Mike Weiss, DO
September 23, 2016
Making Sense of What’s Next: Value
Based P4P Measurement & MACRA
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• Background
• Drivers and Imperatives
• 2016-2021 Measure Set Strategy
• MACRA and the New Landscape
• Now What?
Making Sense of What’s Next in VBP4P
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• IHA Board
• Governance Committee
• Technical Payment Committee
• Technical Measurement Committee
Measure Sets: The Process
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• Importance
• Scientific Acceptability
• Feasibility
• Usefulness
• Alignment with Other Initiatives
Criteria for Selecting Measures
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• Importance
• Scientific Acceptability
• Feasibility
• Usefulness
• Alignment with Other Initiatives
Criteria for Selecting Measures
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• Patients • Valid, meaningful, informative
• Physicians/Advanced Practice Providers • Relevance, realistic
• Health Plans • Quality, satisfaction, cost
• Physician Organizations • Relevance, ability to influence
• Federal and State Agencies • Certification requirements
The Many Stakeholders
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• Internal Medicine Practice, Philadelphia, PA
• 23.7 Calls per day
• 16.8 E-mails per day
• 12.1 Rx Refills per day
• 19.5 Lab Reviews per day
• 11.1 X-ray Reviews per day
• 13.9 Consult Reviews per day
What Does a Doctor Do?
Baron. NEJM, 2010, 362(17) 1632-1636
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• Relevance
• Team-based Care
• Innovative Measures and Methodologies
• Quality, Resource Use, and Cost
• Measure Suites in Defined Clinical Areas
• Increase Alignment
• Target Development Efforts
• Reduce Data Collection Burden and Improve Reporting Timeliness
VBP4P Measure Set Strategy
2012-2015 Strategy 2016-2021 Strategy
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Key strategies and supporting tactics:
1. Increase alignment in the VBP4P measure set
• Work to align with other commonly used measure sets (QRS, NCQA health plan accreditation, MACRA)
• Document and communicate where measure set diverges
• Decrease unwarranted variation in measure specs
2. Targeted development of the VBP4P measure set
• Expand and emphasize Total Cost of Care measurement
• Evaluate potential of e-Measures
• Explore feasibility of patient centered measurement
3. Support less burdensome data collection and more timely reporting
• Understand and identify improvements to data sharing processes
• Support standard mid-year reporting
2016 – 2021 Measure Set Strategy
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• The MY 2017 VBP4P measure set includes 43 measures recommended for payment and/or public reporting – 27 clinical quality, 2 Meaningful Use e-measures, 6 patient experience (CG-CAHPS), 7 resource use, and 1 total cost of care
• 38 measures are recommended for payment and 22 of those are publicly reported
• Of the 27 measures in the clinical quality domain:
• Nearly 75% of measures are currently NQF endorsed
• 19 are NCQA Health Plan Accreditation measures
• 16 are QRS measures (CMS’ Quality Rating System 2016)
• 8 overlap with the MA stars measure set
MY 2017 Measure Set Summary
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Paid/Publicly Reported • Statin Therapy for Patients with Cardiovascular Disease: Received Statin
Therapy • Statin Therapy for Patients with Diabetes: Received Statin Therapy • Immunizations for Adolescents will use Combination 2, including HPV
Vaccination for Adolescents
Retirements • Appropriate Treatment for Children with URI • HPV Vaccinations for Female Adolescents & HPV Vaccinations for Male
Adolescents
Testing • Use of Opioids from Multiple Providers at High Dosage in Persons without
Cancer
MY 2017 Measure Set Changes
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How This Prepares Us For The Future