aim hedis webinar · cell phone or land line or ... discussion portion of the call. please remember...
TRANSCRIPT
This webinar is being recorded.
THE WEBINAR RECORDING, PRESENTATION SLIDES AND
RELATED MATERIALS WILL BE POSTED ON THE AIM WEBSITE
VISIT: WWW.IMMUNIZATIONMANAGERS.ORG/WEBINARS
2
Agenda
Welcome and Housekeeping
The Importance of Quality Measures- Angela K. Shen, ScD, MPH
CAPT(ret) USPHS
California Efforts to Implement New Adult Immunization Performance Measures- Dr. Sarah Royce (CA)
National Quality Landscape- Abby Bownas (AVAC)
Open Discussion/ Q&A
Closing
3
Webinar Tech-Tips 4
Click either:✓ “USE Telephone” for
cell phone or land line OR
✓ “USE Mic & Speakers”for computer audio and voice
Choose EITHER your telephone or your computer’s microphone and speakers.
If you are dialing in on telephone, enter audio pin #yourpin#
www.immunizationmanagers.org
Discussion 5
Type question in
Question Box and AIM
Staff will read your
question to the panelist.
ALL Lines will be unmuted during the
discussion portion of the call.
PLEASE remember to mute your line if
you are not speaking
Mute the line by muting your
phone, or computer mic, or by
clicking the green microphone
button the Go To Webinar control
panel
www.immunizationmanagers.org
Angela K Shen, ScD, MPH
CAPT(ret) USPHS
Adjunct Professor, Drexel Dornsife
School of Public Health
6
ASSOCIATION OF IMMUNIZATION MANAGERS WEBINAR
1 8 D E C E M B E R 2 0 1 8
A N G E L A K S H E N , S C D , M P H
C A P T ( R E T ) U S P H S
A D J U N C T P R O F E S S O R - D R E X E L D O R N S I F E S C H O O L O F P U B L I C H E A L T H
A N G E L A . K . S H E N @ G M A I L . C O M
Quality Measurement & 2019 New HEDIS Adult Immunization Measures
Outline
Introduction – Importance of Quality Measurement Why do we have quality measures?
Shift from volume to value in health care delivery
New HEDIS® 2019 adult immunization measures Prenatal Immunization Status
Adult Immunization Status
Electronic Clinical Data System
Adult & Implementation NCQA accredited plans
CMS – Medicare
Medicaid – state by state action
Why do we have quality measures?
Who delivers vaccinations? Health Plans – pay for services
Providers - provide services
Public Health – assures services to all
What are we trying to do with measures? Improve the quality of healthcare across the lifespan through measurement
We can’t improve what we don’t measure
We want measurement to be transparent so measurement will be accepted
Accountability: once we measure we can expect and track progress
Why do we have quality measures? – 2
How does measurement help? Goals, report cards, score cards - strategies that use measurement. As a result:
Process & Procedures (e.g., standing order in workflow, point of care alerts)
Increased access points and personnel (e.g., MAs to administer, specialty clinics, PN during influenza visits)
Technology Automated Process: Registry (bi-directional), Patient Prompts (call in appointment line, reminders, letters)
Why do we have quality measures? - 3
Why? Compliance with policy & legislation – state by state
School IZ requirements
Standards are tied to reimbursement and public reporting Private plans | HEDIS® measures are accountable, transparent, &
rigorously audited; Cover 184 million people (57% population) HEDIS is used to assess the quality of health plans Tool for improving performance – asks how often insurers provide
evidence-based care to support 70+ aspects of health Measures must be meaningful
• Clinically important to patients & clinicians• Feasible (to get & to report)
Medicare | CMS (STARS rating program) – MIPS, ACO Medicaid | Medicaid core set Accreditation | JOINT COMMISSION Other programs | e.g., Office of Personnel Management, Federally
Qualified Health Centers
12
Goal: High value health care
Healthy/low risk
At risk
High risk
Early symptoms
Active disease
generate 20% OF PEOPLE
80% OF COSTS
Slide: Courtesy of NCQA
Measuring immunization is a good example of focusing on prevention
13
This shift is driving an increased focus on preventive services, such as vaccines, which have been shown to improve health outcomes and reduce healthcare spending and utilization over the long-term
The Volume-to-Value Shift Is Creating Opportunities to Incentivize Vaccination
Cost
Quality A key component of defining the value of health products and services
Reducing costs is well understood, but the role of quality continues to evolve
Volume Value
