MACRA Info Session #3 CMS Measure Development Education & Outreach - PowerPoint Presentation

1. MACRA Info Session #3CMS Measure Development Education & OutreachBuilding a Business CasePresenters: Brenna Rabel, BattelleMatt Humphrey, RELIJanuary 23, 2019 2:00-3:00pm EST

2. Vision and Goals: MACRA Info SessionsCMS Measure Development Education & OutreachAn ongoing process to engage the public in quality measure development. Elicit feedback that will help CMS design resources that can help all of those interested in healthcare quality improvement better understand the goals of quality measurement. Education OutreachDedicated WebsitesMeasure Development RoadmapsListserv opportunities

3. MACRA Info Session #3CMS Measure Development Education & OutreachAgenda:Overview of business cases for measure developmentComponents of the business case templateExamples

4. MACRA Info Session #3What is a Business Case?Documentation of all anticipated impacts of a quality measure (both positive and negative)Resources required Lives savedCosts reducedComplications preventedPatient experience enhancedImplementation challenges expectedEnables decision-making by demonstrating that the anticipated benefits outweigh costs and burden of collection and implementation

5. MACRA Info Session #3Objectives of the Business CaseExplain why the measure is needed (e.g., opportunities for improvement, gaps in existing measure landscape)Show how it will further CMS aims and objectivesDescribe the strength of the evidence supporting the measured process/outcomeIllustrate why it is the best balance of direct and indirect cost, benefits, and risksDescribe all realistic and affordable costsDemonstrate sufficient capacity within the system to implement the measure

6. MACRA Info Session #3Why Build a Business Case?Helps establish measure importanceAligns with NQF endorsement requirementsCan be submitted to the Measure Applications Partnership (MAP) committee during Pre-Rulemaking to inform their recommendationProvides justification for continued investment in measure developmentEnables CMS decision-making about continued use in CMS programs (for implemented measures)

7. MACRA Info Session #3TimingFor measures under development, business case should be made early, drawing from information collected during conceptualizationFor measures in use, an updated business case can inform whether measure performance aligns with anticipated impactsAt every point, the business case should include analysis of existing related measures

8. MACRA Info Session #3Business Case Template: Executive SummaryFrames the business case by explaining, at a high level

9. MACRA Info Session #3Current PerformanceEstablish a baseline for the measureReport relevant morbidity and mortality statisticsReview the literature for supplementary informationDescribe any disparitiesDescribe performance by subgroupConsider drivers of the issue or quality gap

10. MACRA Info Session #3Measure Impact on CareDescribe linkages and steps between measure focus and expected improvements to care provided. For example:Illustrate how a measure focused on reducing opioid overuse could improve or help routinize medication reconciliation processes at healthcare facilitiesDescribe evidence linking the measured process (confirming documentation of an advance care plan) to the desired outcome (patient-led care planning)

11. MACRA Info Session #3Metrics to Consider: Improving CareWhen demonstrating how the measure will improve care, considerClinical performance gapsBenefits of the process (e.g., how the process leads to better outcomes)Lives savedPatient experience or trust in the healthcare systemReduced disparities

12. MACRA Info Session #3Measure Impact on Health OutcomesDescribe the linkages and steps between the measure focus and anticipated health outcomesFor outcome measures: provide evidence that connects the measured outcome to improved health (e.g., describing how the measure will reduce negative health impacts of opioid overuse)For process measures: provide evidence that the measured process will lead to improved outcomes (e.g., demonstrating that medication reconciliation at discharge will reduce unnecessary opioid prescribing, which may reduce opioid-related morbidity and mortality

13. MACRA Info Session #3Metrics to Consider: Improving HealthWhen demonstrating how the measure will improve health, considerIncidence and prevalence of condition or treatmentHow the measure will minimize morbidity and mortality, or hospital readmissions, or reduce average length of stayImpact on other health outcomes or quality of lifeExpected improvement

14. MACRA Info Session #3Evidence Supporting the MeasureClinical practice guidelinesECRI Guidelines Trust (previously the National Guideline Clearinghouse) stores information about the strength of underlying evidenceDirect evidenceDirectly demonstrates the link between the measure focus and the desired outcomeIndirect evidenceRequires that an inference be made about the evidence and the conclusion to be drawn from it

15. MACRA Info Session #3Measure Impact on Healthcare CostsDescribe if and how the measure will impact healthcare costsSavings by preventing complications or unnecessary healthcareEfficiencies created by implementing a new clinical processSavings by improving population health

16. MACRA Info Session #3Influencing FactorsDescribe factors that may influence measure adoption or outcomes resulting from the measure Legislation and regulationEndorsementsStakeholder feedbackCompetitive market pressuresData infrastructure

17. MACRA Info Session #3Influencing FactorsDescribe potential feasibility challenges that might impact successful measure implementationDoes the measure rely on specific technology, and if so, are there risks or gaps associated with it?Consider capacity and readiness within the healthcare system to implement the measureAvailability of data elements (e.g., are electronic clinical quality measure data elements likely to be stored in easily extractable fields?)Workflow or technology implications (e.g., need for training on a new infection prevention protocol)

