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.
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:
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.
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.
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:
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:
Continuous Improvement Driven by Data: Practices will focus on change concepts and tactics in data & measurement by:
RMHP’s Prime pilot sets out data measurement goals for each year of the program:
RMHP Prime 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:
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 September 30, 2019
RMHP is allowing practices to submit data for NQF 2152 if their EHR does not allow them to submit data for NQF 0004.
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.
Reports can be accessed on the Site Reviews webpage of the Department of Health Care Policy and Financing website.