Slide: Courtesy of Avalere
P R E N A T A L I M M U N I Z A T I O N S T A T U S
A D U L T I M M U N I Z A T I O N S T A T U S
( S E E H A N D O U T )
( F O L L O W O N T O F E B 2 2 , 2 0 1 8 P R E S E N T A T I O N )
E L E C T R O N I C C L I N I C A L D A T A S Y S T E M
New HEDIS® 2019 Adult Immunization Measures
HEDIS® Development & Testing
National Committee for Quality Assurance (NCQA) tested and developed Adult immunization status (Adult composite) and Prenatal immunization status (Prenatal composite) measures
Healthcare Effectiveness Data and Information Set (HEDIS), a tool used to assess the quality of care in health plans
Measures are specified using the HEDIS Electronic Clinical Data Systems data collection method This method leverages electronic clinical data for quality measurement
Such data include administrative claims, electronic medical records, case management systems and registries
Measures Added to the 2019 HEDIS® Set
Adult Immunization Status
Percentage of members 19 years of age and older who are up-to-date on recommended routine vaccines for influenza, Td/Tdap, zoster and pneumococcal
Applies to Medicaid, Commercial, Medicare plans
Prenatal Immunization Status
Percentage of deliveries in which women received influenza and Tdap vaccinations
Applies Medicaid and Commercial plans
Major Quality ActivitiesEvidence
Development
Guideline
Development
Measure
Development*
Measure
Endorsement
Measure
Implementation
Develop
evidence base
for effective
treatment
Develop
guidelines for
practitioners
based on
evidence
Develop
performance
measures
based on
guidelines
Ensure
measures are
evidence-
based,
scientifically
sound,
feasible
Use measures
to improve
quality
Example orgs.:
Researchers Advisory Committee on Immunization Practices & others
National Committee for Quality Assurance, Specialty societies
National Quality Forum
Centers for Medicare & Medicaid Services, Clinical Registries, states & others
* Quality measures can be effective tools to compare and monitor health plan performance* Need to balance desirable attributes of importance, scientific acceptability & feasibility* Leveraging health information technology is key
NCQA HEDIS®
A tool used by more than 90 percent of America's health plans to measure
performance on important dimensions of care and service
Existing measures are survey measures; New measures in ECDS gets away from having to conduct field surveys to get this information, by capturing electronic clinical data
Accredited Medicaid and commercial plans are listed here: The 2018-2019 Health Insurance Plan Ratings
Incorporating Quality Measures
Monitor changes in new & existing programs To monitor changes in new and existing programs and payment models (e.g. mandatory
reporting programs, pay for reporting, pay for performance)
Advocate for inclusion of immunization measures in programs
Tying quality measures to payment models Value-based payment structures
Leverage existing payment mechanisms for immunization
Potential programs for measure adoption & implementation: Medicare | health plan, clinical, facility levels
E.g., Merit-Based Incentive Payment System (MIPS), Medicare Shared Savings Program, & Medicare Advantage (MA) – Star Ratings
Medicaid | adult core set, child core set
NQF | Endorsement
19
Opportunities
Advocate for inclusion of immunization to programs and payment models that use quality measures & metrics: Mandatory reporting programs Pay for reporting Pay for performance Value-based purchasing Shared savings programs Incentive arrangements Alternative payment models Accreditation requirements
Archived NAIIS Quality Performance Measure Slides https://www.izsummitpartners.org/naiis-workgroups/quality-and-
performance-measures/
Sarah Royce, MD, MPH
Chief, Immunization Branch
Division of Communicable Disease
Control, Center for Infectious Diseases
California Department of Public Health
22
California efforts to implement new adult immunization performance measures
12/18/2018 AIM meeting
510 230 3593
Outline
1. How can performance measures help raise coverage levels?
2. Which measure to prioritize?
3. Which organization(s) are highest priority for adopting the measure?
4. Strategies to promote adoption
5. Questions for discussion
24
1. How measurement can drive increased immunization
• Inform quality improvement efforts• How are we doing now? (Baseline)
• Where do we need to improve? How target efforts?
• Did they work?