18. MACRA Info Session #3Resources Required for ImplementationDescribe and quantify the resources necessary to implement the measureStaff timeCosts associated with electronic health record modificationsOther direct and indirect costs

19. MACRA Info Session #3Costs of Clinical CareDescribe and quantify the resources necessary to implement the changes in care the measure seeks to changeStaff timeRequired trainingsNew or updated technology requirements Direct and indirect costs related to workflow changes

20. MACRA Info Session #3Potential Unintended ConsequencesConsider unintended consequences related toResource utilizationProvider behaviorPatient satisfaction Leverage qualitative feedback from clinical experts to anticipate potential consequences of the measureFor implemented measures, look for opportunities to assess this quantitatively

21. MACRA Info Session #3Description of Model(s) and Formula(s) UsedExplain the methodology for calculating expected costs and resource use (e.g., variables used in a cost model)Intended to promote transparency in the business case calculations

22. MACRA Info Session #3Limitations of AnalysisDescribe key assumptions and the limitations of those assumptionsExplain weaknesses or gaps in the literature, especially for indirect evidenceIdentify data that are missing or limited

23. MACRA Info Session #3Net BenefitReport anticipated benefits related to:Better health through reduction in morbidity and mortality and improvements in quality of lifeBetter Care through both improvement in the quality of care provided and positive influence on patients’ perception of their careAffordability through direct and indirect cost savings

24. MACRA Info Session #3Designing your Business CaseDevelop a hypothesis about the measure trajectory (e.g., the effect of the measure over time)Compile historical and baseline data about similar measures to identify and monitor performance gapsApply a testable model to quantify benefits of implementing the measure (e.g., cost savings model)Re-evaluate after the measure has been implemented

25. MACRA Info Session #3Business Case Example 1Hypothesis - Adopting a higher cost drug, low molecular weight heparin (LMWH) to treat deep vein thrombosis will actually save money based on a published study showing a 1:5 cost savings ratio when compared to the traditional deep vein thrombosis (DVT) treatment

26. MACRA Info Session #3Business Case Example 1Historical and Baseline Data LMWH costs $50 more per day but can be given in an outpatient settingThis results in reductions in hospitalizations, lab testing, length of stayEstimated cost savings of $800 per patient

27. MACRA Info Session #3Business Case Example 1Testing Adoption rate of treatmentAppropriate use of treatmentCost savings during the measurement periodFindingsAdoption rate was low (29 out of 500 eligible patients in 6 months were on the treatment)Yielded savings of $22,000, but off protocol use made them negligible

28. MACRA Info Session #3Business Case Example 1EvaluationThe organization would need to see wide adoption of the LMWH treatment to realize positive results in this cost savings modelMisapplication must be avoided to prevent cost increase

29. MACRA Info Session #3Business Case Example 2Hypothesis - Patients with high serum cholesterol levels, specifically those with a history of heart disease, would benefit from proper statin use, which can reduce heart attacks and make them less severe, if used properly

30. MACRA Info Session #3Business Case Example 2Historical and Baseline Data Improper use of statins is a common problem in the United StatesThe health system was currently at 53% effective use of the therapy, with an approximate cost of $675 per patient. Research and literature suggests a 1:2 cost savings ratio.

31. MACRA Info Session #3Business Case Example 2Testing: Conducted a trial lipid clinic of 800 patientsMonitored statin use, tracked lipid levels, altered dosage, and provided counseling on diet and exerciseFindings:Improved patient healthPotential 2:1 return on investment

32. MACRA Info Session #3Business Case Example 2EvaluationDespite encouraging results, the program was not expandedReturn on investment was deemed too long-term and patients benefitting now from the treatment may be patients elsewhere at the time future heart attacks would have occurred

33. MACRA Info Session #3Building a Business Case: Resources and TemplatesThe MMS Blueprint containsA Business Case chapter which describes a business case and developmentA Business Case Template and Business Case Form Instructions, which includes detailed instructions for how to compile a business case

34. MACRA Info Session #3ReferencesCMS MMS Blueprint (https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/Downloads/BlueprintVer14.pdfBusiness Case Chapter: Section 3, Chapter 11Business Case Form Instructions: Section 4, #2Business Case Template: Section 4, #3

35. MACRA Info Session #3Discussion Questions

36. MACRA Info Session #3CMS Public Engagement WebinarsPlanned Upcoming Webinars:February 13, 2019 – Patient Reported Outcome MeasuresMarch 6, 2019 – Best Practices for Environmental ScanningEmail: MMSsupport@battelle.org

37. MACRA Info Session #3Contact information:BattelleMeasures Management System Contract Holder: BattelleContact: MMSsupport@Battelle.orgCMSKimberly Rawlings: Kimberly.Rawlings@cms.hhs.gov CMS Measure Development Education & Outreach