurement gaps were identified,including measures of patient experience, functional status,shared decision making, care coordination, cost,appropriateness of care, and mental health▫ Gaps can be “implementation” gaps where appropriate measuresexist but are not included in a given program, or “development”gaps where the desired measures are extremely limited or do notcurrently exist• Focus funding for measure development on prioritized gapareas identified by MAP64

Gaps Across the Measurement SpectrumMeasureConceptualizationMeasureDevelopmentMeasureTestingMeasureEndorsementMeasure UseNationalQualityStrategyMeasure StewardsNQFEndorsementProcessMeasureApplicationsPartnership65

Path Forward• Resolving gaps will require different strategies:▫ Defining measures concepts for true gaps▫ Identifying funding for measure development, testing,and endorsement▫ Assigning stewardship for measure development andmaintenance▫ Constructing test beds▫ Building a common data platform for efficientcollection and reporting of data▫ Ensuring public and private alignment66

Path Forward• MAP needs feedback loops with HHS and the private sectorregarding the actual use, implementation experience, andimpact of performance measures• MAP has identified significant opportunities to furtherintegrate its work with that of the National PrioritiesPartnership (NPP) in pursuit of mutual objectives defined bythe NQS.▫ Undertaking joint NPP and MAP planning to outline aMAP strategy with a 3‐5 year planning horizon willprovide a more coordinated approach to measureapplication67

Upcoming MAP ReportsPerformance Measurement Coordination StrategiesMeasures for Use in Quality Reporting for PPS‐Exempt CancerHospitalsMeasures for Use in Quality Reporting for Hospice CareStrategic Approach to Performance Measurement for Dual EligibleBeneficiaries Final ReportReports dueJune 1, 201268

Ways to Participate in MAP Activities• Visit the NQF website• Attend MAP committee and workgroup meetings▫ All meetings are open to NQF members▫ Upcoming Meetings:» Post‐Acute Care/Long‐Term Care Workgroup In‐Person Meeting,February 14, 2012» Dual Eligible Beneficiaries Workgroup In‐Person Meeting, February 21‐22, 2012» Coordinating Committee In‐Person Meeting, March 15‐16, 2012▫ Materials located on NQF website• Public comment periods for reports• Annual nomination process for new MAP members69

Quality Measurement EnterprisePriorities andGoalsStandardizedMeasuresElectronicDataPlatformMeasure Use inImplementationEvaluationandFeedbackNational QualityStrategyNational PrioritiesPartnershipHigh‐ImpactConditionsMeasure StewardsNQF Endorsementand MaintenanceProcessQuality DataModeleMeasureFormatMeasureAuthoring ToolMeasureApplicationsPartnershipMeasure DatabaseMeasure AlignmentToolMeasure UseEvaluation70

Improving Access to NQF‐Endorsed MeasuresQuality Positioning System (QPS)• Find and compare NQF‐endorsed measures by topic, datasource, national frameworks, and more• Build, share, search and compare ‘portfolios’ or lists of NQFendorsedmeasures created by anyone engaged or interested inmeasurement and reporting• Provide feedback to NQF about any measure and stay informedabout changes in endorsement status• QPS is in beta –tell us what you think!



Quality Measurement EnterprisePriorities andGoalsStandardizedMeasuresElectronicDataPlatformMeasure Use inImplementationEvaluationandFeedbackNational QualityStrategyNational PrioritiesPartnershipHigh‐ImpactConditionsMeasure StewardsNQF Endorsementand MaintenanceProcessQuality DataModeleMeasureFormatMeasureAuthoring ToolMeasureApplicationsPartnershipMeasure DatabaseMeasure AlignmentToolMeasure UseEvaluation82

Some of the Collaboratives Across the Country83

Community Tool to Align MeasurementPurpose: Align to compare results, be well‐positioned, reduce burden• Shaped based on input from 16 Aligning Forces for Quality (AF4Q)groups, with deeper assistance from Cincinnati, Detroit and Maine• Supports decisions consistent with national programs and funding(e.g., National Quality Strategy, payment reform)• Creates ability to compare measure use across regions and offers aroadmap to start, expand, or align measurement and reporting• Is a snapshot in time and not NQF‐endorsed84

Thank You!Tom Valuck, MD, JDSenior Vice PresidentStrategic Partnershipstvaluck@qualityforum.org86

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