Tracking metrics in the cloud
Collection and reporting of key metrics are required by many emerging initiatives. By Anil Kottoor
ew care and reimbursement models are forcing healthcare organizations — physicians, hospitals and health plans — to step up their game when it comes to performance data. Collection and reporting of key metrics are required by many emerging initiatives, while several long-established programs are now embracing strong quality-enhancement strategies. Many are going so far as to link reimbursements and fi nancial or other incentives to quality scores. For example, the Department of Health and Human Ser- vices (HHS) in January 2012 issued a set of 26 core quality measures to be used for adults enrolled in Medicaid. Though initial reporting will be voluntary, it nonetheless sends a strong signal to states that have been lax in addressing low Medic- aid program results that the federal government intends to continue sharpening its focus on quality reform. Similar quality-based approaches are being taken by the Centers for Medicare and Medicaid Services (CMS) with Medicare Advantage plans, accountable care organization (ACO) pilots, Medicare physician and hospital quality pro- grams and the Comprehensive Primary Care (CPC) initiative. For example: • Providers that wish to establish an ACO must report on 33 quality and performance measures, many of which are more holistic health plan measures and therefore relatively new concepts for hospitals and physician groups. CPC initiative pilot entities will also need to report on quality over time. • As of 2015, Medicare Advantage plans with lower than four stars will not receive quality bonuses to help them remain competitive from a benefi ts standpoint. Further, high-performing plans will be allowed to enroll year-round, giving them a leg up in a very competitive enrollment environment that is usually limited to a few weeks per year.
To aid organizations with compliance, integrated care management, quality and compliance platforms deployed via the cloud have emerged as a secure and cost-effective way to consolidate, analyze and exchange actionable and
14 July 2012
meaningful data with all participants in a patient’s care. Do- ing so facilitates the effi cient and accurate monitoring of key data in real time so that steps can be taken when necessary to increase (and protect) quality and risk scores and deliver higher-quality care at lower costs.
Data takes center stage
The metrics required or proposed under today’s care and reimbursement models are not new. They draw from those of a myriad of other programs, such as National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS) measures, Star/Quality Assurance Reporting Requirements (QARR) ratings, elec- tronic medical record (EMR)/electronic health record (EHR) incentive programs and Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys.
What is new is the need to integrate clinical and admin- istrative data from multiple disparate sources to enable real-time exchange and continuous monitoring to remediate care gaps and infl uence performance outcomes and quality scores. Also required is the ability to undertake more accurate predictive modeling and risk profi ling to better manage care and utilization and lower costs without impacting quality. To accomplish this, provider and payer organizations must be able to share comprehensive clinical histories for each pa- tient. For example, because they are essentially plan-like enti- ties operating in the fee-for-service (FFS) system, provider- centric organizations, such as ACOs, must have the technical capability to receive enrollment, eligibility, demographic and claims data on assigned benefi ciaries from multiple sources. To maintain Star ratings, Medicare Advantage plans need real-time access to HEDIS, pay-for-performance (P4P) and proprietary quality and performance measures, as well as data for patient, provider and population profi ling. However, access to data is not enough. Success hinges on the ability to utilize that data in a way that allows ini- tiatives to infl uence outcomes and quality scores, such as through the proactive patient assessments to determine and properly address chronic care and preventive health needs.
HEALTH MANAGEMENT TECHNOLOGY www.healthmgttech.com