WIXLIB

1All Things Quality MeasurementQuality & Performance Measures (QPM)Workgroup (WG)May 10, 2017Angela Shen, ScD, MPHNational Vaccine Program Office (NVPO)U.S. Department of Health & Human Services (HHS)angela.shen@hhs.govAmy Groom, MPHIndian Health Service (IHS)/HHSamy.groom@ihs.govQPM WG: Represented Organizations Federal Agencies– Centers for Disease Control & Prevention (CDC)– Centers for Medicare and Medicaid Services (CMS)– Department of Defense (DoD)– Department of Veterans Affairs (VA)– Health Resources and Services Administration (HRSA)– Indian Health Service (IHS)Professional Associations/Networks– Infectious Diseases Society of America (IDSA)– Adult Vaccine Access Coalition (AVAC)– American Academy of Family Physicians (AAFP)– American Association of Nurse Practitioners (AANP)– American College of Nurse Midwives (ACNM)– American Immunization Registry Association (AIRA)– Heartland Kidney Network– Immunization Action Coalition (IAC)– Kidney Care Quality Alliance (KCQA)– March of Dimes– Pharmacy Quality Alliance (PQA)– Quality Innovation Network-Quality ImprovementOrganizations (QIN-QIOs)2–– Renal Physicians Association (RPA)The American College of Obstetricians and Gynecologists(ACOG)– The Gerontological Society of America (GSA)– American College of Physicians (ACP)Academia– Johns Hopkins Bloomberg School of Public Health (JHBSPH)– University of Arkansas for Medical Science (UAMS)– University of Kansas Medical Center (KUMC)Local/State Health Departments– California Department of Public Health– Michigan Department of Health and Human Services– Minnesota Department of Health– New York City Department of Health and Mental Hygiene– New York State Department of Health– Virginia Department of HealthCorporations– GlaxoSmithKline (GSK)– Merck– Pfizer– Rite Aid– Sanofi Pasteur2017 National Adult and Influenza Immunization Summit – 5/10/20171

Session AgendaI.3Quality Measure Adoption Pathways Healthcare Quality Reporting (e.g. CMS) Health Plans (e.g. HEDIS)II. Update on Measures Current WG Status Pharmacy Quality Alliance (PQA) – Adult Immunization TaskForceIII. Announcements4I. QUALITY MEASURE ADOPTIONPATHWAYS2017 National Adult and Influenza Immunization Summit – 5/10/20172

5 Things to Consider for ionData SourceLevel of Measurement5Pharmacy Quality AllianceFederal Quality Improvement ProgramsHospital Quality Meaningful use EHRincentive Inpatient quality reporting Outpatient quality reporting Ambulatory surgical centers Readmission reductionprogram HAC payment reductionprogram PPS-exempt cancer hospitals Inpatient psychiatric facilitiesPhysician Quality Merit-basedIncentive Payment(MIPS) Maintenance ofcertificationPAC Quality Inpatientrehabilitation facility Nursing HomeCompare measures LTCH qualityreporting Hospice qualityreporting Home health qualityreportingPayment ModelsPopulation Health Medicare SharedSavings Program(ACOs) Medicare Part C Hospital valuebased purchasing Medicaid Adult CoreMeasures Physician Feedback Medicaid Child CoreMeasures ESRD QIP Innovations Pilots Medicare Part D Health InsuranceExchange QualityReporting System(QRS)6Pharmacy Quality Alliance2017 National Adult and Influenza Immunization Summit – 5/10/20173

