Tag Archives: Quality Improvement

Quality Reporting Season


Post by Josh Schwartz


Healthcare Analytics Program Manager

As you prepare to submit your organization’s clinical quality data, let us take a look back at the changes the Centers for Medicare and Medicaid (CMS) implemented this year and some strategies for success with quality reporting and ongoing quality improvement efforts.

Consolidation and Simplification of Reporting

The end of calendar year 2017 (CY 17) marked the completion of the first year of the Quality Payment Program (QPP). QPP consolidates the various innovative payment models with the intent to move Medicare physician reimbursement away from fee-for-service and towards a value-based care model. As all Medicare physicians move towards value-based reimbursement, a two-year transitionary period (CY 17 & 18) allows reporting providers to ramp up to the ultimate levels of cost savings and quality improvement goals in 2019 that they will be accountable for moving forward. The chart below breaks down the percentages of reporting categories by weight, with payments being adjusted two years following the calendar year of the reporting period. In CY 17 the quality category made up 60% of the payment calculation and after the transition to more cost accountability it will remain equally important, representing nearly one-third of the total cost calculation.


Calendar Year Payment Year Quality Cost
2017 2019 60% 0%
2018 2020 50% 10%
2019 2021 30% 30%

Already during this transition period, CMS has received a lot of feedback in consolidating and simplifying its payment and reporting programs to use the same reporting options. In CY 17 the CMS Web Interface replaced the Group Practice Reporting Option (GPRO) of the Physician Quality Reporting System (PQRS) as the “self-service” reporting mechanism for group practices. It is in this interface that CMS uploads a list of patients for which clinical data points and quality measures must be reported. On January 8th these lists were uploaded, with the submission window running from January 22nd until 5pm PST on March 16th. Providers need to prepare immediately to ensure that their data is validated and reported in a timely manner.

Best Practices for Reporting and Performance Analysis

Quality reporting is an involved process that requires data documentation, data validation, and audits to capture and populate thousands of clinical data fields. Having a plan in place for a systematic approach to completing the web interface template will go a long way towards a successful reporting effort.

  1. Start early. The window from the time the patient sample is provided to the deadline for reporting is 10 weeks. You may have to perform hundreds if not thousands of chart audits to complete this process, so give yourself some extra time.
  2. Divide and conquer. If you have multiple clinics reporting together, make sure to delegate responsibilities in an effective manner.
  3. Develop a timeline. Establish internal check points, milestones and deadlines to ensure progress is on track.
  4. Review your work. Leave time to complete spot checks and conduct self-auditing before submission.

While these steps will guide an efficient and accurate quality reporting effort, regular analysis of clinical quality data remains a keystone of population health. Evaluating quality measure performance at the provider group, facility, and individual provider level enables you to identify areas that need performance improvement and learn from established best practices that can be replicated across provider networks. Incorporating performance review into regular workflows and quality practices will help avoid scrambling at the end of the year to improve performance and serve as the foundation for improvement year over year.

Caradigm Quality Improvement and CMS Web Interface Extract

To facilitate quality management, we have continued to iterate on our quality improvement application, Caradigm Quality Improvement. Leveraging the power of the application’s Advanced Computation Engine, quality measure performance can be evaluated across your organization at all levels. Empowered with this information and the ability to conduct root cause analysis, you can use the application to conduct quality improvement campaigns. The highly configurable solution integrates with the workflows of quality managers and clinicians.

We take our commitment to quality management a step further with the Web Interface Extract. This feature provides an extract of the clinical variables required by CMS for the reporting of quality measures. We do this by running the patient sample list provided by CMS against the Caradigm Intelligence Platform, and then extract and translate the data into the format required by CMS. This extract is then transmitted back to you to serve as the basis for your organization’s reporting.

While clinical quality is top of mind during the reporting period, it is important to remember that quality is the responsibility of everyone involved in the delivery of healthcare for the sake of patients. Good luck with your submission and happy Quality Reporting Season!

 

For more information on the content or author, please contact us.

Weathering Change and the Promise of Digital Transformation in Healthcare


Post by Neal Singh


Chief Executive Officer, Caradigm

Providers are among those most impacted by the turbulence in today’s healthcare landscape – whether it be adding facilities, covering more patients, changing leadership, providing additional services, or entering new value-based programs such as MACRA, Bundled Payments, or DSRIP. The “Quadruple Aim” was put forward to address the experience of providers in delivering care that is increasingly tied to cost and quality metrics. The so-called, second wave (post-EHR) of digital technology might be their greatest hope as providers manage this massive transformation to new value-based care and reimbursement models.

With clinicians supporting new populations, managing multiple data sources, and being tasked with additional processes, the burden of administrative tasks should be eased through the availability of resources that drive efficiency and enable a community-oriented, risk-based care approach. Paradoxically, it seems the introduction of new technology and processes can often be an added weight for clinicians to learn and adapt to. As we continue down the path of digital transformation, these tools should evolve to smoothly integrate into workflows and yield quick, measurable benefits for teams.

