Measuring Quality and Value in Oncology

The Need for Measurement

• Payers (Medicare and private insurers) are demanding quality, cost control, accountability, and predictability

– Measuring quality and value in cancer care now enabled by IT

• The cost of treating cancer is increasing

– Payment of cancer care is at a crossroads

– Cancer patients under active therapy represent 1% of patients but 10% of payer’s costs

The Need for Measurement

Little effort to measure health care quality until just a few decades ago Most aspects were considered unmeasurable I don’t judge my colleagues quality of care through

formal measurement That may work for me, but what about everyone else?

The Need for Measurement

Additional research revealed wide variability in the safety and quality of health care

Success in measuring hospital readmission rates National readmission rates declined from 19% to 17.5%

Not all measurements produce good behaviors CMS hospital quality measure: first dose of antibiotic

given within 6 hours after presentation Led to inappropriate antibiotic use in patients without

pneumonia

Federal Initiatives

Physician Quality Reporting System (PQRS) Meaningful Use of Electronic Health Records

Federal Initiatives

Federal Initiatives

Federal Initiatives

Federal Initiatives

Federal Initiatives

Federal Initiatives

Federal Initiatives

The McNamara Fallacy

Just because you can measure it, doesn’t mean it is relevant, important, or informative

The COA OMH Game Plan Create general consensus and unity among stakeholders

• Patients

• Payers

• Providers

Agree on quality and value• Measures

– With benchmarking

– Patient satisfaction

– With benchmarking

Create a template for viable payment• Private payers

• Medicare

Help practices implement• Process change

• Payer contracting

• Accreditation

• IT Solutions

Model

Identify Stakeholder Needs

Define Model Elements

Develop Certification/Recognition

MeasurementImplementation

Identify Vendors

Categorize ToolsDevelop Practice Implementation Guide

Payment

Identify Viable Payment ModelsDevelop Private Payer TemplatesDevelop Medicare Model

Develop Quality/Value Measures

Develop Patient Satisfaction Tool

Oncology Medical Home

Oncology Medical Home Summary

IT Advisory Team Representation

Industry Representation Practice Representation

Altos Florida

COA Georgia

CoC Ohio

COME HOME Texas

Elekta

FlatIron

iKnowMed

Net.Orange

Unlimited Systems

Varian

Oncology Medical Home

Oncology Medical Home

Oncology Medical Home

Oncology Medical Home

Oncology Medical Home

Cancer Care Satisfaction Survey: Developed by oncology stakeholders for oncology

stakeholders

Using guidance and resources from:

ALL resources are FREE to ALL providers of cancer care

Practices must register on the OMH web site for benchmarking:

http://www.medicalhomeoncology.org/coa/register.htm

Cancer Care Satisfaction Survey: Current usage:

Over 36,000 surveys 1,165 registered providers Our practice, surveys performed twice

Update is being planned Aligns with upcoming changes to CAHPS core

questions Will allow comparisons to other specialties Target date - May 4th, 2015

14 Benchmarking/Survey Reports

Example: Summary Scoring

Patient Satisfaction SurveysQuestion   Median Result

In the last 12 months, how many days did you usually have to wait for an appointment when you needed care right away?

Same day 50%1 day 23.6%2 to 3 days 16.5%4 to 7 days 5.7%More than 7 days

2.7%

   

In the last 12 months, when you phoned this provider’s office during regular business hours, how often did you get an answer to your medical question that same day?

  Median Result

Always 71.4%Usually 21.0%Sometimes 5.9%Never 1.6%

Patient Satisfaction SurveysIn the last 12 months, did you feel that this provider always told you the truth about your health, even if there was bad news?

  Median Result

Yes, definitely 92.7%

Yes, somewhat 6.4%

No 0.7%

   

In the last 12 months, how often did this provider spend enough time with you?

  Median Result

Always 80.5%

Usually 16.4%

Sometimes 2.1%

Never 0.4%   

In the last 12 months, did your primary care physician or other specialist team seem informed and up-to-date about the care you received from your hematology/oncology provider?

  Median Result

Always 61.8%

Usually 23.4%

Sometimes 7.9%

Never 4.0%