Last Chance for Public Comment, KY Core Healthcare Measures Set

The public comment period for the Kentucky Core Healthcare Measures Set ends on Thursday, May 24, 2018 at 11:59 p.m. (ET). This is the final opportunity for healthcare stakeholders to weigh in on the relevance and feasibility of new and revised measures.

The Kentucky Core Healthcare Measures Set includes 38 provider performance measures in the areas of prevention, pediatrics, chronic and acute care, and behavioral health. Ultimately, the expectation is for the measures set to be adopted by public and private organizations to better focus improvement efforts toward shared areas.

The PMAC Executive Committee will weigh the opinions, suggestions, and comments resulting from the public comment period. If you are a healthcare stakeholder in Kentucky, please download and review the draft KCHMS on the KHC website here and fill out an online form to submit your comments.

Please email any questions to sclouser@khcollaborative.org.

KY Core Measures Set Now Available for Comment

Stephanie Clouser

Last year, the Kentuckiana Health Collaborative partnered with Kentucky Department for Medicaid Services to form the Kentucky Performance Measures Alignment Committee (PMAC), a public-private partnership with the goal of creating a core measures set for Kentucky stakeholders to align to. The goals of the core healthcare measurement set are to establish broadly agreed upon priority quality measures that improve the quality and value of care, reduce provider reporting complexity, and align Kentucky’s healthcare organizations to focus on key indicators of quality healthcare in the Commonwealth. The final measures chosen will be included on a core healthcare measures set. Ultimately, the expectation is for the measure set to be adopted by public and private organizations to better focus improvement efforts toward shared areas.

Today, a draft of the core measures set, the Kentucky Core Healthcare Measures Set (KCHMS), is available for public feedback. This public comment period will end on May 24, 2018.

PMAC consists of a large oversight committee and four subcommittees dedicated to areas of primary care and pediatric care: Preventive Care, Pediatric Care, Chronic and Acute Care, and Behavioral Health Care. Subcommittees have spent the last several months creating recommended sets of measures in their area of focus. The result is a measures set with 38 unique measures.

Of those 38 measures in the recommended set, 24 are defined as high priority. The committees found high priority measures to be strong predictors of quality care and reflect priority conditions for Kentucky. These measures had very strong consensus for adoption, and often there was additional enthusiasm from the group around these measures. Standard measures are also important, but they are not elevated to the level of high priority because of either being smaller predictors of quality care, data availability challenges, or lack of provider focus in that area.

There were a few themes that we saw throughout the committees, particularly around behavioral health, BMI, and chronic conditions. For example, behavioral health and preventive health teams both selected the same tobacco screening and cessation measure, and the pediatric group also selected a tobacco screening and cessation measure directed specifically at adolescents. Although the chronic care team didn’t review tobacco measures, they made it clear that tobacco use has a large impact on chronic conditions and asked the other subcommittees to make that a priority in their selection. The behavioral health team selected depression screening and follow up (NQF #418, a CMS measure), and the pediatric group selected as a future area of development a new HEDIS depression screening and follow up measure that was also based on the CMS measure that the behavioral health group chose.

The large PMAC oversight committee has begun to work with these recommendations to create a final set of measures, which will include weighing the opinions, suggestions, and comments resulting from the public comment period. If you are a healthcare stakeholder in Kentucky, please download and review the draft KCHMS on the KHC website here, and fill out an online form to submit your comments.

Please email any questions to sclouser@khcollaborative.org.

National Quality Forum Releases Opioid Stewardship Playbook

Louisville Metro also releases two-year action plan for addressing substance abuse

 

For the past several months, the KHC has put an increased focus on the behavioral health issues that face our region, including substance use disorder. One of the activities KHC has been involved in is the creation of an opioid stewardship playbook, through National Quality Partners (NQP) Opioid Stewardship Action Team, a program by the National Quality Forum. The KHC joined more than 40 other organizations across the country to develop the National Quality Partners Playbook™: Opioid Stewardship, which provides strategies for healthcare organizations and clinicians across practice settings and specialties of care.

This month, the playbook was released and is now available for download. It contains resources for organizations of all sizes to practice opioid stewardship. The NQP Playbook identifies fundamental actions to support high-quality, sustainable opioid stewardship, including:

  • promoting healthcare leadership commitment and implementation of organizational policies that support opioid stewardship;
  • advancing clinical knowledge, expertise, and practice in pain management and opioid prescribing guidelines;
  • engaging patients and family caregivers in discussions about the risks and benefits of pain management strategies, especially the use of opioids;
  • tracking, monitoring, and reporting performance data on opioid stewardship and pain management;
  • establishing accountability for promoting, establishing, and maintaining a culture of opioid stewardship; and,
  • supporting community collaboration to achieve maximum impact.