• Incentives for providers, medical groups, health plans• Pay for Performance
• Public reporting • Feedback to providers can be a powerful motivator
• To inform consumer, employer choice
• Allow consumers (taxpayers) to hold payers, Health Plans accountable
25https://www.thecommunityguide.org/sites/default/files/assets/What-Works-Factsheet-Vaccination.pdf
2. Prioritize Prenatal IZ
• Public health impact in CA• Risk of flu morbidity/mortality in pregnant woman and infants
• Pertussis cases < 4 mos of age
• Even in lower incidence years: ~100 cases and 1-2 deaths/year
• Infants born to women in the Medi-Cal program were 2.5 times more likely to develop pertussis than infants born to privately insured women*
• Performance improvement is needed • Large gaps in prenatal immunization levels
• Medi-Cal disparity
26
*Winter. Pediatric Infectious Disease Journal. 2018Link for “Shelf Talker”in English and Spanish to place in pharmacy aisles: http://eziz.org/resources/pertussis-promo-materials/prenatal-tdap/
27
Reported receipt of Tdap vaccination during pregnancy, Maternal Infant Health Assessment, by insurance status CA, 2016
https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/Immunization/MIHA-FactSheet2016.pdf
(Called PRAMS in other states)
More reasons to prioritize Prenatal IZ
• Evidence based practices to raise IZ rates are available • Ex. Stocking immunizations on site works
• Barriers are amenable to intervention. In a trace back study, • pregnant women with Medi-Cal were less likely to be appropriately
immunized, even when provider stocked Tdap
• providers cite reimbursement and contracting barriers
• (if don’t stock) referrals not working Barriers to Receipt of Prenatal Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccine Among Mothers of Infants Aged <4 Months with Pertussis — California, 2016
• Feasible for Health Plans to implement the measure: aligns with existing maternity care measures, short look back period
28
Adult composite measure, 18-49, 50-64, 65+ years of age• Public health impact in CA/year
• > 100k zoster and 1000’s of pneumococcal cases could be prevented, especially in > 65 year olds (Medicare)
• Millions cases of flu
• Low IZ levels, disparity
• Less feasible: 10 year look back for Td
• Uncertainty of PCV 13 recommendation after 2019
• RZV supply constraints
29
3. Which state level organizations are highest priority for adopting the measure?Medi-Cal, given infant pertussis and maternal Tdap disparities
• Medi-Cal managed care plans (MCPs) • Report performance on a list of measures, rates posted on line
• Are held to minimum performance levels
• Not sufficient to have Medi-Cal contracts requiring Plans to assure ACOG compliance; make adult immunizations available in pharmacies https://files.medi-cal.ca.gov/pubsdoco/medsupply/MediCal_coverage_immunizations_faq.asp
• Need actual prenatal IZ levels to • Hold Plans accountable for assuring immunization of pregnant women
• Focus and inform quality improvement at Plan and provider levels
30
Proposed Medicaid adoption of prenatal immunization measure
• Adding to CMS Core Child Set would help foster state Medicaid adoption now (mandatory in 2024) https://www.medicaid.gov/federal-policy-
guidance/downloads/sho18010.pdf; https://www.medicaid.gov/medicaid/quality-of-care/performance-measurement/child-core-set/index.html
• Federally Qualified Health Centers (FQHCs) provide a significant portion of prenatal care in the Medi-Cal program • Medi-Cal managed care plans assess FQHC performance for their members
(even if not required for FQHC reporting to HRSA in the Uniform Data System)
31
Other state level organizations to consider
• Regional Health Improvement Collaborative (RHICs in 30 states)• common measure set
• Health Plan incentive payments to physician groups (Pay for Performance) https://www.iha.org/sites/default/files/resources/fs_amp_commercial_hmo.pdf
• public reporting http://reportcard.opa.ca.gov/rc/medicalgroupcounty.aspx
• CA’s RHIC will test prenatal immunization measure this spring
• NCQA-accredited health plans • Required reporting on a list of measures
• Look up your state’s Health Plans: The 2018-2019 Health Insurance Plan Ratings
All payer claims data base
32
4. Strategies for fostering adoption of measure• Enlist partners to select measure(s) and orgs, test, adopt
• IZ coalition, professional orgs, health systems and plans, Medicaid agency
• Build/convey a strong argument • National Quality Forum criteria for measure selection (See draft sample)
• Find out timing of windows for comment, decisions
• Use Immunization Info System (IIS)• Promote use by Plans, medical groups, providers and pharmacies
• Run coverage rate using HEDIS specifications (AIM can provide)• Example: match with birth certificates to identify pregnant women and determine
weeks gestation at time of immunization (CA, MN, WI studies)
33
AVAC Meeting October 19, 2018
35
Association of Immunization Managers Webinar December 18, 2018
Abby BownasManager,
Adult Vaccine Access Coalition
Adult Vaccine Access Coalition
• AVAC began in 2015• AVAC has brought together over 50
diverse organizations under one umbrella working to bring federal policy changes to increase adult vaccination rates
• Members include vaccine innovators, health care providers, pharmacy, public health, registry, patient and minority health organizations
• AIM is an active member of AVAC!
AVAC Core Areas1. Build. AVAC is committed to improving reporting of adult vaccinations to
immunization registries and encouraging greater utilization of health
information technology to track vaccination status and improve patient
outcomes and care.
