Clinical Quality Framework cqframework.info All Hands Meeting April 7, am-12:30pm ET

2 Logistics As a reminder, please mute your phone when you are not talking to the group. When speaking, please say your name before making your comment. You can ask questions by unmuting or by using the “Chat” feature on the web meeting. To find the “Chat” feature, look for the “Chat” bubble at the top of the meeting window. From S&I Framework to Participants: Could you please explain how the terminologies are used in this instance? All Panelists CQF Wiki: cqframework.info 2 Send your “chat” to All Panelists in order to ensure the comments are addressed publicly. This meeting is being recorded. Should you need to take another call, please leave the meeting and rejoin (i.e., please do not put the meeting line on hold).

Agenda TopicPresenter WelcomeSwapna Bhatia, Project Support CQF Implementation: Blue Cross Blue ShieldLenel James, Blue Cross Blue Shield CQF Implementation: HumanaAngelica Garcia-Gutierrez, Transcend Insights Next StepsFloyd Eisenberg, CQF Co-Coordinator Questions and DiscussionFloyd Eisenberg, CQF Co-Coordinator CQF Wiki: cqframework.info 3

Welcome Announcements, Meeting Schedules, Agendas, Minutes, Reference Materials, Use Cases, Project Charter, and General Information are posted on cqframework.info cqframework.info Clinical Quality Framework (CQF) All Hands meetings are held bi-weekly on Thursdays from 11am to 12:30pm ET Dial In: Access code: CQF Data Model meetings are held weekly on Wednesdays from 1 to 2pm ET NQM-8ENJ&rnd= NQM-8ENJ&rnd= Dial In: Participant passcode: CDS-on-FHIR/CQF Office Hours meetings are held weekly on Wednesdays from 11am to 12pm ET Dial In: Participant passcode: CQF Wiki: cqframework.info 4

Clinical Quality Language 101 Webinar The Centers for Medicare & Medicaid Services (CMS) invites you to a Clinical Quality Language (CQL) 101 webinar. This webinar will provide a high level overview for measure developers, implementers, and end users on the CQL standard which aims to unify the expression of logic for Electronic Clinical Quality Measures (eCQMs) and Clinical Decision Support (CDS). Join us for this CQL introduction and understand how it supports eCQMs. Register for the webinar taking place on Wednesday April 13, 2016 at 3:00PM EDT: 2/onstage/g.phpMTID=e24307fef4f595ed8cca557035f0cadc0 If you have any questions or need additional information, please contact Amira Elhagmusa at 5

Electronic Clinical Quality Improvement (eCQI) Resource Center Discussion 6 CMS is working with providers, health IT developers, quality measure stewards and developers, and other federal agencies to usher in a learning health system where health information is collected, shared, used, and measured to improve patient, public, and population health. The Electronic Clinical Quality Improvement (eCQI) Resource Center supports this effort by: Providing a centralized location for critical eCQI, Electronic Clinical Quality Measures (eCQM), and Clinical Decision Support (CDS) resources and information necessary to support healthcare transformation and payment reform Unifying the eCQI community and connecting related activities Streamlining the time and effort to find guidance and provide feedback for all users We invite you to join us for a brief session to collect feedback and suggestions for continued improvement of the eCQI Resource Center. Please consider joining CMS and the eCQI Resource Center support team via WebEx April 19, 2016, 3-3:45 PM EDT or April 20, 2016, 11-11:45 AM EDT. If you are not able to attend either of these sessions, we invite you to submit your comments and requests to ecqi-resource- Register for either session: 1.April 19, Tuesday 3:00-3:45: April 20, Wednesday 11:00-11:45:

CQF Implementation Pilot Blue Cross Blue Shield Lenel James 7

Agenda Introduction Work-to-Date by Payers Overview on CQF on FHIR and clarify FHIR eQM Discuss Payer Priorities and Options Next steps for CDS on FHIR and for Payers 8

“Top Six” Spreadsheet 15 The “Top Six” spreadsheet includes element-level look back periods, value set names, and code types within those value sets These are the 6 top-priority measures, from the top 15 out of the total of 64 HEDIS members There are also two added elements to the list for those measures that might improve the value of data collection from a provider’s EHR