The NQP Playbook includes concrete examples and tactics for implementation, identifies barriers and corresponding solutions, and connects clinicians to important tools and resources that are applicable across care settings. Implementation examples are organized into basic, intermediate, and advanced to allow organizations with varying levels of resources and expertise to identify opportunities for action. The intent is for organizations to determine which approach best fits their individual efforts and community needs.

Public Webinar on Opioid Stewardship Planned for March 29

NQF will host a public webinar on opioid stewardship on March 29 in conjunction with the NQP Playbook. NQP Opioid Stewardship Action Team chairs, Christina Mikosz, Centers for Disease Control and Prevention, and Paul Conlon, Trinity Health, will speak, along with other members of the Action Team.

The webinar will address the national opioid epidemic and will highlight how healthcare organizations and clinicians can take concrete steps to drive effective pain management and opioid stewardship, including authentic engagement of patients and family caregivers. Members of the NQP Opioid Stewardship Action Team will address the critical roles that various stakeholders play in making opioid stewardship programs successful and sustainable. To register for the webinar, click here.

NQF will also host a fully accredited, one-day workshop on May 1 for clinicians and healthcare quality leaders to learn about implementing the NQP Playbook. For more information, click here.

Louisville Metro Substance Action Plan Released

Locally, the Louisville Metro Department of Public Health and Wellness released its two-year action plan for addressing substance use and misuse in Louisville, “Coming Together for Hope, Healing & Recovery.” The 80-page report includes a science-based analysis of the use of illegal drugs, tobacco, and alcohol in Louisville and 10 strategies for accelerating the city’s fight against drug abuse:

  1. Prevent and reduce youth substance abuse
  2. Increase trauma informed care
  3. Reduce stigma
  4. Increase harm reduction
  5. Expand diversion from emergency rooms and jail
  6. Improve connection to treatment
  7. Measure the quality of treatment programs
  8. Establish guidelines for sober living houses
  9. Make expungement affordable
  10. Improve job placement

Approximately 50 organizations provided insight and expertise for the creation of the action plan, including the KHC. Click here to read the report.

Progress Update: KY Core Healthcare Measures Set

Last year, the KHC began a partnership with the Kentucky Department for Medicaid Services (KDMS) to create a core healthcare measures set for Kentucky’s primary care providers, with the ultimate goal of aligning the priorities of Medicare, Medicaid, and commercial insurers. The project was announced in September by Secretary of the Kentucky Cabinet for Health and Family Services Vickie Yates Brown Glisson, and soon after, four subcommittees formed in key areas got to work, evaluating national core measures sets, Kentucky performance data, organizational healthcare priorities, and more.

There continues to be much interest in the work, called the Kentucky Performance Measures Alignment Committee (PMAC). But the KHC hasn’t provided an update recently on PMAC or what the 73 experts from around the state are doing as part of the measures selection process.

After spending a considerable amount of time considering local and national priorities, the landscape of healthcare metrics, and data collection capabilities, the members of the subcommittees – Preventive Care, Chronic and Acute Care, Pediatric Care, and Behavioral Health Care – began the process of evaluating possible measures for inclusion using a scoring rubric that the subcommittees collaboratively created. For the last few weeks, each subcommittee has been going through the process of going over these evaluations to reach consensus on the status of these measures. Committee members are weighing a number of criteria, such as reporting capabilities, national and local measure priorities, and health and cost impact.

By the end of March, each subcommittee will finalize its list of measures to propose of the large oversight committee, which was announced in November. This large oversight PMAC team will meet for the first time in April, when it will hear the presentations of each subcommittee and kick off the next few months of work on their own deliberations.

PMAC members are working hard to release the measures set by August. Look for more updates on progress in the near future.

Members for KHC/KDMS Measurement Alignment Committee Announced

Members have been selected for the Kentucky Performance Measures Alignment Committee (PMAC), a public-private committee formed to create a common primary care measures set in the Commonwealth of Kentucky. Applicants were selected jointly by the Kentuckiana Health Collaborative and Kentucky Department for Medicaid Services.

Kentucky PMAC will oversee the measurement alignment work and determine the final core measurement set. KHC received an overwhelming response from individuals and organizations with a passion for quality healthcare measurement from various types of stakeholders, including plans, providers, purchasers, consumers, academia, and government.

Committee members will attend meetings in-person or virtually from April 2018 to July 2018. PMAC committee member organizations and individual representatives are below.

PMAC Members

Aetna Better Health of Kentucky

Donna Hall

 

American Board of Family Medicine

Michael Hagen

 

Anthem BCBS

Amy Mattingly

 

Ashland Children’s Clinic

Ishmael Stevens Jr.

