# Presentation: 229275

## Quality Alliance Steering Committee – High Value Health Care Project

**Notes:**
Organizations involved with the High Value Health Care Project include the Robert Wood Johnson Foundation, America’s Health Insurance Plans, the American Board of Medical Specialties, and the Engleberg Center for Health Care Reform at the Brookings Institution.

## The Quality Alliance Steering Committee (QASC)

- Voluntary multi-stakeholder collaboration formed in 2006
- Co-chairs: Carolyn Clancy, MD, and Mark McClellan, MD, PhD
- National coordination to enable value-driven health care across all care settings
- Stakeholder include quality alliances, government, physicians, pharmacies/pharmacists, hospitals, health insurers, consumers, accrediting agencies, and foundations to ...
- advance high-value/quality, cost-effective, patient-centered health care by coordinating various entities engaged in the implementation of nationally endorsed performance measures and public reporting of provider performance information to enhance:
- Performance Improvement;
- Consumer decision-making; and
- Effective (payment) policy making and incentive structures for consumers.

## National Framework for High-Value Care

**Notes:**
This slide describes the National Framework for High-Value Care developed by the Quality Alliance Steering Committee or QASC.  QASC sees the framework as a wheel that has consumer outcomes in the center.  The framework begins with 1) setting national goals and priorities to drive improvement and affordability; 2) developing and testing evidence-based measures; 3) endorsing and maintaining measures and incorporating specifications into EHRs; 4) developing coordinated and streamlined implementation strategies: prioritization timelines, and process solutions; 5) aggregating data, pilot testing, and validating performance information; 6) generating public reports on quality and cost; 7) establishing effective public policies, payment policies, and consumer incentives to reward or foster better performance; 8) improving quality and reducing waste; and 9) continuously evaluating health and healthcare and letting that feed back into the national priority setting process.  For each of these activities, the key players involved are identified. 

## Addressing Gaps

**Notes:**
This slide presents the situation today and gaps as it relates to four key areas of the QASC framework for high value care:  1) foundational steps including priority setting, measure development; 2) Generating Performance Information, which includes implementation strategies, aggregation and integration; 3) Disseminating Performance Information; and 4) Using Performance Information for payment and improvement.

## Activity 1: Data Aggregation

**Collaboration**

- AHIP Foundation
- Multiple health plans participating, and more coming, including BCBS FL, CIGNA, HealthPartners, Humana, and United
- Close coordination with CMS

**Scope of **
**Work**

- Develop approaches and infrastructure to generate physician performance information based on limited set of performance measures
- Focus on AQA/NQF endorsed measures
- Test and implement methods and software for securely and consistently extracting and aggregating claims from national and regional health plans to construct the broadest possible empirical basis for performance reports
- Potential testing of additional quality and cost measures for future NQF endorsement
- Thought model: distributed data network

**Results**

- Provider-level summary data (not individual patient data) across plans
- Results will be made available to regional collaboratives for computation of physician performance reports that span experience of multiple plans

**Notes:**
I THOUGHT WE HAD MORE PLANS INCL WELLPOINT ON BOARD AT THIS POINT. NOT SURE WE SHOULD JUST LIST THESE 5 (ACTUALLY 8?) – THAT IS EITHER OUT OF DATE OR WILL BE SOON. 

We can’t seem to figure out which plans Carmella feels comfortable with sharing publicly. But we believe the ones listed are “official”.

## Activity 2: Episode-based Cost of Care Measures

**Collaboration**

- Kevin Weiss, MD, MPH (American Board of Medical Specialties)
- Workgroups with broad technical/strategic stakeholder representation including physician specialties, researchers/ methodologists, purchasers/payers, consumers, and others

**Scope of **
**Work**

- Identify/construct cost of care measures for an initial set of 20 prioritized conditions consistent with emerging NQF framework on episode-based efficiency
- Conditions include:
- Acute myocardial infarction (heart attack), Angina, Asthma, Breast cancer, Bronchitis, Chronic obstructive pulmonary disease, Colon cancer, Congestive heart failure, Depression, Diabetes, Hiatal hernia/ Gastroesophageal reflux disease (GERD), Hip fracture, Hypertension, Hysterectomy, Osteoarthritis, Pneumonia, Prostate cancer, Sinusitis, Spine: lumbar, Stroke

**Results**

- Broadly-supported, transparent set of efficiency measures that take into account appropriate use of resources and provide an overall picture of high value care

## Activity 3: Performance Measurement Infrastructure

**Collaboration**

- Mark McClellan, Brookings Institution
- Close collaboration with AHRQ, CMS and others

**Scope of **
**Work**

- Operational/strategic plan for QASC
- Effective integration of nationally generated performance information in regionally distributed report cards
- Identifying options for expanding performance reporting beyond claims-only based performance reports
- Establishing knowledge resource for performance reporting

**Results**

- White papers/manuscripts
- Tested prototypes for expanding performance measurement infrastructure
- Successful integration of nationally produced performance information into regional dissemination/improvement efforts

## Transitioning performance data streams

**Notes:**
Transitioning performance data streams will require a shift from primarily using claims data to a future where different types of data are integrated together to provide data to inform the provision of quality care.  To get to that future, intermediate expansion is needed where different types of data are combined with claims data and that expansion is evaluated through pilot studies.  The additional types of data that could be merged with claims data include pharmacy data, lab data, data from registries and from EHRs.  

## Activity 4: Addressing racial/ethnic disparities

**Collaboration**

- Key stakeholders and experts focused on next steps to measure and address disparities, including through upcoming workshop

**Scope of **
**Work**

- Identify practical steps to assist communities and others to understand disparities in health care performance
- Identify and test state-of-the-art approaches to estimating disparities for application with administrative data sets
- Develop and test state-of-the art methods for direction data collection on racial/ethnic identified

**Results**

- National conferences on findings
- Easy-to-use software modules for estimating community-specific disparities

## Appendix

- Project Timelines

## Data Aggregation

|  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
|  |  |  |  |  |  |  |  |  |  |
|  |  |  |  |  |  |  |  |  |  |

**Notes:**
This slide describes the timeline for the previously described data aggregation work efforts.  

## Cost of Care Measures

|  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- |
|  |  |  |  | 

 |  |  |  |
|  |  |  |  |  |  |  |  |

**Notes:**
This slide describes the timeline for the cost of care measure development work efforts. 

## Performance Measurement Infrastructure

|  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
|  |  |  |  |  |  |  |  |  |  |
|  |  |  |  |  |  |  |  |  |  |

**Notes:**
This slide describes the timeline for the previously described performance measurement infrastructure work efforts. 

## Addressing Racial/ethnic Disparities

|  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
|  |  |  |  |  |  |  |  |  |  |
|  |  |  |  |  |  |  |  |  |  |

**Notes:**
This graphic describes the timeline for the previously described racial and ethnic disparities-related work efforts.