16

Proposed High Value Commercial Measures Comprehensive Diabetes Care.. (Stars CDC) Controlling High Blood Pressure.. (Stars CBP) Adult BMI Assessment.. (Stars ABA) Colorectal Cancer Screening.. (Stars SNP COL) Breast Cancer Screening..(Stars BCS) Cervical Cancer Screening. (Medicare CCS) 1.CDC - Primary 2.CBP - Primary 3.ABA 4.COL -Alternate Screen, (1 of 3), difficult, history and multiple types of procedures 5.BCS – Alternate Screen (2 of 3) 6.CCS – Alternate Screen (3 of 3) Look-back time range: a.CDC – 2 years b.CBP – 3 years (need to get historic diagnosis) c.ABA – 2 years d.COL – 10 years- non accreditation measure for Medicaid e.BCS – 3 years f.CCS – 5 years 17

CQF Implementation Pilot 18 Transcend Insights: Humana Angelica Garcia-Gutierrez

April, Enterprise Solutions

About Us 20 Humana  A Health and Well-Being Company  Medical, Dental and Vision Insurance Plans  Humana Medicare Advantage Plan: An alternative to Original Medicare and Medicare supplements with a single plan administered by Humana.  13.1 Million Members following its acquisition by Aetna Transcend Insights  Health Tech subsidiary of Humana  Enterprise Services Business Unit that focus on Healthcare Analytics Solutions, including  Gaps in Care – Organizes gaps in a patient’s care, such as missing procedures, labs or medications, and prompts the clinician to intervene.  Drug Safety Analytics– Displays adverse drug interactions pertaining to a patient’s active medication regimen, and classifies the interaction in order of severity.  Since Humana is a large Medicare player, the key for us is Quality Measures April, 2016

Transcend Insights: Enterprise Services Solutions 21 Insight  An analytical clinical engine based on the implementation of HEDIS measures.  HEDIS measures are used to measure performance on important dimensions of care and service.  HEDIS measures include a broad range of important health data, such as asthma medication use, persistence of beta-blocker treatment after a heart attack, and data on breast cancer screening. April, 2016 IntelligentRx  A real-time prescription drug benefit service that supports providers with patient-specific prescription information at the time the prescription is being written (Point of Prescribe) as well at the point that the Medication is dispensed (Point of Sale).  Provides support of Payer specific clinical policies and drug alternatives, and patient safety alerts.

Current Challenges 22 Insight  No machine-readable measure representation (XML, JSON) exists for HEDIS Measures  NCQA HEDIS Technical Specifications are published in human-readable format  Measures are difficult to represent using the Quality Data Model as our data source is Claim Data IntelligentRx  No standardized format to represent drug knowledge:  Drug to Disease contraindications based on corroborated diagnoses and inferred conditions (Claim data)  Medication Adherence rules based on Diagnosis (Claim Data)  Possession Ration based on filled prescriptions (Claim Data)  Drug to Drug interaction detection rules April, 2016

Goal 23 To adopt a human-readable language, both computable and implementable that can be used to define Quality Measures April, 2016  Current interest is in the Clinical Quality Framework Initiative QUICK-CQL ELM Care Insights Engine Use QUICK/CQL to create a computable and human readable representation of Quality Measures Generate ELM-XML Representations Measure Implementation

Subscribe to Clinical Quality Framework Please visit the “Join the Initiative” section of the CQF wikipage to subscribe to our list serve: – ework+Join+the+Initiative ework+Join+the+Initiative 24

Next Steps Join the Initiative Engage in Workgroups ( Pilots – Co-Coordinator, Ken KawamotoKen Kawamoto – Co-Coordinator, Floyd EisenbergFloyd Eisenberg Standards Development – Subject Matter Expert, Bryn RhodesBryn Rhodes Join us for the upcoming Clinical Quality Framework All Hands meeting: 4/21/16 CQF Wiki: cqframework.info 25

Questions and Discussion Name Ken Kawamoto, Floyd Eisenberg, Swapna Bhatia, Initiative cqframework.info CQF Wiki: cqframework.info 26