 

CareSource

Nicole Johnson

 

Estill Medical Clinic

Donna Isfort

 

Family Health Centers

Julia Richerson

 

Foundation for a Health Kentucky

Rachelle Seger

 

GE Appliances, a Haier company

Diana Han

 

Friedell Committee

Richard Heine

 

Humana

Misty Roberts

 

Kentucky Cabinet for Health and Family Services

Judy Baker

 

Kentucky Department for Medicaid Services

Gil Liu

 

Kentucky Employees’ Health Plan

 

Kentucky Equal Justice Center

Cara Stewart

 

Kentucky Medical Association

Lindy Lady

 

KentuckyOne Health Partners

Don Lovasz

 

Kentucky Primary Care Association

Kayla Rose

 

Kentucky Regional Extension Center

Trudi Matthews

 

Kentucky Rural Health Information Organization

Andrew Bledsoe

 

Kentucky Voices for Health

Emily Beauregard

 

Louisville Metro Department of Public Health and Wellness

Lori Caloia

 

Louisville Metro Department of Public Health and Wellness

Sarah Moyer

 

Mountain Comprehensive Health Corporation

Mahala Mullins

 

Norton Healthcare

Ken Wilson

 

Papa John’s

Greg Potts

 

Passport Health Plan

Jamie Long

 

Passport Health Plan

Stephen Houghland

 

QSource

Margie Banse

 

St. Elizabeth Physicians

Dan Cole

 

WellCare of KY

Laura Betten

 

White House Clinics

Brittany Arthur

 

University of Kentucky

Scottie Day

 

UofL Hospital

Tina Claypool

 

UAW/Ford Community Healthcare Initiative

Randa Deaton

 

UAW/Ford Community Healthcare Initiative

Teresa Couts

 

University of Louisville Physicians

Jamie Jenkins

A Week of Gathering Opioid Best Practices at U.S. Capital, Hoosier State

Stephanie Clouser

The KHC has recently embarked on efforts to contribute to the battle against the opioid epidemic on multiple fronts, including participating in the creation of Louisville Metro Department of Public Health and Wellness’ city addiction response plan; making the focus of our annual conference on connecting behavioral and physical health (including addiction treatment strategies); adding Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (IET) to our yearly reports; and joining a national, 40-member opioid action team.

Last week, I spent most of my week working on opioid-related efforts, coming away with an overwhelming amount of information about initiatives that are happening at the local and national level. I want to share some of the themes of the week’s conversation at the in-person forum in Washington, D.C., and at the Employers’ Forum of Indiana in Indianapolis, IN.

National Quality Partners Opioid Stewardship In-Person Forum

National Quality Forum (NQF) has put together a 40-member Opioid Stewardship Action Team, comprised of organizations from across the country, to identify strategies and tactics for opioid addiction prevention and collaborate to accelerate and amplify current efforts going on across the country.

The Action Team, which includes KHC, gathered in Washington for an all-day summit that included presentations and workgroups to provide practical guidance to advance opioid stewardship, identification of barriers for successful implementation of opioid solutions, and discussion of alignment and action on policy levels and measurement approaches to support opioid stewardship.

One of the more interesting discussions of the day was a presentation given by Dr. Rachel Levine, Acting Secretary of Health and Physician General for the Commonwealth of Pennsylvania, which outlined Pennsylvania’s response to the opioid epidemic. Their efforts include working with medical schools on education of students, provider education through continuing education credits, expanding naloxone access, focus on “warm hand off” to treatment, and more. Particularly interesting is the “warm hand off” program, where the state is implementing a warm hand-off process to help overdose survivors who appear in emergency departments (ED) to receive counseling and a doctor’s referral to be transferred directly from the ED to a drug treatment facility.

The rest of the day was spent in small group settings to tackle various aspect of the playbook that is being developed to identify strategies for prevention. I attended discussions on Tracking, Monitoring, and Reporting and Community Collaboration. In these discussions, we worked on more of the elements that will end up in the playbook. There were a few themes that emerged in many conversations throughout the day, including getting more real-time data that can help identify those at risk of dependence before they become dependent. Much of the Community Collaboration discussion was around coordinating the efforts of multiple organizations in the community to prevent duplication of efforts and streamline solutions. There was a lot of emphasis on promoting pain management techniques other than opioids (physical therapy, meditation, etc.), instead of making opioid prescriptions the first line of defense. It was agreed that even using the word “alternative” to describe these treatment options makes opioids sound like the default method of treatment, which might not always be the appropriate default treatment method. There was a lot of focus on using return on investment information to help drive efforts and track their efficacy.

In January, the strategies we identified at last week’s forum will be incorporated into an initial draft of the playbook. There will be an open comment period, and by March, the playbook will be released. We will continue to provide updates on this project.

