1. Quality Measurement Evolution
Connecting Michigan for Health 2017
Bo Borgnakke
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

2. 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

3. 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

4. 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 with hypertension
Patients with blood pressure <140/90 at most recent visit
ESRD, dialysis, renal transplant,
pregnancy
HEDIS: Allows patients ages 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. Controlling High Blood Pressure
HEDIS: Allows patients ages 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

11. 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:
This work made possible by funding from the Michigan Department of Health and Human Services
Copyright 2017 Michigan Health Information Network Shared Services

12. 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:
This work made possible by funding from the Michigan Department of Health and Human Services
Copyright 2017 Michigan Health Information Network Shared Services

13. 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

14. 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”
QRDA
QRDA
QRDA
Measure Payload
QRDA
SCDF
CCD
Any Quality Measure
Health Provider Directory
REST API
Validate Sender NPI and Use Case Agreement
This work made possible by funding from the Michigan Department of Health and Human Services
Copyright 2017 Michigan Health Information Network Shared Services

15. 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

16. 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

17. 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

18. 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

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