Tales from the Front Lynn Pezzullo, RPh Senior Director, Quality Innovation Lpezzullo@PQAalliance.org

PQA’s Multiple Sclerosis eCQM Development Background Measure gap Meaningful measures needed for neurologist reporting PQA focus: medication-related measures Multiple sclerosis: Treatment & Monitoring White Paper: “Accountable Care Measures for High-Cost Specialty Care and Innovative Treatment” Findings: Measurement gaps span the breadth of MS care, including assessment of imaging and physical examinations, access to therapists, monitoring of disease progression, and medication management and adherence. MRI: Magnetic Resonance Imaging RRMS: Relapsing remitting multiple sclerosis

Four Draft eCQMs Use of Disease Modifying Therapy (DMT) in Persons with Relapsing Forms of Multiple Sclerosis (MS) Magnetic Resonance Imaging: Prior to Initiating or Switching DMT in Patients with Relapsing Forms of MS To Establish a New Baseline After Initiating or Switching DMT in Patients with Relapsing Forms of MS For Follow-Up in Patients with Relapsing Forms of MS Being Treated with DMT Use of disease modifying therapy (DMT) to treat RRMS MRI to assess DMT efficacy and subclinical disease activity

Multi-stakeholder Task Force Patients with MS Neurologists w/ primary focus in MS Professional Societies Payers Neuro-Radiologists Advocacy Organizations Ensuring all perspectives/interest are represented

Engaging the Task Force Successes Challenges In-person kick-off meeting Alignment of objectives “Team-building” Patient representatives Other measure developers Collaboration Subgroup to expedite MRI measure development Learning curve Guideline- vs. measure- development Balancing project timeline with clinician availability Address our approach; when we convened the TF 2 patients on the TF; brought AAN in early How we addressed challenges Speak to what we would do differently

Measure Testing Successes Challenges Existing relationship with primary contact Four (4) practices using two (2) EHRs Draft eCQMs aligned with MS Improvement Collaborative objectives Timeline delays due to contracting Practices new to testing Communications Speak to what we would do differently

Submission to JIRA – MUC List Challenges Perceived vs. actual requirements What we learned CMS feedback Provide MAT output for all eCQMs Submit eCQMs once testing is completed What I wish I had known Speak to what we would do differently (need to have testing results prior to submitting) Review CMS requirements

Measure Maintenance and Updates Measure Update Panel Reviews PQA-endorsed measures and consider revisions to ensure: Alignment with current evidence, guidelines and standards Accurate medication lists Clarity and consistency

Implementation Opportunities Objective: Measures included in Merit-Based Incentive Payment System (MIPS) Meet with key stakeholders CMS Spotlight Series CMMI Approach Raise awareness; stimulate interest Highlight measures and status with CMS Partner with complementary initiatives

Collaboration to Support Adoption PQA Clinical Quality Measure Development (Use of DMT and MRI) NQF Measure IncubatorTM (PRO Project) MS-Advance Study (Single-Center, Patient-Centered Specialty Practice Pilot) MS CQI Collaborative (Multi-Center Research) Identify and Address Gaps in MS Care

Next Steps Activity Timeline Feasibility Testing 3-4 MS practices; 2 EHR systems; ~100 patients Nov - Dec 2017 Validity and Reliability Testing Jan 2017 - Feb 2018 Review by PQA Quality Metrics Expert Panel March 2018 PQA Endorsement Consideration PQA membership vote Q2 2018 Submission into JIRA Issue and Project Tracking System CMS evaluates for potential addition to the Medicare Measures under Consideration (MUC) List (summer 2018) Q2 2018* Implementation Goal Adoption into Merit-Based Incentive Payment System (MIPS) 2019 Also consider NQF endorsement *By June 30 deadline