Opportunity to Participate on NQF Committees

Building on prior efforts that support consumer and purchaser decision-making in health care based on cost and quality, the National Quality Forum (NQF) is establishing new Standing Committees to review performance measures in high priority areas: cost and resource use measures, and measures of hospital admissions and readmissions. These projects will address issues that are critically important to consumers and purchasers. By injecting your coalition voice into the endorsement process and into oversight of the portfolio of measures in these topic areas, you can help ensure that the measures used for quality improvement and CMS reporting and payment programs are measures that matter to consumers and purchasers. 

Nominations for these Standing Committees are due on November 12, 2013 and additional information on each topical area is provided below and on the NQF website. Please note that if you are selected to serve on a Standing Committee, you will be expected to serve for a two- or three-year term, and participate in conference calls, web and in-person meetings, and offline measure reviews.

• Cost and Resource Use: Building on previous work this effort will continue to evaluate cost and resource use measures. Initially, this work will focus on cardiovascular and pulmonary conditions.

• All-Cause Admissions and Readmissions: This work will build on a number of previous NQF projects addressing readmissions related to specific conditions or settings, as well as a 2012 project examining all-cause readmission measures. This Committee is particularly important because the Medicare Hospital Readmissions Reduction Program, a pay-for-performance program that ties a financial penalty for hospitals to excess readmissions, is required to use NQF-endorsed measures of readmissions.

We hope you will seize this opportunity and join the Consumer-Purchaser Alliance in our efforts to drive health care quality and affordability for consumers and purchasers.

For support from the Consumer-Purchaser Alliance staff in learning more about these projects or submitting a nomination, please get in touch with us by phone or email:

• Stephanie Glier, Senior Policy Analyst, sglier@pbgh.org or 415-615-6341 
• Emma Kopleff, Senior Policy Advisor, ekopleff@nationalpartnership.org or 202-238-4875

New RWJF Resource on Hospital Quality Data

The Robert Wood Johnson Foundation has created a national directory designed to enable the public to access reliable hospital quality data through a centralized database. Consumers can search by state and browse reports. The purpose of creating the tool is to allow the public to have easy access to reliable information on quality of care in their communities. The database currently houses 182 state and local public reports and 26 national reports.

Health Plans Moving Toward Value-Based Payment Models

An Availity study finds that almost 60% of surveyed health plans expect to transition to value-based payment models over the next five years, with 60% of those respondents saying they are about halfway through adoption. The study also notes that 90% of health plans believe that automating the way new data that is required under such payment models is exchanged is crucial to success. The study highlights the consensus among plans that information sharing with physicians must be automated – primarily in real-time – for these models to achieve success. Transitioning to payment models that base compensation on outcomes requires physicians and health plans to exchange new kinds of information – different from what is required under today’s predominant fee-for-service arrangements. The study also details the lines of business targeted for new payment models, payment model maturity, and expectations for growth over the next 18 months.

New RWJF/Urban Institute Study on Performance Measurement

To improve performance, health care leaders need to understand the strengths and weaknesses of performance measures, according to a Robert Wood Johnson Foundation-funded report from the Urban Institute, "Achieving the Potential of Health Care Performance Measures: Timely Analysis of Immediate Health Policy Issues."

The authors offer seven policy recommendations for reaching the full potential of performance measurement in health care:

1. Decisively move from measuring processes to outcomes.
2. Use quality measures strategically, adopting other quality improvement approaches where measures fall short.
3. Measure quality at the level of the organization, not the clinician.
4. Measure patient experience with care and patient-reported outcomes as ends in themselves.
5. Use measurement to promote the concept of the rapid-learning healthcare system.
6. Invest in the "basic science" of measurement development.
7. Task a single entity with defining standards for measuring and reporting quality and cost data, similar to the role the Securities and Exchange Commission serves for the reporting of corporate financial data, to improve the validity, comparability and transparency of publicly reported healthcare quality data.

CMS Publishes Hospital-Specific Medicare Charge Data for 100 Common Procedures

CMS has released data showing that U.S. hospitals charge widely varying amounts for the same services, and also illustrating the significant variation in how much Medicare pays for those services. The database includes hospital charges for 100 most frequently billed discharges by the more than 3,000 hospitals reimbursed under the inpatient prospective payment system. The numbers reflect $66.7 billion in Medicare spending during fiscal 2011 and represent 7 million discharges.

Hospitals determine what they will charge for items and services provided to patients and these charges are the amount the hospital bills for an item or service. The Total Payment amount includes the MS-DRG amount, bill total per diem, beneficiary primary payer claim payment amount, beneficiary Part A coinsurance amount, beneficiary deductible amount, beneficiary blood deducible amount and DRG outlier amount.

