Wisconsin Collaborative for Quality Healthcare

Alignment of Measures Portfolio WCHQ 2016 Goal

Many of you may have made resolutions or set goals for yourself at the start of this year. Three months into 2016 some of those resolutions or goals may have been forgotten or set aside in favor of other goals, but some of you may still be forging ahead on your original goals, much as we are here at WCHQ.

Late in 2015, at the annual WCHQ Board retreat, we had a discussion about aligning our measures portfolio in anticipation of changes occurring at the national level. A representative from the Centers for Medicare & Medicaid Services (CMS) attended that meeting to provide background and information about changes to the Medicare payment system and the development of quality measures to support it.

What we learned in this discussion was CMS is seeking to tie 30 percent of Medicare payments to quality or value through alternative payment models by the end of this year, and 50 percent by the end of 2018. These measurable goals are intended to move the Medicare program and the healthcare system at large toward paying providers based on quality instead of quantity of care.

We also learned that the Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act of 2015 (MACRA) supports the transformation to paying for quality care through the development of new Medicare payment and delivery models for physicians and other clinicians. In response to MACRA, CMS created a draft plan --the Quality Measure Development Plan (MDP) -- for the development of quality measures for use in the Medicare Merit-based Incentive Payment System (MIPS) and to certain Medicare alternative payment models (APMs).

Beginning in 2019, CMS will apply a positive, negative, or neutral payment adjustment to each physician under the MIPS based on a composite score across four performance categories: quality, resource use, clinical practice improvement activities, and meaningful use of certified electronic health record (EHR) technology.

The quality performance category measures are a specific focus of the MDP. MIPS will build upon existing quality measure sets from the Physician Quality Reporting System (PQRS), Value-based Payment Modifier, and Medicare EHR Incentive Program for Eligible Professionals (i.e., Meaningful Use). To fill identified measure and performance gap areas, CMS will expand and enhance existing measures to promote alignment in the selection of measures and specifications, while also developing new ones. MACRA also establishes incentive payments for providers participating in certain types of APMs and requires the quality measures used in APMs to be comparable to the quality measures used in MIPS.

With CMS developing new quality measures and aligning measures across programs, it is WCHQ’s goal to ensure that our measures are in sync with the national sets of measures.

In addition to aligning our measures with the MACRA-related measures, we are also beginning to work with purchasers and payers on a local level to determine the set of measures that are most important to them. Initial conversation has been held with organizations represented on the WCHQ board – WEA, WPS, The Alliance, and the Business Healthcare Group – as a starting point and we will be reaching out to other organizations in the coming months. Our end goal is to establish a definitive and mutually beneficial commitment of support on the part of payers and purchasers to a set of measures reported by WCHQ.

We are in the early stages of these discussions and during the coming months will engage not only payers and purchasers but also you, our members and readers, to determine the priority we give to certain measures and how we can best align them with national benchmarks. Some questions that will need to be answered in the course of these discussions include how we will capture specialty areas in addition to primary care, chronic disease, and screening; how we effectively meet the challenge of capturing the voice of the patient through measures that cross a broad array of areas; and how we prepare organizations to measure and report on individual provider performance. We also will seek to accomplish all of these things without adding to the measurement burden for providers.

Our goal is to complete our discussions, and develop and present a final proposal to the WCHQ board by November, with implementation of the refreshed and aligned measures portfolio in 2017. It is possible that implementation of some measures could take place before 2017 if the core national measures are ready.

There is still much work to be done as we move ahead toward meeting our goal by the end of the year. There will be opportunities to engage in discussion at upcoming assembly meetings and other sessions, but if you have thoughts or questions regarding the work we are doing, please do not hesitate to contact me.