2. Access. AVAC aims to improve adult immunization rates among at-risk
populations by reducing financial barriers for patients, reducing
administrative hurdles for providers, and eliminating missed opportunities
for immunization.
3. Measure. AVAC supports the development and adoption of federal
benchmarks and measures to encourage better tracking, better reporting,
and increased adult immunization rates.
AVAC’s Work to Strengthen Adult Immunization Quality Metrics • Comment regularly on federal proposed rulemaking. Fighting against
efforts to eliminate quality measures under a variety of Medicare
payment programs.
• Promote the availability new Adult Immunization Composite Measures
with federal payment programs and provider organizations.
• Advocate for lifespan immunization measures as part of Healthy People
2030 objective development process at DHHS.
Supporting Quality Measures Through the Federal Regulatory Comment Process • There are opportunities to review and provide comments to several proposed rules from
CMS throughout the year.
• Last year, AVAC submitted over a dozen comment letters with the theme of “protecting and preserving” existing measures, as well as proposing the adoption of updated and streamlined immunization quality measures.
• A sample of CMS regulatory comment opportunities:
o Physician Fee Schedule
o CY 2019 Home Health Prospective Payment System
o Hospital Inpatient Prospective Payment
o CMS Skilled Nursing Facilities Quality Reporting Program
o CMS Medicare Advantage and Part D Call letter
Advocating for Next Generation of Adult Immunization Composite Measures• NCQA added the adult immunization composite measure to their
2019 Healthcare Effectiveness Data Information Set (HEDIS) using the new Electronic Clinical Data System (ECDS) reporting domain.
• The measure will now be available for health plans to test as part of their HEDIS data sets. The results of this measure will not be public until after the measure is finalized.
• Measures in the HEDIS ECDS domain are calculated using electronic data from administrative claims, electronic medical records, case management systems and registries.
Opportunities to Advocate for the Adult Immunization Composite Measure• The National Quality Forum (NQF) released its Measures Under Consideration (MUC) on
December 3. These measures are being considered for future use in Medicare.
• Adult Immunization Status Measure (Medicare Shared Savings Program). The MSSP measure -- the MAP voted 68% (15 supported and 4 opposed) to provide conditional support but highlighted concerns with differential timing with measure reporting.
• Adult Immunization Status Measure (Merit-based Incentive Payment System). The MIPS composite measure – MAP voted 89% (17 supported and 2 opposed) to not support the measure with an opportunity for mitigation.
• NQF will release a draft report for public comment on December 21.
• Public comments on draft report due January 10.
Additional Opportunities to Advocate for the Adult Immunization Composite Measure
• Adult Immunization Composite Measure on Medicare Star Ratings Display Page
• FY19 Medicare Advantage Call letter included the adult immunization composite as a “Potential New Measures for 2020 and Beyond.”
• AVAC drafted a memo to CMS urging adoption of HEDIS Composite as part of the FY2020 Medicare Advantage Call Letter (12/12/19)
• Next MA Call letter is expected to be released in Feb 2019
• Opportunity to submit comment in response to draft letter
• Medicaid Adult Core Set (Aug)
• Medicaid Childhood Core Set (maternal immunization composite) (Aug)
Healthy People 2030 Process • HHS Office of Disease Prevention and Healthy Promotion goal to streamline Healthy People
objectives (reduce from 1000 in 2020 to just over 300 for 2030)
• Proposed Objectives for HP2030 released December 4
• Cut immunization measures in half from 2020
• Proposed objectives -https://www.healthypeople.gov/sites/default/files/ObjectivesPublicComment508.pdf
• Elimination of many childhood and adolescent objectives
• Maintains only 2 adult objectives
• Flu (6mos+, core), Tdap (pregnant women, developmental objective)
• Immunization advocates will need to make case for these quality measures!
• Deadline to comment on proposed HP Objectives – January 17
• Expect additional opportunities to comment on other elements of HP2030 in 2019
Ways to Support Adult Immunization Quality Measures
• Submit letters during pubic comment periods
• Provide information and resources to Members of Congress to educate them on how these proposed changes will impact your work in their districts and states
• Share stories with AIM on how quality measures (or removal of measures) will impact your work
AVAC Meeting October 19, 2018
47
Learn more: www.adultvaccinenow.orgFollow: AVAC @AVACNOWEmail AVAC:
Discussion Questions
• What efforts to implement these new measures are underway or
are you contemplating in your jurisdiction?
• Which measure did/would you prioritize? Why?
• In which health care system in your jurisdiction is it most
important to adopt the measure? Why?
• How would measure adoption help raise immunization rates?
• What organizations can help get the measure adopted? What’s
in it for them?
• How can AIM, NAIIS, CDC help support jurisdiction-level efforts?
48