One of the most concerning aspects of the data is the wide variation in what Medicare pays hospitals for treating the same conditions, which does not seem to be driven by the provider's status as a teaching hospital or higher capital costs of some facilities. CMS speculates that the reason for such disparity is the wide variations in the average morbidity of patients and local costs at different hospitals. Specifically, hospitals with sicker patients receive health status outlier payments and add-on payments based on the geographic location.

CMS Webinar: Learn How to Access and Use Medicare Data

In July 2012, the Centers for Medicare & Medicaid Services (CMS) announced that in July 2013, the platform for the downloadable data on the Medicare.gov Compare websites (Dialysis Facility Compare, Home Health Compare, Hospital Compare, and Nursing Home Compare) would be Data.Medicare.Gov.

The Centers for Medicare & Medicaid Services will be hosting a webinar, “Data.Medicare.Gov: Get Started!” to:

• Provide an introduction to Data.Medicare.Gov, 
• Demonstrate options for accessing the data, and 
• Describe how to make use of the site's tools for exploring and interacting with the data. 

The webinar is appropriate for both technical and non-technical users of Compare website data, for example, researchers, health care administrators, and quality improvement professionals.

WHEN: Thursday May 16, 2013 1:00 PM to 2:00 PM Eastern Daylight Time

WEBINAR REGISTRATION INFORMATION: In order to receive log-in information, you must register for the webinar though the following link: https://cc.readytalk.com/r/vutakpmjxr7j

Participants are strongly encouraged to register early because space is limited and to dial in 10 minutes early to ensure that you are able to connect and view the presentation.

If you are unable to join, you can:

• View the video recording in the Help section of http://www.data.medicare.gov following the event. 
• Visit http://www.data.medicare.gov before or after the event and click the Help button. There you can find a variety of useful videos and resources to help you use the site.

CMS Launches Chronic Condition Dashboard

CMS has launched its new Chronic Conditions Dashboard, an interactive tool that provides quick analyses and reports based on the data CMS houses in its Chronic Conditions Warehouse. The dashboard is housed on a CMS website created to help researchers access federal data on Medicare Fee-For-Service patients. The dashboard focuses on patients with diseases such as heart disease and diabetes.

It offers "new and critical data that can help us develop better patient-centered approaches to improve health outcomes, lower costs and maximize quality of life," says HHS Assistant Secretary Dr. Howard Koh.

CMS Announces First Qualified Entities to Receive Medicare Data

The Centers for Medicare & Medicaid Services (CMS) has announced the first three participants in the Medicare Data Sharing for Performance Measurement program. Authorized under the Affordable Care Act, the program makes Medicare claims data available, under strict privacy requirements, to groups that CMS certifies as qualified to handle this data and protect patient privacy. These groups will combine Medicare and private insurance data to create comprehensive, useful reports on provider performance.

The three organizations are:

• Health Improvement Collaborative of Greater Cincinnati
• Kansas City Quality Improvement Consortium (serving the Greater Kansas City area in Missouri and Kansas)
• Oregon Health Care Quality Corporation

To receive certain Medicare claims data, organizations participating in the program must show that they can manage and process consumer-focused data and can prevent breaches of protected health information. The organizations must also show that they are working with private insurers to access other payer data in order to produce comprehensive reports on provider performance.

The program takes important steps to protect the privacy of patients. Information that could identify specific patients will not be publicly released and strong penalties will be in place for misuse of the Medicare data.

With access to provider performance reports, employers and consumer organizations can identify and reward high quality health care providers in their local areas and develop online tools to help consumers and their families make health care choices informed by this useful data.

For more information on CMS’ Qualified Entity Program, visit:
http://www.cms.gov/QEMedicareData/

Join a Webinar—Using WhyNotTheBest.org to Benchmark and Improve Performance: Stories from the Field

WhyNotTheBest.org gives health care professionals and researchers a tool to benchmark health care performance and find resources to guide their improvement efforts. Created by The Commonwealth Fund, the free Web site brings together performance data from multiple sources to track the delivery of recommended care, readmission and mortality rates, incidence of bloodstream infections, patient safety and quality, use of health information technology, and more. Users can build reports comparing individual hospitals or hospital groups to others like them, such as safety nets, academic medical centers, or rural hospitals. With the site’s interactive map, they can explore regional variation and track delivery system reforms, like the emergence of accountable care organizations.

Join a webinar on Friday, November 16, at 11 a.m. E.T. to see a demonstration of WhyNotTheBest.org and hear stories from the field from those using the tool in their work.

Speakers include Joy Gill, clinical data analyst, Adventist HealthCare; Justine Carr, M.D., chief medical officer and senior vice president of quality and safety, Steward Health Care System; and Kim Paull, director of analytics, Rhode Island Office of the Health Insurance Commissioner, with Kevin Quinn, vice president, payment method development, Xerox State Healthcare. The Commonwealth Fund's Anne-Marie Audet, M.D., M.Sc., and Martha Hostetter will demonstrate the tool and moderate the event.