So how do organizations scale activities and enable their teams to deliver care more efficiently and consistently throughout this period of rapid change?

Weather the Uncertain Regulatory Environment

While lawmakers continue to battle it out we should face one fact: value-based care is here to stay.  Providers should push forward with a “no regrets” strategy. Prioritize efforts to drive more consistent, efficient and coordinated care, integrate your IT systems to support accurately forecasting patient risk, lowering cost structures, and building deeper relationships and loyalty with patients. Providers should not miss out this is an incredible time of innovation in healthcare that I believe is going to accelerate even more as healthcare organizations build off their early successes and learnings. With uncertainty in legislative direction for healthcare (ACA, Value Based Payment Reforms, etc.), providers may feel uncertain about their IT buying decisions. Rather than feel uncertain, I suggest providers should continue moving forward, with a keen focus on flexible and extensible solutions to support any outcome of legislative direction.

Quick Time to Value with an Eye for the End Game

Healthcare organizations need strong capabilities to aggregate data from across the community to connect all clinicians responsible for a targeted population. Providers should demand short implementations to ensure rapid time to value. Beyond this, seeking a flexible and configurable solution “future proofs” the organization to accommodate new programs that may be launched. This “future proofing” will provide organizational agility to rapidly configure to meet continuously evolving payment reforms and legal requirements. Selecting a population health tool should include an evaluation of the vendor’s ability to meet organizations where they are and grow with them across programs, such as Medicare Shared Savings Program, Comprehensive Primary Care Plus, Bundled Payments, etc.

Intelligent Analytics and Sophisticated Tools

Finding tailored software applications that enable clinicians to streamline workflows will drive positive results throughout your organization and help achieve scalability. Tools that facilitate targeted care management activities for prioritized patients will support care team efficiency. Interoperability is especially key in the case of mergers and acquisitions, considering the critical need to bring together data from potentially dozens of systems. Sophisticated risk stratification tools that consider clinical and claims data, financial information, social determinants, behavioral factors, and that employ predictive analytics will further help organizations determine where to focus constrained resources to achieve the highest return and greatest impact on patient outcomes. These are all factors to consider when searching for the right IT solutions to support your organization’s growth and goals, while advancing the health of the population.

Application Integration into Clinical Workflows –  They Can Only Use It if They Can Find It

While many providers recognize the value of using data and analytics to improve the quality of care and lower costs, there are many that have not yet integrated these directly into clinical workflows to realize the greatest impact and efficiency. This integration is especially important for accountable care organizations (ACOs) and clinically integrated networks (CINs). Timely access to data is critical when you are responsible for the health of a population of patients who may be geographically dispersed and receiving care from several hospitals or specialists. IT solutions should be leveraged to surface gaps in care, risk scores, and full medication histories so that a clinician can make educated care decisions while in the presence of the patient.

Value-based care initiatives should be addressed as a series of interconnected activities rather than as distinct, siloed efforts. A successful strategy takes a team-based approach and engages staff across different facilities to focus not only on individual patients with individual diagnoses, but also the health and wellness of the community. IT solutions need to create a unified user experience to support the interconnectedness that plays an integral role in an organization’s evolving strategy. ACOs and CINs should integrate an enterprise solutions portfolio encompassing the capabilities critical to success in value-based care programs, including: data control, healthcare analytics, and care coordination and engagement. Providers should also partner with vendors that have deep industry experience to provide advisory services. The pace of change in our industry continues to accelerate, and no organization should feel they are navigating these waters alone.

 

For more information on the content or author, please contact us.

Quality Improvement: Going Beyond Retrospective Reporting With Population Health Management


Post by Kendra Lindly


Senior Product Manager, Caradigm

Often, quality efforts in healthcare are focused too much on retrospective reporting of measures, and not on improvement of those measures. It’s important to understand the past, but that alone does not drive improved patient outcomes. To drive measureable improvement, you need to identify the root cause of care gaps and apply the intelligence within clinician workflows to close those gaps. 

As a result of the rise in population health management, solutions have emerged to help healthcare organizations take this next step.  For example, a clinical analyst can quickly drill down in a specific ACO 33 measure to determine the root cause of non-compliance, then guide actions of clinicians to remedy that gap. Advanced population health solutions can track gaps and surface areas of non-compliance within the workflow of the EMR while the physician is still in the presence of a patient.  This enables a physician to address gaps before the patient leaves. Care managers can have a task list automatically generated for them that prioritizes their daily activities. These are just a few of the many practical ways that new solutions are innovating quality improvement efforts.

 Check out this infographic to learn more about the impact of poor quality on patients, healthcare providers and the economy—and how it can be remedied. You can also download our whitepaper entitled ‘Quality Improvement in the Advent of Population Health Management’ by completing this form.