Data & Measurement

Problem: 

You can’t improve what you can’t measure, and you can’t measure without data. But data acquisition requires sustained efforts and individualized support. The task is not just getting data out of systems, but developing a secure, well-designed system where meaningful data is collected. Health care is among the last economic sectors to efficiently collect and then leverage data for quality improvement.

Our Solutions: 

The Practice Transformation team works with practices to facilitate the advanced use of health care information technology and electronic health information tools. In all programs practices are asked to report on the clinical quality measures that are described within program requirements.

Practices participate in performance improvement activities that aim to support practice transformation work around clinical quality measures. In these activities, practices:

  1. Choose three elective performance measures from RMHP’s measures of focus, along with  3 required performance measures
  2. Prepare and submit Aim Statements for each identified measure
  3. Collect and analyze baseline data for the chosen performance measures, comparing current performance to clinical guidelines and determining the cause(s) of variation from desired performance outcomes
  4. Participate in process improvement activities; Plan-Do-Study-Act (PDSA)  cycles for each chosen CQM to:
    1. Identify appropriate interventions to address the variations
    2. Set appropriate year end targets for each measure
    3. Test the process change/intervention
  5. Re-assess and reflect on the outcomes of each change/intervention
  6. Submit each PDSA cycle and a final project summary of outcome changes, if any, resulting from this activity to RMHP

Each quarter, upon completion of the reporting period, the practices Clinical Informaticist collects and analyzes all the data submitted. The practices Quality Improvement Advisor and Clinical Informaticist provide a feedback report that contains the submitted clinical quality measures. The RMHP generated feedback reports are developed to create a high level overview of data that practices may consider monitoring as it pertains to their particular program. The Clinical Informaticists are able to utilize these reports as a method of facilitation during virtual or on site, face to face visits where data can be the primary focus.

Colorado’s Medicaid Accountable Care Collaborative (ACC) is a central part of Medicaid reform, and Rocky Mountain Health Plans serves as the Regional Care Collaborative Organization (RCCO) for Region 1.
 
The ACC program uses three performance metrics:  
  • Percent improvement in ER visits 
  • Percent improvement in well-child visits 
  • Post-partum care
The State Data and Analytics Contractor provides and crunches performance data for incentive payments, quality improvement activities and cost-effectiveness. Through the SDAC web portal dashboard, organizations--providers as well as the RCCO-- track and analyze performance of the four indicators. Incentives are tied to how well providers and the RCCO do in meeting these metrics.
 
Initial results of the ACC program’s performance have been promising. We've seen cost savings in each year of the program and have logged improvements on each of the key performance indicators. 

 

Accountable Care Collaborative (ACC) Annual Reports

 

Statewide Key Performance Indicator (KPI) Tracking Reports

These reports provide a statewide comparison of the 7 RCCO regions based on the Key Performance Indicator (KPI) Trends report provided by the State Data & Analytics Contractor (SDAC).   The left side portrays this year's KPI metrics and the right side portrays other metrics that may be of interest. The Actual Ranks are based on the “actual values”, with Well-Child Checks (both ages 3-9 and 0-20) and Post-Partum Care ranked from high to low, while Total Cost of Care, ER Utilization, High Cost Imaging, and Readmissions are ranked from low to high.  You may view / download these quarterly reports at the links below.

 

Accountable Care Collaborative (ACC) Evaluation

With support from the Colorado Health Foundation and Rose Community Foundation, the Department of Healthcare Policy and Financing contracted with the Colorado School of Public Health to conduct an evaluation of the Accountable Care Collaborative (ACC) program. This report includes findings of the quantitative and qualitative analysis of the impact of the ACC on health care utilization, costs and quality. The quantitative study analyzes administrative claims data between July 2009 and June 2014, a period that spans the introduction and establishment of the ACC. The qualitative portion of the evaluation, which includes interviews conducted with representatives of designated primary care medical providers, is focused on practice experiences and perspectives with the program to date. The findings are being used to inform current and future implementations of the ACC program. This report presents findings from the first year of a two-year engagement for evaluation. The second year of evaluation will examine where cost savings occurred, key performance indicator performance, quality measures utilized in an Oregon companion project, unique aspects of rural and frontier areas, what support is most helpful for practices, and a deeper dive into care coordination and the team-based approach.