Immunization Measures in Federal ProgramsMeasureTotal Federal ProgramsProgramsAdolescent IZ Status4PQRS; Medicaid CHIPRA; Health Insurance Marketplaces; MIPSChildhood IZ Status4PQRS; Medicaid CHIPRA; Health Insurance Marketplaces; MIPSHepatitis A1PQRSHPV in females1Medicaid CHIPRAInfluenza9Hospital Inpatient Quality Reporting; Inpatient Rehabilitation Facility; Nursing HomeCompare Measures; LTCH Quality Reporting; Home Health Quality Reporting; MedicareShared Savings Program; Medicaid Adult Core; Health Insurance Marketplaces;Medicare Part CInfluenza Healthcare Professionals8Hospital Inpatient Quality Reporting; Outpatient Quality Reporting; Ambulatory SurgicalCenter Quality Reporting; Inpatient Rehabilitation Facility; LTCH Quality Reporting; PPSExempt Cancer Hospitals; Inpatient Psychiatric Facilities; ESRD QIPInfluenza Screening4PQRS; Home Health Quality Reporting; Medicare Shared Savings Program; MIPSPneumococcal6Hospital Inpatient Quality Reporting; PQRS; Nursing Home Compare Measures; HomeHealth Quality Reporting; Medicare Shared Savings Program; MIPSPneumococcal Screening1Home Health Quality ReportingRegistry Submission Capability1Medicare and Medicaid EHR Incentive: Meaningful Use Stage 2 Core7Pharmacy Quality AllianceHEDIS as a pathway – what can land in 2019?8*Source: HEDIS 2017 Measures2017 National Adult and Influenza Immunization Summit – 5/10/20174

9II. UPDATE ON MEASURESCurrent WG Activities10SubgroupComposite MeasuresMaternal ImmunizationTdap and influenzaAdult ImmunizationTdap, pneumococcal, and zoster(influenza is under consideration)End-Stage Renal DiseaseInfluenza, pneumococcal, and Hepatitis B2017 National Adult and Influenza Immunization Summit – 5/10/20175

Rationale for Composite Measure Provides a broad perspective on the system of vaccination at afacility–Rather than a campaign to increase coverage with one vaccine, encourages a systematic approachfor all vaccines Multiple measures make it challenging to implement broad-basedimmunization quality improvement activities “Composite measures can enhance measurement to extendbeyond tracking performance on separate measures and canprovide a potentially deeper view of the reliability of the caresystem”Institute of Medicine, Performance Measurement: Accelerating Improvement, Washington, DC: NationalAcademies Press; 200615Maternal Immunization Subgroup Maternal Composite Measure Testing currently underway with National Committeefor Quality Assurance (NCQA) Goal: Incorporation into the Healthcare EffectivenessData and Information Set (HEDIS) Public comment early 2018 (Handout)172017 National Adult and Influenza Immunization Summit – 5/10/20176

13Maternal Immunization (Cont’d)Measure Development Activities & TimelineReview EvidenceField TestingWinter 2017Spring/Summer/Fall 2017Clinical guidelinessupporting influenzaand Tdap vaccines forpregnant womenCollect and analyzedata from a variety ofhealth plans and datasourcesStakeholderFeedbackOngoingTest sitesSeek Approval1.Winter/Spring 20182.3.Committee onPerformanceMeasurementAdvisory panelsNCQA Board ofDirectorsConsider howvaccinations fit withinoverall pregnancyhealthrecommendationsPublic commentIf interested in participating in the field test, contactLindsey Roth (roth@ncqa.org)14III. ADULT MEASURES2017 National Adult and Influenza Immunization Summit – 5/10/20177

PQA’s Current Measure Concepts Immunization Information System Reporting (IISR) [Seeking measure testers]– The percentage of claims for administered adult vaccinations that are recorded in Immunization InformationSystems(Handout)Companion Medication Therapy Management (MTM) Measures [PQA QMEP Review]– Immunization Status Assessment within MTM –The percentage of adult health plan members who met eligibility criteria for medication therapymanagement (MTM) services who receive an immunization status assessment within the eligibility periodACIP Compliance following Immunization Status Assessment within MTM 15The percentage of immunization status assessments completed in an adult health plan MTM eligiblemember population that are documented as ACIP compliantUp-to-date Vaccination Status for Persons with Diabetes [early development]–The percentage of adult patients with diabetes mellitus who are up to date on all routinely recommendedAdvisory Committee for Immunization Practices (ACIP)/Centers for Disease Control and Prevention (CDC)vaccinations.16Adult Immunization Subgroup* Update on testing and timelines at the nextJun/July working group meeting Discussion on components v. composite infeasibility and likelihood of adoption2017 National Adult and Influenza Immunization Summit – 5/10/20178

