Medicare Quality Improvement and Provider Technical Assistance:

An Overview of the Next Five YearsDecember 8, 2014

Mary Fermazin, MD, MPA, Chief Medical OfficerHealth Services Advisory Group

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Presentation Outline

• A review of QIN-QIO’s scope of work in general, with special emphasis on the work with physician practices

• Technical Assistance to Providers– Million Hearts campaign– Chronic care management of diabetes care

• Patient Community Meetings– Diabetes Self Management Education– Check.Change.Control

QIN-QIO Framework

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QIN- QIO : Results Oriented Quality Improvement

• Serve as neutral convener and actively engage providers, partners and patients

• Utilize data as core component of QI efforts, provide regular data feedback reports

• Use Learning and Action Networks to facilitate rapid learning, disseminate best practices that lead to system changes and sustainable results

• Provide focused technical assistance and coaching4

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Chronic Care Model

Cardiac Health

Disparities in Diabetes

Chronic Disease Management

Through Meaningful Use

Healthcare-Associated

Infections in Hospitals

Coordination of Care

Value-Based Payment Program

Healthcare-Acquired

Conditions in Nursing Homes

Patient is at the center of care.

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Improve Cardiac Health and Reduce Disparities

• Implement evidence-based practices to improve cardiovascular health

• Support Million Hearts® initiative

• Promote the use of Aspirin, Blood pressure control, Cholesterol management, and Smoking assessment and cessation (ABCS)– Work with racial and ethnic minority beneficiaries/dual-

eligibles, and providers to improve ABCS

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Technical Assistance

• Million Hearts– Physician Quality Reporting System using EHR

– EHR reports on patients with hypertension

– Workflow analysis and redesign for managing patient panels

– Controlling High BP; Tobacco Use: Screening and Cessation; IVD: Use of Aspirin or Another Antithrombotic; and Fasting LDL-C Test Performed and Stratified

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Technical Assistance

• TA focus: those providers who manage patients with the greatest cardiovascular health needs and those most challenged to succeed in implementing evidence-based practices to improve cardiovascular health and support the Million Hearts® initiative.

• Eligible Providers– Current measures below Million Hearts goal of 65%– Target providers who serve racial and ethnic minority

Medicare beneficiaries, dual-eligible Medicaid and Medicare beneficiaries

Reduce Disparities in Diabetes Care: Everyone with Diabetes Counts

• Improve HbA1c, lipids, blood pressure, and weight control– Combination of provider-based

and community-based strategies

• Decrease number of beneficiaries requiring lower-extremity amputations– Claims data evaluation and

aggregation of data for the state and the QIN-QIO area

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Reduce Disparities in Diabetes Care: Self Management Education Training Classes

• Use train-the-trainer program to increase the number of certified diabetes educators and community health workers

• Refer diabetic patients from recruited medical providers

• Use community-based approach to encourage program spread

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Reduce Disparities in Diabetes Care: Increase Adherence of Utilization Measures

• Includes HbA1c, lipids, eye and foot exams– Provider engagement

strategies– Clinical data input and

reporting through EHR– Reporting on eye exams and

foot exams

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Technical Assistance

• Chronic care management of diabetes care– EHR reports on patients with hypertension– Workflow analysis and redesign for managing patient

panels– Increasing adherence to clinical guidelines for

appropriate use of utilization measures for HbA1c, Lipids, and Eye Exams

– Decrease lower extremity amputations– Refer patients with diabetes to DSME

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Technical Assistance

TA Focus: • At least 25% of a Participating Practitioner

Clinics/Offices/Practices Medicare diabetes patient population are a racial or ethnic minority/rural/ or in an underserved area

• Based on analysis of Medicare claims, each Participating Practitioner Clinic/Office/Practice with claims results ranked in the lower 50th percentile among all practices in the QIN-QIO area for at least two of the three utilization measures: HbA1c, Lipids, and Eye Exam. (FQHCs and RHCs are exempt)

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Quality Improvement through Value-Based Payment Programs

• Increase number of eligible physicians and physician groups submitting data through Physician Quality Reporting System (PQRS)

• Demonstrate improvement in quality of care delivered by physician groups and hospital outpatient departments

• Increase national performance levels on hospital VBP measures

• Increase percentage of ambulatory surgery centers and inpatient psychiatric facilities that improve quality on poorly performing quality measures

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Patient Community Meetings

• Engage patients and families in the community through meetings where they congregate:– Senior centers– Faith-based organizations– Libraries

• Engage partners in patient community meetings, such as providers, the American Heart Association, clinical pharmacists, etc. to educate patients on:– Self management of chronic disease– Patient portals– Medication safety– Availability of community health resources

Questions?

Mary Fermazin|818.265.4657|mfermazin@hsag.com Chad Vargas|818.265.4688|cvargas@hsag.com

Kim Salamone |602.801.6960|ksalamone@hsag.com

This material was prepared by Health Services Advisory Group, Inc., the Medicare Quality Improvement Organization for California, under contract with the Centers for

Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.

Publication No.CA-11SOW-B.1-09242014-02