Quality Measurement Evolution Connecting Michigan for Health 2017 Bo Borgnakke bo.borgnakke@mihin.org Population Health Analyst This work made possible by funding from the Michigan Department of Health and Human Services Copyright 2017 Michigan Health Information Network Shared Services

Copyright 2017 Michigan Health Information Network Shared Services Agenda Introduction to Quality Measures Two Tracks – CMS & HEDIS Quality Reporting Document Architecture (QRDA) Format Certified EHR Technology (CEHRT) MiHIN Quality Measure Infrastructure (QMI) Upcoming Standards Goals – Report Once This work made possible by funding from the Michigan Department of Health and Human Services Copyright 2017 Michigan Health Information Network Shared Services

What are Quality Measures? Quality measures are: Tools that help quantify healthcare: Processes Outcomes Patient perceptions Organizational structure or systems Used to evaluate six goals of high-quality healthcare* I assume there are different levels of understanding on quality measures. I will very briefly intro to bring us to the same leve Effective Safe Efficient Patient-Centered Equitable Timely *Source: CMS.gov This work made possible by funding from the Michigan Department of Health and Human Services Copyright 2017 Michigan Health Information Network Shared Services

Example Measure: Controlling High Blood Pressure Percentage of adults 18–85 years of age with a diagnosis of hypertension whose blood pressure was adequately controlled at the most recent visit Patients 18-85 with hypertension Patients with blood pressure <140/90 at most recent visit ESRD, dialysis, renal transplant, pregnancy HEDIS: Allows patients ages 60-85 to have higher pressure (150/90) Emphasize that this measure is one of the three that overlap ALL sets. Other 2 overlappers are: Breast Cancer and Cervical Cancer screening This work made possible by funding from the Michigan Department of Health and Human Services Copyright 2017 Michigan Health Information Network Shared Services

Who Benefits from Quality Measures? Patients Can evaluate plans and providers Providers Best practice care Payers Reduce visits Outcomes Experience Cost Recognized for plan performance Reward efficient care Recognized for high performance This work made possible by funding from the Michigan Department of Health and Human Services Copyright 2017 Michigan Health Information Network Shared Services

Copyright 2017 Michigan Health Information Network Shared Services Why Quality Measures? Accomplish Triple Aim for patients, providers, payers Essential to transformation from volume-based to quality-based delivery and payment Help identify and improve common deficiencies in healthcare delivery (Gaps in Care) Facilitate care improvement Potentially even while patient is still on site! As I just showed with diagram, Obviously, quality measures are essential to future and success of healthcare, but we are going to go through some pains to get there Let me show you what the pain looks like This work made possible by funding from the Michigan Department of Health and Human Services Copyright 2017 Michigan Health Information Network Shared Services

Issues in Today’s Landscape Increasing provider burden More and more reporting requirements Lack of standardization in export, transport, calculation and submission methods Custom solutions and loose requirements Performance feedback is not actionable at point of care Lack of real-time reporting hinders improvement Provider burden is worst problem today Intro This work made possible by funding from the Michigan Department of Health and Human Services Copyright 2017 Michigan Health Information Network Shared Services

Two Quality Data Tracks Medicare / Medicaid Health Plans Meaningful Use MIPS CPC+ Reporting Format Manual Attestation QRDA HEDIS Reporting Incentive Programs Reporting Format Proprietary pipe-delimited .csv specifications Provider burden is worst problem today Intro This work made possible by funding from the Michigan Department of Health and Human Services Copyright 2017 Michigan Health Information Network Shared Services

Copyright 2017 Michigan Health Information Network Shared Services QRDA Format Quality Reporting Document Architecture Category 1 – patient level data elements Category 3 – aggregate physician reports XML-based specification created by Health Level Seven International (HL7) Category 1 files only extract specific data elements required for measure(s) Patient/provider info, diagnoses, procedures, labs Establishes a national standard by which to exchange clinical quality information Talking point: state these goals are federal, state, and locally supported by all stakeholders, including X Y AND Z This work made possible by funding from the Michigan Department of Health and Human Services Copyright 2017 Michigan Health Information Network Shared Services

Controlling High Blood Pressure HEDIS: Allows patients ages 60-85 to have higher pressure (150/90) Emphasize that this measure is one of the three that overlap ALL sets. Other 2 overlappers are: Breast Cancer and Cervical Cancer screening This work made possible by funding from the Michigan Department of Health and Human Services Copyright 2017 Michigan Health Information Network Shared Services

Copyright 2017 Michigan Health Information Network Shared Services CEHRT Achieving Certified EHR Technology (CEHRT) requires vendors to undergo testing and certification process Must demonstrate ability to produce QRDA format files CEHRT compliance is being strictly enforced EHR Adoption Rates of Office-Based Physicians Talking point: state these goals are federal, state, and locally supported by all stakeholders, including X Y AND Z Source: https://dashboard.healthit.gov/quickstats/pages/physician-ehr-adoption-trends.php This work made possible by funding from the Michigan Department of Health and Human Services Copyright 2017 Michigan Health Information Network Shared Services

