1. Electronic Clinical Quality Measures – Session #1 ONC Resource Center

2. Agenda Context eCQM Affinity Group Objectives eCQM Framework - Discussion – Building capacity to support measurement – Governance Next session topic overview – Session #2 – Technical models and data considerations – Session #3 – Technical analytics – Session #4 – Operational uses of CQM information

3. HHS describes HHS has set payment and delivery reform goals moving to value- based purchasing and alternative payment models Multiple proposed rules (e.g., 2015 CEHRT, MU3, MACRA) identify use of technology, registries, and eCQM standards to support VBP and APMs For summaries and visuals, see the background information. Context

4. Discuss eCQM framework for building measurement capacity; Support strategic planning for innovation and value based payment models; Discuss governance opportunities, barriers, and policy levers; Understand technical model options and considerations for choosing appropriate technical model for your state; and Discuss using quality measurement data to support quality improvement activities. eCQM Affinity Group Objectives Are these the right objectives? What is missing?

5. Build Capacity for Measurement Key Components Leverage new MU req’ts Promote HIT infrastructure development Develop measurement infrastructure for analysis, reporting Broaden Governance Key Components Identify multi-stakeholder governance structure Identify common objectives Identify value proposition for all stakeholder groups (payers, purchasers, providers, patients) Align around a model Common benefits – use quality measures for developing new VBP products Strengthen Technical Infrastructure Key Components Assess current technical assets in the state to build technical capacity for measurement Identify opportunities for shared technical services across organizations Evaluate current core capabilities, roadmaps, and expanding functions Assess needs of data users and sources Improve use of CQM information Key components Create efficiencies for reporting requirements and reporting among multiple quality programs Establish accurate source of key provider information Support community analytics Enhance data transparency and availability improving availability of information Programmatic performance evaluation eCQM Framework

6. Build Capacity for Measurement Key Components Leverage new MU req’ts Promote HIT infrastructure development Develop measurement infrastructure for analysis, reporting Broaden Governance Key Components Identify multi-stakeholder governance structure Identify common objectives Identify value proposition for all stakeholder groups (payers, purchasers, providers, patients) Align around a model Common benefits – use quality measures for developing new VBP products Strengthen Technical Infrastructure Key Components Assess current technical assets in the state to build technical capacity for measurement Identify opportunities for shared technical services across organizations Evaluate current core capabilities, roadmaps, and expanding functions Assess needs of data users and sources Improve use of CQM information Key components Create efficiencies for reporting requirements and reporting among multiple quality programs Establish accurate source of key provider information Support community analytics Enhance data transparency and availability improving availability of information Programmatic performance evaluation eCQM Framework for Discussion

7. Certified Electronic Health Record Technology (CEHRT) Meaningful Use of CEHRT ReportingAdd’l uses of clinical quality data Align with Medicaid VPM programs Certified EHR Technology to capture discreet data elements, import and calculate quality measures, and report quality measures as aggregate data by provider and/or individual patient level Eligible Professionals and Hospitals must: - Incorporate use of CEHRT in clinical workflow to capture discreet data for measurement, calculation, and reporting To successfully attest to Medicare and Medicaid Meaningful Use: - Eligible Professionals must be able to report eCQMs by provider level aggregate level reporting of numerators and denominators, patient level eCQM data Capture data once and use multiple times: - Clinical Decision Support to drive evidence-based practice with data capture for reporting built-in - Reduce duplicative, unnecessary workflows to capture additional eCQM data. Align and standardize measures and supporting data to minimize administrative burden of implementing quality improvement programs eCQM Framework: Build Capacity for Measurement Building on current HIT infrastructure and programs Questions ? How have states leveraged Medicaid MU programs and support Medicaid VBP models? How have states moved from Medicaid only to multi-payer models? All states are accepting multi- payers not just medicaid patients, intrinsic to the submission How are the states leveraging eCQM efforts to build their capacity

8. eCQM Framework: Governance Step 1Step 2Step 3Step 4Step 5Step 6Step 7 Identify key stakeholders and convene stakeholder advisory groups for eCQM Strategy/Engag ement Plan; Identify scope of delivery and payment models; align programs and technical options with current investments; scan the broader health system environmental scan Develop common goals and objectives; Identify value add for all stakeholders (e.g., purchasers, payers, providers, consumers) Selection and harmonization of standardized measures; align with national measures Evaluate current technical assets in the state to support measurement strategy Evaluate policy levers through state of federal authorities (e.g., SPA, waivers) ; Develop implement’n plan Develop and manage ongoing community governance process Solidify governance to strengthen trust among key stakeholders and build measurement capacity Coordinate across health transformation efforts