To register, go to https://cc.readytalk.com/cc/s/showReg?udc=y1pzq7oj8el8

Sharp Increase in Use of Employee Incentives in Wellness Programs

An Aon Hewitt survey of nearly 2,000 employers representing approximately 20 million covered lives found that U.S. employers are increasingly relying on incentives to drive participation in health programs and encouraging employees and their families to take better care of themselves. 

Currently, 84 percent of employers offer employees incentives for participating in a health risk questionnaire (HRQ) and almost two-thirds (64 percent) offer an incentive for participation in biometric screenings. Just over half (51 percent) provide incentives to employees who participate in health improvement and wellness programs. The use of monetary incentives, in particular, has increased dramatically over the past year. In 2012, 59 percent of employers used monetary incentives to promote participation in wellness and health improvement programs, up from 37 percent in 2011. The use of monetary incentives for participating in disease/condition management programs almost tripled in 2012, from 17 percent in 2011 to 54 percent.

Aon Hewitt's survey shows a growing number of employers are beginning to link incentives to a result, as opposed to simply participating in a program. Of companies that offer incentives, 58 percent offer some form of incentive for completing lifestyle modification programs, such as quitting smoking or losing weight. About one-quarter offer incentives for progress or attainment made towards meeting acceptable ranges for biometric measures such as blood pressure, body mass index, blood sugar and cholesterol.

Critics caution against the potential privacy implications of the use of such rewards. What types of information should your employer be allowed to collect and use? There are also serious legal questions, too, about health-related rewards and penalties. While they're allowed under health laws like HIPAA (the Health Insurance Portability and Accountability Act of 1996), that doesn't mean companies couldn't face potential action in the courts. These questions could become more problematic as the ACA provision allowing an increase in premium differential from 20% to 30% to be tied to participation in wellness programs.

Population Health, Value-Based Care Drive Health Information Exchanges

The pursuit of population health and value-based care "may be reviving the business case for organizations to join health information exchanges," according to a HealthLeaders magazine article. Now more than ever, providers need accurate and complete patient data to effectively manage chronic care populations and earn incentives or shared savings; they need their own data as well as that of their affiliates and competitors. Bringing down costs in the health care system as a whole depends on sharing data. Nevertheless, although preliminary results suggest HIEs can help health care organizations save money, some are still reluctant to participate.

An HIE is an organized regional network that enables hospitals, physicians, and other care providers to upload and access patient health information. HIEs connect data for organizations—from affiliates to competitors—to share clinical data that can improve a patient's overall care. The HIE is generally connected through a provider portal, giving easy access to clinical applications that allow caregivers to see all of the patient's clinical information in real time while restricting access to any claims data or other financial information. Early data indicates the HIE can reduce costs for participants. But one of the main barriers to participation may be issues associated with costs; and not just the actual dollar amounts required to make the investment, but who makes the investment and who controls the flow of capital. Whether to participate in HIE is a strategic conversation, but all the participants have to be willing put aside their individual issues and agenda and to work toward a solution that's best for the patient.

Although the American Recovery and Reinvestment Act (ARRA) allotted grants to encourage the establishment of HIEs, participating in an HIE still doesn't come free. Participants must have an EHR in place, and most HIEs ask participants to pay a fee to connect; that price can vary depending on an organization's size and the degree and complexity of the connectivity needed. Employers have a unique role to play as purchasers in the encouragement of HIE establishment because employers all need employees whose health conditions are well-managed. HIE establishment presents a unique opportunity for employers to partner with and work directly with providers.

Utah's All-Payer Claims Database Fails to Deliver

The Salt Lake Tribune reports that simply having an All-Payer Claims Database (APCD), without the support in place to actually use the data, will not provide consumers with useful and actionable information about which doctors, clinics and hospitals deliver the best care for the best price. Utah’s APCD, a repository of all medical and pharmacy insurance claims filed statewide, has failed to deliver this critical information.

Utah’s database was conceived in 2008 by a legislative health reform task force as means to arm consumers with the information they need to take charge of their health. It was intended to expose how much value patients receive from their insurance, how much they pay for tests and surgeries, and help them comparison-shop for coverage and medical care.

But State Department of Health employees charged with building and overseeing the database have moved on to other positions in state government. The New Jersey-based vendor hired to mine the data, Care Advantage, went out of business last month. And promised reports comparing health centers on certain quality measures have yet to materialize.

Many point to the lack of funding as the major reason for the database's failure. Utah’s database was held out as an example of what can be done on the cheap. While most states spent millions to get their versions running, Utah budgeted $800,000. At last count, the database contained more than 65 million insurance claims dating back to Jan. 1, 2007.

But until the health department hires a replacement for Care Advantage, there’s no way to extract data. The department isn’t staffed or equipped to run complicated queries, such as tracking "episodes of care," or patient outcomes from diagnosis through treatment and any follow-up.