Performance measurement, and the management of that performance, may be the defining factor for successful relationships between provider organizations and health plans, but with each passing year the level of measurement fatigue and exhaustion that I’m seeing in executive teams is increasing. The main reason for this is simple—performance measurement in health and human services is an evolving, growing science.
And a great example of this is the 2019 updates to the Healthcare Effectiveness Data and Information Set (HEDIS), from The National Committee for Quality Assurance (NCQA). Earlier this month, NCQA released its updates to HEDIS (see NCQA Updates Quality Measures for HEDIS 2019), which included four additional measures, and changes to four existing measures. The new measures include:
Hospitalization Following Discharge From a Skilled Nursing Facility—This measure will track the percentage of skilled nursing facility discharges to the community that result in an unplanned hospitalization within 30 days and 60 days, and will be used to assess the coordination of provider organizations and services to support a successful transition to the community from a skilled level of care across Medicare Advantage plans.
Risk of Continued Opioid Use—A pair of measures will assess members with a new episode of opioid use who are dispensed opioids for a period of time that puts them at an increased risk of continued use, using two rates:
- The percentage of members whose new episode of opioid use lasts at least 15 days in a 30-day period.
- The percentage of members whose new episode of opioid use lasts at least 31 days in a 62-day period.
Prenatal Immunization Status—This measure assesses receipt of important prenatal vaccines, tracking the percentage of deliveries on or after 37 gestational weeks in which women received influenza and diphtheria and pertussis (Tdap) vaccines.
Adult Immunization Status—This measure assesses routine vaccination against influenza, tetanus, diphtheria and pertussis for all adults 19 years and older, and vaccination against herpes zoster and pneumococcal disease for older adults 19 years and older.
Also new in the world of measurements are recent updates from the National Quality Forum (NQF), which in May announced four new measures in its Behavioral Health and Substance Use Fall 2017 project (see NQF Endorses Four Behavioral Health Measures). The new measures address continuity of care for adult Medicaid beneficiaries admitted to detoxification, follow-up care for adult Medicaid beneficiaries newly prescribed an antipsychotic, timely medication reconciliations for people newly admitted to inpatient settings, and provision of psychosocial screening during well-child pediatric visits.
Continuity of Care for Medicaid Beneficiaries after Detoxification (Detox) From Alcohol and/or Drugs—This measure is focused on adult Medicaid beneficiaries ages 18 to 64 who are discharged from a detoxification episode. The measure tracks the percentage of these discharges that are followed within 7 or 14 days by a treatment service for addiction disorder.
Follow-Up Care for Adult Medicaid Beneficiaries Who are Newly Prescribed an Antipsychotic Medication—This measure tracks the percentage of new antipsychotic prescriptions for beneficiaries in the target population who have completed a follow-up visit with a clinical professional with prescribing authority within four weeks (28 days) of prescription of an antipsychotic medication.
Medication Reconciliation on Admission—This measure tracks the percentage of newly admitted people for whom a designated Prior to Admission (PTA) medication list was generated by referencing one or more external sources of medications and for which all PTA medications have a documented reconciliation action by the end of Day 2 of the hospitalization when the admission date is Day 0.
Psychosocial Screening Using the Pediatric Symptom Checklist-Tool (PSC-Tool) —This measure tracks the percentage of children whose pediatric well-child visit includes administration of a Pediatric Symptom Checklist (PSC) Tool as a visit component.
The reaction of many of my colleagues who are executives of provider organizations has been—”more measures?” The solution is to invest in technology that makes reporting different measures to different health plans as painless and inexpensive as possible. As we have reported before, all payers are moving to more focus on performance and value (see Crawl, Walk, Run To VBR and Why Your Performance Reporting Should Include ‘Episodes Of Care’). And, our recent analysis found that more health care dollars are being managed by health plans (see Value = ‘Whole Person’ Approach)—health plans that see good performance on the NCQA/HEDIS and NQF measures as critical to their sustainability. They are going to be looking for provider organization partners that can deliver on these measures.
How to approach this hydra-like market situation? If you’re just getting started on metrics-based performance management for payer contracts, develop an incremental plan. First, identify the payers/health plans with the greatest effect on your revenue. Secondly, what are their most important performance measures? Finally, develop an incremental plan to measure your organization’s performance relative to those measures (whether it the actual measure or a proxy measure). These performance metrics provide your organization with a competitive advantage, no matter how limited or elemental they seem. (One of my favorite expressions come to mind—“In the land of the blind, the one-eyed man is king.”)
For more on keeping ahead of the measurement tidal wave, check out these resources in the OPEN MINDS Industry Library:
- Are You Suffering From Measurement Fatigue?
- A Few More Drops In The Performance Measurement Bucket
- For All The Performance Measurement, Are We Really Measuring Performance?
- When It Comes To Performance Measurement, The “Work” Is Never Done
- Who’s Measuring Performance? An Overview Of The Measures, By Market
- Moving To ‘Healthy Days’ As A Measure Of Success
- The Dominant Performance Standards Of Today – CMS Stars & NCQA HEDIS
- The Five-Step Process To Demonstrate Your “Performance” To Health Plans
- Is One Set Of Performance Measures Possible?
- Make Your Data ‘Count’
And for more on measuring and reporting “value”, join OPEN MINDS Senior Associate Joseph P. Naughton-Travers on October 24 at The 2018 OPEN MINDS Technology & Informatics Institute for his session, “What Do We Mean By “Value”? A Discussion Session On Defining, Measuring & Reporting Value.”