 

Data Sharing with Primary Care Practices and Care Teams

RMHP provides practices and care teams with monthly reports, using raw claims data from the state. These reports are used to sort and classify patient populations across a number of metrics, including ER utilization and hospital readmission rates, cost of care and medical complexity. The reports allow providers to identify and target those needing care management and care coordination. 
 
New data sharing arrangements and reporting infrastructure provide Community Care Teams with data from multiple sources, enabling them to make the greatest impact possible with limited resources.

The Comprehensive Primary Care Plus program consists of key drivers, change concepts and change tactics which guide participating practices through care delivery redesign. This model contributes to the Institute for Healthcare Improvements triple aim of better care, smarter spending and healthier people.

In the CPC+ program, practices will redesign the care that is provided to their entire patient population based key drivers. Specifically, the care delivery drivers of the Comprehensive Primary Care Functions are supported by three foundational drivers:

  1. Use of Enhanced, Accountable Payment
  2. Optimal Use of Health IT
  3. Continuous Improvement Driven by Data

The entire CPC+ model, and all of its drivers, is supported through Aligned Payment Reform.

Two of the 3 foundational drivers specifically target the areas of data and measurement in this care delivery redesign process; Optimal Use of Health IT and Continuous Improvement Driven by Data.

Optimal Use of Health IT: Practices will focus on change concepts and tactics in data & measurement by:

  1. Reviewing their internal measurement review process both at the practice and provider panel level,
  2. Creating a culture of improvement by engaging both clinical and administrative staff in practice improvement,
  3. Promoting data transparency to accelerate improvement activities and patient/family engagement, and
  4. By actively participating in shared learning via engagement with other practices working on similar measures.

Continuous Improvement Driven by Data: Practices will focus on change concepts and tactics in data & measurement by:

  1. Developing the capacity for optimal use of health information technology that is also certified by the Office of the National Coordinator to meet Quality Payment Program reporting criteria,
  2. Participating in data exchange via local health information exchanges and/or other service providers where shared patients exist, and
  3. Developing the capability to report clinical quality measures at both the practice and provider level.

RMHP’s Medicaid Prime pilot sets out data measurement goals for each year of the program: 

Year 1

  • Patient Activation Measurement (PAM) Target: 10 primary care medical providers and at least 50 percent of the attributed target population
  • Adult BMI target
  • Anti-depressant Medication Management 
  • Cholesterol Management and Control – LDL-C Level <100 mg/dL

Year 2

  • Practices will start reporting on the specified measures, so 2014 reported performance can be used as the baseline for establishing 2015 performance targets.

RMHP's Medicaid Prime program is the first full-cost and performance accountability Medicaid program to address volume-based payment with condition- and risk-based global payments to providers and an opportunity to earn added payment for performance on the key metrics. In the Prime program, data is used to recognize a member's functional medical home as well as to drive quality.

Clinical Quality Measures

Clinical quality measures, or CQMs, are tools that help measure and track the quality of health care services provided by eligible professionals, eligible hospitals and critical access hospitals (CAHs) within our health care system. These measures use data associated with providers' ability to deliver high-quality care or related to long term goals for quality health care. CQMs measure many aspects of patient care including: 

  • health outcomes
  • clinical processes
  • patient safety
  • efficient use of health care resources
  • care coordination
  • adherence to clinical guidelines 

Measuring and reporting CQMs helps to ensure that our health care system is delivering effective, safe, efficient, patient-centered, equitable, and timely care.

The graphs below represent data as of March 31, 2017

 

Site Reviews

Reviews are performed on-site at the Managed Care Organization (MCO)/Prepaid Inpatient Health Plan (PIHP) health care delivery system sites to assess the physical resources and operational practices in place to deliver health care. There are various components of a site review such as desk audits, emergency site visits, profiling, compliance reporting requirements, and other quality and program integrity review activities. The final report is reviewed by the Department of Health Care Policy & Financing in order to make recommendations for contract changes and for future audit process improvement.

Below are the RCCO Region 1 Site Review Reports:

RCCO Region 1 Site Review Report SFY 2015-16

Colorado Beacon Consortium Reports

CBC 2013 Final Program Report