Meeting Notes (PDF) - PDF by rvc12495


									                                                     The Commonwealth of Massachusetts
                                                     Health Care Quality and Cost Council
                                                         Two Boylston Street, 5th Floor

 DEVAL L. PATRICK                                  617-988-3360 • Fax 617-727-7662 • TTY 617-988-3175
                                       •                         JUDYANN BIGBY, M.D.

                                                                                                                                   KATHERINE BARRETT
 Lieutenant Governor
                                                     Health Care Quality and Cost Council                                          Administrative Director
                                              Expert Panel on Performance Measurement Meeting
                                                                          Date: January 7, 2010
                                                                          Time: 3:00 pm – 5:00 pm
                                                                          Place: 1 Ashburton
                                                                          21st Floor, Boston, MA

       Participants: David Polakoff, Dwight McNeill, Katherine Barrett, Brennan Holmes, Kaitlyn Kenney, Kathryn Coltin, Sarah Gordon, Dana Gelb Safran, Pamela
       B. Siren, Qi Zhou, Susan A. Abookire, David Smith, Richard Lopez, B. Dale Magee, Kiame Mahaniah, Richard Antonelli, Charlie Homer, Susan Jo Roberts,
       Alice Bonner, Jewel Mullen, Arnold M. Epstein, Thomas Sequist, Barbra Rabson, Paula Griswold, Gareth Parry, Thomas H. Lee,

       Unable to attend: Craig Melin, Deborah Wachenheim, David Ives

       Topic                  Discussion                                                                                            Action Items

       Welcome/               Dr. Polakoff welcomed the group and provided a short review of the agenda for the
       Introductions          Performance Measurement Expert Panel meeting.
       (Chair, David

Updates from   Updates were provided by the following workgroups:
                   1) Systems Level Measures (Dana Safran)
                         o The group is led by four executive committee members, Dana Safran, Rich
                             Antonelli, Tom Lee, and Susan Abookire
                         o The first meeting of the workgroup was held on Wednesday, January 6th
                             and discussions emerged to clarify the charge of the group.
                                       The charge of the group is to put ideas on the table for measures
                                      that are not necessarily currently being use and to also consider
                                      aspects of care that require integration of care across providers.
                         o Additional brainstorming of ideas and measures led to establish or agree on
                             a framework.
                         o The Institute of Medicine’s six domains of healthcare quality - safe, timely,
                             effective, efficient, equitable, and patient-centered (STEEEP) was
                             suggested as a starting framework with some creativity needed to map
                             indicators to the framework. (i.e. mapping indicators for health outcomes
                             to Effectiveness)
                         o The group agreed to use the STEEEP framework and as Rich Antonelli
                             explained, the challenge will be in determining the measures need for
                             establishing an integrated care entity versus an accountable care entity.
                         o Finally, Charlie Homer asked if there was deliberation in the workgroup as
                             it relates to outcomes and process measures for the adoption of EHR and
                             meaningful use criteria.
                         o Dana Safran cited some examples of measures that the workgroup is
                             currently considering as it relates to EHR and will be mapped to the
                             STEEEP framework.
                   2) Scorecard (Dwight McNeill)
                         • Dwight McNeill provided an overview of the work for the Scorecard
                           working group 
                         • Invited expert panel member participation in the workgroup 
                   3) Performance Measurement Alignment (MAHP – Larry Gottlieb)
                             • Larry Gottlieb shared that the workgroup is meeting on Monday,
                                  January 11th and will have an update for the next meeting
Discussion on      Dwight McNeill presented on the expert panel’s role in reviewing performance measures.
performance        (reference slides)
measures review
function (Dwight   Discussion on presentation:
                   Alice Bonner:
                       • Looking for alignment/overlap
                       • Dwight responded by stating the measures are clustered
                   Barbra Rabson:
                       • Expressed concern for measure standardization with so many efforts and initiatives
                       • For example, MAHP initiative has already done a lot of work.
                       • Dwight responded that MAHP’s effort is for measures alignment for pay-for-performance
                           and it is specifically for payment. The database/repository of measures may feed into that
                       • Larry Gottlieb also stated that the measurement alignment for pay-for-performance is not
                           necessarily the overall goal of the PMEP and agreed that the larger goals will feed into the
                           pay-for-performance approach
                   Paula Griswold:
                       • Asked if the database is descriptive or normative?
                       • Pay-for-performance has mostly included private payers but has more recently included
                           public payers across all programs
                   Tom Lee:
                       • Performance measurement should be focused on quality improvement not on pay-for-
                       • Create a structure that makes you compete with yourself from the previous year’s
                           performance – it should not be about market share
                   Larry Gottlieb:
                       • Agrees that the framework and the effort of the PMEP should not be about pay-for-
                   Dana Safran:
                       • Referring to the presentation (slide # _) “Locating: Project type and purpose” Dana
                           encouraged the group to keep an eye on the audience.
                       • The projects have relevance for the headings but the task is to have state surveillance,
                           public reporting, and quality improvement
                       • If payment is picked up as a result of the work – that is a bonus
                   David Smith:
                       • Expressed concern about the group’s identity crisis – Expert panel on performance
                           measurement versus expert panel on performance measurement alignment
                       • Asked if alignment is a principle purpose for the group
                   Qi Zhou:
                       • Stated that provider feedback and pay-for-performance can be independent but can have
                           some collaboration
                   Full presentation on QCC Expert Panel website -