Copyright 2017 Michigan Health Information Network Shared Services CEHRT 2015 Edition Excerpt Record and Export: A system user will be able to record and export individual patient-level eCQM data formatted to the HL7 Quality Reporting Data Architecture (QRDA) Category I Release 3 Implementation Guide (IG) at any time the user chooses, for one or multiple patients without needing to request support from a developer to operate […] The ability to export eCQM data will serve two purposes. First, this functionality will allow a provider or health system to view and verify their eCQM results for quality improvement on a near real-time basis. Second, the export functionality gives providers the ability to export their results to multiple programs, such as those run by CMS, states, and private payers. Talking point: state these goals are federal, state, and locally supported by all stakeholders, including X Y AND Z Source: https://www.healthit.gov/sites/default/files/2015editioncqm_10615.pdf This work made possible by funding from the Michigan Department of Health and Human Services Copyright 2017 Michigan Health Information Network Shared Services

Quality Reporting Maturity Model Status quo is on left. Where the world needs to get is on the right “goals” You will hear a lot about pieces of this today. This will be a long and complex journey. MiHIN is doing a number of things to help accelerate Michigan’s journey Source: CMS eCQM Affinity Group Session #5 1/26/2016 This work made possible by funding from the Michigan Department of Health and Human Services Copyright 2017 Michigan Health Information Network Shared Services

CQMRR: Clinical Quality Measure Reporting/Repository Senders Eligible/Critical Access Hospitals Eligible Providers Patients Quality Data Mart Reporting Layer Reports, Dashboards, Comparisons, Mining Providers Medicaid Consumers Medicare (MIPS) Data Warehouse Payers Quality Portals VPN/REST API Trusted Data Sharing Organization Convert to Desired Format QRDA Validate Store Quality Check Quality Score MIDIGATE® “Catch, Detach, Dispatch” cat3@direct.mihin.org QRDA QRDA QRDA Measure Payload QRDA SCDF CCD Any Quality Measure Health Provider Directory REST API Validate Sender NPI and Use Case Agreement cat1@direct.mihin.org This work made possible by funding from the Michigan Department of Health and Human Services Copyright 2017 Michigan Health Information Network Shared Services

Quality Measure Data Flow All-payer / All-patient Quality Data Payer-Specific Filtered Data Oakland Southfield Physicians MIHIN Once the QRDA data starts flowing from EHRs and POs, we can assist the payers to receive additional supplemental clinical data Everybody connects once to MiHIN, one format one location REPORT ONCE Would you rather have this or One format and one location for: POs to submit quality measures Payers to submit Gaps in Care POs to close Gaps in Care Health Plans Physician Organizations This work made possible by funding from the Michigan Department of Health and Human Services Copyright 2017 Michigan Health Information Network Shared Services

Migration Path from Proprietary to eCQM CQMRR HEDIS Reporting Physician Organizations Supplemental data format (BCN/APS) Supplemental data format (BCN/APS) SIM Reporting MACRA / MIPS Specialists PCPs Medicaid MU Hospitals CPC+ ACO QRDA Conversion Service Other APMs QRDA Format Files This work made possible by funding from the Michigan Department of Health and Human Services Copyright 2017 Michigan Health Information Network Shared Services

Copyright 2017 Michigan Health Information Network Shared Services Upcoming Standards Fast Healthcare Interoperability Resources (FHIR) HL7 Allows for query of discreet data elements necessary to calculate quality measures Query itself could contain calculation logic Clinical Quality Language (CQL) HL7 specification which enables the structuring and encoding of quality data Will become the logic layer of HQMF Talking point: state these goals are federal, state, and locally supported by all stakeholders, including X Y AND Z This work made possible by funding from the Michigan Department of Health and Human Services Copyright 2017 Michigan Health Information Network Shared Services

MiHIN Quality Infrastructure Goals Reduce burdens for physicians and health plans Automate quality measure reporting workflow EHRs can be configured to report measures with no provider effort Decrease labor costs for data collection Report Once and send to multiple destinations Results analysis and improvement opportunity Receive real-time feedback for clinical quality improvement Perform cross-clinical and cross-provider comparisons Standardize quality data sharing Working towards one unified format submitted to one place Utilize national standards for export, transport, and submission This work made possible by funding from the Michigan Department of Health and Human Services Copyright 2017 Michigan Health Information Network Shared Services

Questions? Bo Borgnakke Population Health Analyst (734) 223-3977 borgnakke@mihin.org This work made possible by funding from the Michigan Department of Health and Human Services Copyright 2017 Michigan Health Information Network Shared Services