1. Using Quality Measurement to Drive Change
Shantanu Agrawal, MD, MPhil
President and CEO, National Quality Forum
SNP Alliance, 13th Annual Leadership Forum
Washington, DC
November 3, 2017

2. Facilitate Transition to Value
Connect to Frontlines
Provide Thought Leadership

3. Making Care Safer, More Effective

4. Measure Endorsement Endorsement = high confidence
Each endorsed measure evaluated for:
Importance
Scientific rigor
Feasibility
Usability
Alignment across public and private sectors

5. NQF-Endorsed Palliative and EOL Measures

6. Building on NQF’s Palliative Work
NQF is convening a Geriatrics and Palliative Care Standing Committee to evaluate measures that address:
Physical, emotional, social, psychological, and spiritual aspects of palliative and geriatric care
Patient and family engagement and experience with care
Caregiver support
Care planning
Appropriateness and cost of care
Multiple chronic conditions
Get involved
Through Nov. 13: Nominate Standing Committee Members
Through Nov. 15: Submit measures
Dec. 11-April 12: Participate in public comment periods

7. NQF-Endorsed Behavioral Health Measures
14 measures endorsed in 2017, including:
Tobacco use
Alcohol and substance use
Psychosocial functioning
ADHD
Depression
Health screening and assessment for individuals with serious mental illness
New behavioral health and substance abuse work:
Nov. 30-Mar. 28: Participate in public comment periods
January 2018: Join the Standing Committee deliberations

8. Measure Selection and Reduction: Measure Applications Partnership

9. NQF’s MAP Medicaid Task Forces and Dual Eligible Beneficiaries Workgroup
NQF released new measure recommendations for high- cost, high-need care areas for Medicaid beneficiaries
Goal: Support federal efforts to help states tie payments (totaling $553 billion in 2016) to improved value
Focus on promoting integrated and coordinated care to address social risk for dual eligible populations, with measures that address:
Function change
Hospital discharges to community settings
Patient feedback about quality of LTSS in community settings
Population-level HIV viral load suppression

10. NQF’s National Quality Partners™ Action Team issued a national call to action for all stakeholders to ensure that individuals with advanced illness, their families, and caregivers are at the center of all care decisions.

12. Advancing Quality of Care for Individuals with Serious Illness
Supported by the Gordon and Betty Moore Foundation
NQF working with the Center to Advance Palliative Care to drive improvement in performance measurement, accountability, and outcomes among community-based providers of serious illness care:
Clinics
Home-based services
Nursing homes
Assisted living facilities
Other providers that integrate medical and social services
Will identify future pathways for implementation of an accountability system and areas for further research

14. NQF’s Health Equity Program

15. Health Equity Has Been a NQF Focus For Over a Decade
Healthcare Disparities & Cultural Competence
Health and Wellbeing
Prevention and Population Health
MAP Adult and Child Core Sets
Measure Prioritization
Measure Selection and Endorsement
Population Health
Rural Health
Home and Community-Based Services
Food Insecurity and Housing Instability
Cultural Competency
Disparities- Sensitive Measure Criteria
Guiding Principles for Culturally Competent Care
Community Action Guide
Risk Adjustment for Socioeconomic Status (SES)
Approach for Taking Action on Social Determinants of Health (SDOH)
Roadmap to Promote Health Equity and Eliminate Disparities
Measurement Frameworks
Principles and Best Practices
Implementation Guidance

16. Comprehensive, Multi-Year, Action-Oriented Approach
Aligns with NQF’s transformation of pursuing improvement in healthcare quality for all
Includes a planned, broad portfolio of cross-cutting projects that put into action guidance laid out by NQF’s substantive work in health equity
Incorporates our leadership of practical, action-oriented initiatives and facilitation of measure development to address critical gaps
Brings together partners to leverage national efforts

17. Identify Disparities and Those Affected by Health Inequity
NQF Will:
Projects:
Approaches to address data challenges
Identification, showcase of innovative examples from the field
SDOH measurement frameworks
Promote a common understanding and standardized language around health equity to address data and infrastructure challenges
Gather innovative strategies for social risk factor data collection and use

18. Influence Performance Measurement
NQF Will:
Projects:
Facilitate development of needed measures to promote health equity and reduce disparities
Drive toward the systematic approach laid out in the NQF Health Equity Roadmap for using measures to eliminate disparities and promote health equity
Measure concepts to fill measurement gaps
Facilitation of measure development and testing
Technical expertise on high priority measures

19. Inspire Implementation of Best Practices through Innovative Approaches
NQF Will:
Projects:
Practical, applied implementation guidance
Education and peer forums to share resources and solutions
Lead and engage strategic partners to implement effective interventions and best practices
Disseminate effective interventions, best practices, and lessons learned
Facilitate use of innovative, successful interventions

20. Inform Payment NQF Will:
Projects:
Convene experts to address the impact of payment on health equity
Spur resource allocation to those meaningfully affecting change
Create tools and resources to facilitate uptake of payment models that promote health equity
Explore emerging issues related to risk adjusting performance measures for social risk factors
Continuing work on SDS Trial
Convening experts to develop payment guidance

21. Measuring Food Insecurity and Housing Instability
Multi-stakeholder panel examining SDOH: housing, income, education levels
Panel will review evidence of effective interventions, conceptual frameworks, and performance measures and related outcome measures for hunger and homelessness
Measurement structure will inform quality improvement and accountability initiatives

22. NQF Social Risk Factor Impact Initiative 2.0
New 3-year initiative to continue to include social risk factors in outcome measures submitted for endorsement
NQF will explore unresolved issues from earlier trial:
Conceptual basis
Empiric analyses
Social risk factor availability and selection
Implementation and impact
Disparities reduction strategies tied to measurement
NQF Scientific Methods Panel will review outcome measures, provide guidance on appropriateness of risk adjustment methods

23. Measure Innovation: NQF Measure IncubatorTM

24. Capturing Input from 60,000+ Patients
Cross-cutting NQF Work:
Measure Endorsement
Measure Applications Partnership
Measure Incubator™

25. November 15, 2017 bit.ly/NQPABX REGISTER NOW
Fully accredited workshop for quality improvement professionals:
5.75 AMA PRA Category 1 Credits™ for physicians
5.75 continuing nursing credits
5.75 continuing pharmacy credits
5.75 CPHQ continuing education hours
bit.ly/NQPABX

26. NQP Opioid Stewardship Action Team
NQP Playbook™, March 2018
NQF recently endorsed 3 measures developed by PQA to address use of high-dose opioids from multiple providers (excludes cancer patients)
NQP Action Team builds on public- and private-sector efforts to address the opioid epidemic and improve prescribing patterns
Helps physicians, other providers better manage patients’ pain while reducing risk of addiction

27. Shantanu Agrawal, MD, MPhil