Adult Immunization (Cont’d)17Components Age 19-59 Tdap ever and Tdap/TD in the last 10 yearsAge 60-64 add zoster*Age 65 one dose of pneumococcal (either) at age 65 /- Influenza*to/will align with ACIP recommendations18End Stage Renal Disease Subgroup Influenza Hepatitis B-CMS testing data this Fall-Understanding CMS TEPconcerns and challenges tofeasibility Pneumococcal-Unclear how can this beconstructed for thisMedicare beneficiarypopulation? Engagement with CMS ESRD, ESRD QUIP, ESRDNetworks2017 National Adult and Influenza Immunization Summit – 5/10/20179

19Current State – What we know Coverage for adult vaccines is low Testing and development of immunization measuresare occurring Current adult immunization measures are mostlylimited to influenza and pneumococcalIV. ANNOUNCEMENTS2017 National Adult and Influenza Immunization Summit – 5/10/201710

21Recruitment Health Plan Recruitment for Field Testing– PQA (see handout)– NCQA (see handout) Recruitment of QM SME for Expert Panel– CMS’s Technical Expert Panel for the Skilled NursingFacility Quality Reporting Program. Nomination is dueTHIS FRIDAY, May 12, 2017. Call for Technical Expert Panel(TEP) related to Quality Measure Development from CMS22Please complete theevaluation form!!!2017 National Adult and Influenza Immunization Summit – 5/10/201711

23Questions?Angela K. Shen, ScD, MPHNational Vaccine Program OfficeOffice of the Assistant Secretaryfor Health, HHSAngela.Shen@hhs.govAmy Groom, MPHIndian Health ServiceAmy.Groom@ihs.gov24BACK-UP SLIDES2017 National Adult and Influenza Immunization Summit – 5/10/201712

HHS Measurement Policy Council (MPC) 25Background– MPC is an inter-agency council established in 2012 with the goal of aligningmeasures across HHS– NVPO met with MPC in March 2017 to present current measurement gapsof adult immunization and seek feedback on approaches to measuredevelopmentTakeaways– NQF endorsement is highly recommended but not mandatory for allprograms– Successful elements for program adoption: Demonstrated evidence of performance gap (e.g. disease burden) Feasibility is an important factor in considering measure types(i.e. process/outcome/composite)CMS Quality Reporting Programs26Implemented Measures(CMS MUC List, Feb 2017)Medicare ProgramsNQFEndorsed?Influenza Vaccination Coverage Among HealthcarePersonnel (HCP)1) Ambulatory Surgical Center Quality Reporting; 2) Hospital InpatientQuality Reporting; 3) Hospital Outpatient Quality Reporting; 4) InpatientPsychiatric Facility Quality Reporting; 5) Inpatient Rehabilitation FacilityQuality Reporting; 6) Long-Term Care Hospital Quality ReportingYes (#0431)1) Influenza Immunization Contraindicated; 2) InfluenzaImmunization Offered and Refused For Current Flu Season;3) Influenza Immunization Received for Current Flu Season;4) Pneumococcal Polysaccharide Vaccine Contraindicated;5) Pneumococcal Polysaccharide Vaccine Ever Received; 6)Pneumococcal Polysaccharide Vaccine Offered and RefusedHome Health Quality ReportingEndorsementRemoved: 1)#0522 & 2)#0525Influenza Immunization1) Hospital Inpatient Quality Reporting; 2) Hospital Value-Based Purchasing;3) Inpatient Psychiatric Facility Quality ReportingYes (#1659)Pneumococcal ImmunizationHospital Inpatient Quality ReportingYes (#1653)Percent of Residents or Patients Who Were Assessed andAppropriately Given the Seasonal Influenza Vaccine (shortstay)1) Inpatient Rehabilitation Facility Quality Reporting; 2) Long-Term CareHospital Quality ReportingYes (#0680)Pneumococcal Vaccination Status for Older Adults (PNU)Medicare Shared Savings ProgramEndorsementRemoved#0043Preventive Care and Screening: Influenza ImmunizationMedicare Shared Savings ProgramYes (#0041)2017 National Adult and Influenza Immunization Summit – 5/10/201713