Presentation on     Julie Lewis, Director of Health Policy at the Dartmouth Institute for Health Policy and
national approach   Clinical Practice, presented on the early collaborative work with the Brookings Institution
to ACO              on performance measurement in accountable care organizations.
(Julie Lewis,       Discussion on presentation:
Dartmouth and       Question:
Aaron McKethan,        • Were measures related to behavioral health examined for use in the
Brookings)                 Dartmouth/Brookings ACO model?
                       • Julie Lewis remembered behavioral health issues being discussed as an important
                           issue but could not recall if the measures were not good enough and promised to
                           follow up.

                    Rich Antonelli:
                       • NQF has a vote out for care coordination – Asked Julie, how do you define care
                       • Julie responded by saying that they would like their definition to be better and are
                          working with their committees/workgroups to stretch the definition. Julie
                          welcomed collaboration with the PMEP group and is open to using new measures
                          or comments for guidelines

                    Full presentation on QCC Expert Panel website -

Disparities       Cynthia Sacco, MD, MassPro, presented an evaluation of disparities in performance
performance       measurement in MassHealth.
measurement in
Commonwealth      Discussion on presentation:
(Mass Health,     Question:
Harvard Pilgrim      • Differences in disparities seem to be small – is there a significant difference?
and Tufts)                  o Response: There wasn’t a lot of disparity but they are still struggling to
                                deal with the sample size, socioeconomic status, and process of care
                            o The sample size is also limited by the available data used – a subset of
                                Medicare data because data of other payers are not available

                  Dana Safran:
                     • Expressed concern that the data showing little disparity will lead to complacency
                        in the hospital instead of asking additional questions to decrease other disparities
                        or improve quality

                  Kathy Coltin from Harvard Pilgrim Health Care added that they also deal with the same
                  numbers problem and in fact use the same racial/ethnic categories as MassHealth in order
                  to have a large enough sample size. In addition, Harvard Pilgrim combines multiple years
                  of data for outcomes measures and will also combine multiple measures to deal with the
                  sample size issue. Kathy commented that the all payer claims database can be much more
                  helpful in dealing with these issues.

                  Qi Zhou from Tufts Health Plan also added that for health plans, a big challenge is not
                  having racial, ethnic, linguistic, geo-surname estimation for populations. Satisfaction
                  surveys still have a small sample size. Data collection is a huge gap. For commercial
                  plans the survey data the disparities might be in language barriers more than other
                  categories and this is useful information as it applies to the provider level and plan
                  communication to the members.

                  Pamela Siren
                     • Collection of racial and ethnic data for ACO’s may be challenging because of
                        sample size but it can have a lot of traction by sharing. Neighborhood Health Plan
                        has identified disparities for Hispanic groups by blending product lines. There are
                        opportunities for ACO’s to collect this data
                  Full presentation on QCC Expert Panel website

measures review: Alice Bonner, PhD and Joel Weissman, PhD presented a Strategic Plan for Care
Care Transitions Transitions to the EPPM. The discussion was postponed to the next meeting due to time
(Alice Bonner and constraints.
Joel Weissman)

                   Full presentation on QCC Expert Panel website -

                                         NEXT PANEL MEETING (#3): To be scheduled –

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