9. eCQM Framework: Governance Step 1Step 2Step 3Step 4Step 5Step 6Step 7 Identify key stakeholders and convene stakeholder advisory groups for eCQM Strategy/Engag ement Plan Identify scope of delivery and payment models; align programs and technical options with current investments; scan the broader health system environmental scan Develop common goals and objectives; Identify value add for all stakeholders (e.g., purchasers, payers, providers, consumers) Selection and harmonization of standardized measures; align with national measures Evaluate policy levers through state of federal authorities (e.g., SPA, waivers) Evaluate policy levers through state of federal authorities (e.g., SPA, waivers) ; Develop implementatio n plan Develop and manage ongoing community governance process Solidify governance to strengthen trust among key stakeholders and build measurement capacity Coordinate across health transformation efforts Governance Models – 1.Do states have the governance model to support additional measurement capacity? 2.What are barriers or challenges states face when embarking on broadening governance?

10. eCQM Framework: Governance Step 1Step 2Step 3Step 4Step 5Step 6Step 7 Identify key stakeholders and convene stakeholder advisory groups for eCQM Strategy/Engag ement Plan; Identify scope of delivery and payment models; align programs and technical options with current investments; scan the broader health system environmental scan Develop common goals and objectives; Identify value add for all stakeholders (e.g., purchasers, payers, providers, consumers) Selection and harmonization of standardized measures; align with national measures Evaluate policy levers through state of federal authorities (e.g., SPA, waivers) Develop implementatio n plan Develop and manage ongoing community governance process Solidify governance to strengthen trust among key stakeholders and build measurement capacity Coordinate across health transformation efforts Measure alignment – 1.How have states aligned measures across programs and payers? 2.What were barriers and strategies to overcome barriers?

11. eCQM Framework: Governance Step 1Step 2Step 3Step 4Step 5Step 6Step 7 Identify key stakeholders and convene stakeholder advisory groups for eCQM Strategy/Engag ement Plan; Identify scope of delivery and payment models; align programs and technical options with current investments; scan the broader health system environmental scan Develop common goals and objectives; Identify value add for all stakeholders (e.g., purchasers, payers, providers, consumers) Selection and harmonization of standardized measures; align with national measures Evaluate current technical assets in the state to support measurement strategy Evaluate policy levers through state of federal authorities (e.g., SPA, waivers) ; Develop implementatio n plan Develop and manage ongoing community governance process Solidify governance to strengthen trust among key stakeholders and build measurement capacity Coordinate across health transformation efforts Technical organization capacity 1.What technical assets in the state can support a measurement technology? 2.What technical services can be shared across agencies/organizations? 3.What capabilities does an entity need to have to implement and operate an eCQM technical strategy?

12. eCQM Framework: Governance Step 1Step 2Step 3Step 4Step 5Step 6Step 7 Identify key stakeholders and convene stakeholder advisory groups for eCQM Strategy/Engag ement Plan Identify scope of delivery and payment models; align programs and technical options with current investments; scan the broader health system environmental scan Develop common goals and objectives; Identify value add for all stakeholders (e.g., purchasers, payers, providers, consumers) Selection and harmonization of standardized measures; align with national measures Evaluate policy levers through state of federal authorities (e.g., SPA, waivers) Evaluate policy levers through state of federal authorities (e.g., SPA, waivers) ; Develop implementatio n plan Develop and manage ongoing community governance process Solidify governance to strengthen trust among key stakeholders and build measurement capacity Coordinate across health transformation efforts Policy levers and enablers– How have states used policy levers to support CQM? What are other enablers to build capacity for measurement?

13. eCQM Framework: Governance Step 1Step 2Step 3Step 4Step 5Step 6Step 7 Identify key stakeholders and convene stakeholder advisory groups for eCQM Strategy/Engag ement Plan Identify scope of delivery and payment models; align programs and technical options with current investments; scan the broader health system environmental scan Develop common goals and objectives; Identify value add for all stakeholders (e.g., purchasers, payers, providers, consumers) Selection and harmonization of standardized measures; align with national measures Evaluate policy levers through state of federal authorities (e.g., SPA, waivers) Evaluate policy levers through state of federal authorities (e.g., SPA, waivers) ; Develop implementatio n plan Develop and manage ongoing community governance process Solidify governance to strengthen trust among key stakeholders and build measurement capacity Coordinate across health transformation efforts Ongoing governance– How do states measure and hold organizations accountable? How will you fund the strategic measurement plan and technology? 1.Out of the four bullets 2.Ratio – of content and discussion 3.Role call – 4.Put stuff in the front

14. Session #2 – Week of December 7, 2015 – Technical models and data considerations Session #3 – Week of December 28, 2015 – Technical analytics/measurement Session #4 – Week of January 7, 2016 – Operational uses of CQM information Next Steps