2. Quality Measurement A Changing Landscape

3. Overview New HEDIS Measures
Use of Electronic Clinical Data Systems (ECDS) for HEDIS reporting
HEDIS Learning Collaborative
Future Quality Measurement strategies

4. New Measures for HEDIS® 2017
Follow-Up After Emergency Department Visit for Mental Illness
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Dependence
Standardized Healthcare-Associated Infection Ratio
Depression Remission or Response for Adolescents and Adults

5. Follow-Up After ED Visits
Follow-Up After Emergency Department Visit for Mental Illness
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Dependence
Ensure patients who have an exacerbation of their chronic behavioral health condition receive timely follow up care for behavioral health

6. Follow-Up After ED Visits
M1: FU After ED Visit for MI
M2: FU After ED Visit for AOD
Denominator
ED visits for members 6+ years with a primary ED diagnosis of mental illness
ED visits for members 13+ years with a primary ED diagnosis of AOD
Numerators (two rates reported)
Num 1: 7-day - An outpatient follow-up visit with any provider with a primary diagnosis of mental health (or AOD) within 7 days after the ED visit
Num 2: 30-day - An outpatient follow-up visit with any provider with a primary diagnosis of mental health (or AOD) within 30 days after ED visit
Exclusions
ED visits followed by admission or direct transfer to an inpatient care setting within the 30-day follow-up period

7. Standardized HAI Ratio
Using hospital-reported standard infection ratios (SIR), plans report a weighted SIR, adjusting for the percentage of members discharged from each acute care hospital
Four plan-weighted SIRs reported:
CLABSI
CAUTI
MRSA
C-DIFF

8. Standardized HAI Ratio
Report a plan weighted average SIR according to member use of hospitals and corresponding facility SIR from CMS Hospital Compare
Report the proportion of total patient discharges at high/ moderate/low risk and hospitals w/unavailable data
Hospital
Hospital SIR
% Member Discharges
Indicator 1
Plan level weighted SIR:
Indicator 2:
% of discharges from hospitals that are: A
0.6
45%
High risk
30% B
1.0
25%
1.08
Mod. risk C
1.8
20%
Low risk D
2.0
10%
Unavailable 0%

9. Electronic Clinical Data Systems
Now Serving……
Electronic Clinical Data Systems

10. Electronic Clinical Data Systems
Patient experiences captured in a structured, electronic format
Maintained over time
Includes some or all key clinical data relevant to care
Bidirectional, automated sharing of information
Accessible by the healthcare team at the point of care

11. HEDIS ECDS Reporting
An ECDS framework is being developed around three core principles to ensure that HEDIS ECDS quality reporting will:
Support appropriate access to electronic health data across the entire care continuum,
Emphasize a member-centered, team-based approach to quality health care services, and
Support a learning health system that encourages innovation.

12. Framework of ECDS

13. HEDIS Learning Collaborative
Voluntary collaborative of health plans interested in using ECDS to report depression measures
Includes 13 organizations
Pilot focused on reporting three measures of depression care quality
Learning Collaborative provides:
Education and technical assistance
Bi-directional learning
First step toward more reporting of HEDIS ECDS measures

14. Potential inclusion in HEDIS 2018
Depression Care
Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults
Included in HEDIS 2016
Optional reporting
Depression Remission or Response for Adolescents and Adults
Proposed for HEDIS 2017
Depression Screening and Follow-up for Adolescents and Adults
Potential inclusion in HEDIS 2018
New data collection method using data from Electronic Clinical Data Systems (ECDS)

15. Depression Remission or Response
All members age ≥12 with depression
Members covered by ECDS
Elevated PHQ-9 at baseline
Had follow-up PHQ-9 at 5-7 months
Achieved remission at 5-7 months
Demonstrated response at 5-7 months
Rate 1
Rate 2
Rate 3
Rate 4

16. Moving to Measuring Outcomes
Measures must prioritize information that is meaningful, actionable, and effective
Increased use of ECDS for quality reporting facilitates data sharing, prepares the environment for new outcome measures
Consistent retrieval of electronic patient data from ECDS makes possible a precision measurement approach tailored to individuals

17. The Future of Measurement
Quality measurement must shift from “What happened” (surveillance) to “What will happen” (opportunity)
Current measures describe outcomes in the past tense– offers only very incremental improvement (if any)

18. Changing the Foci
Technology can be extremely disruptive to delivering high quality healthcare
Huge volume of data required for a patient- centric, precision medicine approach
Predictive solutions minimize data collection burden and maximize effectiveness of tracking accomplishment

19. Predictive Quality Measurement
Precision approach to monitoring the cardiovascular risk of the patients in a healthcare practice
Looks for patterns in data to “score” risk
“Global” = comprehensive
Multiple factors inform risk, all can be accommodated by an ensemble predictive model
Individual patient clinical data informs overall risk profile of patients within a practice

20. Looking Forward
A new quality concept based on predictive analytical scoring to define Global Cardiovascular Risk, or GCVR, is on the horizon
GCVR is a summary estimation of the proportion of potentially avoidable events (e.g., stroke, AMI) in a patient population
Predicts 5-10 year mortality/morbidity
Sensitive to changes in individual patient risk factors over time

21. Cardiovascular risk is predictable therefore CV events are preventable
Quality Improvement
Practices wish for real information on how to improve quality
Not everyone is fluent in layered neural networks or Bayesian multivariate linear regression
GCVR score would ideally be used as a real time decision support tool to supplement clinician judgement
Cardiovascular risk is predictable therefore CV events are preventable

22. What does the future hold?