Employers’ Forum of Indiana

The other event I attended last week related to opioid response was the Employers’ Forum of Indiana All-Stakeholders Meeting. The Employers’ Forum was kind enough to invite me to attend the event, which was focused on opioid efforts, because of my interest in the subject. The afternoon’s agenda included presentations (slides can be found here) about multiple efforts going on in the Hoosier State.

Justin Phillips, whose career background was in preventing unintentional injuries and deaths, founded Overdose Lifeline after the overdose death of her son in 2013. Overdose Lifeline, based in Indianapolis, provides support in many ways. Much of Phillips’ presentation last week focused on the organization’s harm reduction efforts, including the passing of Aaron’s Law, named after Phillips’ son, which allows for layperson access to opioid overdose reversal medication naxolone. Overdose Lifeline also provides training and equips first responder personnel with naloxone across the state of Indiana. To date, the organization has trained 263 law enforcement and fire departments and distributed more than 9,000 intranasal single dose naloxone kits.

Indiana also has received technical assistants from The Pew Charitable Trusts, which works with states to create framework for an effective substance use disorder treatment system tailored to each state. At no cost to the state, Pew works with each state for 12 to 14 months. They identify gaps in a state’s treatment system, develop a consensus package of evidence-based policy solutions, and enact policy changes.

The day finished with a presentation from Dr. Jen Walthall, Secretary of Indiana Family and Social Services Administration, who outlined the state’s efforts to address the opioid crisis. As she mentioned, many of the Pew’s suggested solutions for Indiana were things the state was already working on, which Walthall said was reassuring, knowing that Indiana was going in the correct direction. Indiana’s efforts include collecting data (and making it available to the public via an open source data hub), multiple programs through $10.9 million in 21st Century Cures grants, a Medicaid waiver to expand recovery support efforts, creating of a toolkit, and partnerships with law enforcement, faith-based communities, elected officials, and more.

Conclusions

It was an intense week, diving deeply into opioid strategies from all angles and really studying the impact of opioids locally and across the country. Although I knew that each state was working on this to some extent, there is a lot more going on – and much more advanced – than I originally was aware of. The pieces to effectively tacking the opioid crisis are there. We just need to start putting them together.

Call for Applications – KY Performance Measures Alignment Committee

Recently, KHC announced the creation of a public-private partnership to create a common measures set in Kentucky, the Kentucky Performance Measures Alignment Committee (PMAC), led by KHC and KY Department for Medicaid Services. The 12-month initiative will produce a common set of measures related to five key areas of healthcare focus, with the ultimate expectation that the measure set be adopted by public and private organizations to better focus improvement efforts toward shared areas.

To support that effort, we are now taking applications to participate on the PMAC committee, which will be chosen jointly by KHC and KDMS. Kentucky PMAC will oversee the measurement alignment work and determine the final core measurement set. We are looking for individuals and organizations with a passion for quality healthcare measurement from various types of stakeholders, including plans, providers, purchasers, consumers, academia, and government.

Committee members will attend an estimated six meetings in-person or virtually from November 2017 to July 2018. For more information about the project, an invitation to apply for a subcommittee, list of roles and responsibilities of committee members, and an application, click here.

Submissions will be due by Wednesday, October 25. Any questions, please contact sclouser@khcollaborative.org.

What is Your Organization Doing to Address the Opioid Crisis?

Last week, KHC announced that we have been selected to be part of a 40-member opioid action team that will identify strategies and tactics for opioid addiction prevention and collaborate to accelerate and amplify current efforts going on across the country. It’s no secret that this is a priority in our state and in Southern Indiana, so we are excited to team up with some of the best minds in the country to produce a playbook that addresses the crisis from many angles, including:

  • Leadership and Culture
  • Patient and Family Engagement and Education
  • Clinical Knowledge and Expertise
  • Organizational Policies and Clinical Practice
  • Tracking, Monitoring, and Reporting
  • Accountability
  • Community Collaboration

Over the next several months, the National Quality Forum Opioid Stewardship Action Team will meet in person and virtually to identify best practices for implementing opioid stewardship and tools and resources related to overcoming barriers.

As we begin this work, I want to ask our community partners and friends – what is your organization (or organizations that you work with) doing to address the opioid crisis in our community? The more information we gather about what is going on in our community, the more productive we can be in our work with NQF.

If your organization has launched, plans to launch, or is even thinking about launching a program or strategy related to this, I want to hear from you. Please send me an email at sclouser@khcollaborative.org.

KHC Joins Forces with Other Healthcare Stakeholders in Measurement Alignment Initiative

KHC representatives join Secretary Vickie Glisson for announcement of PMAC.

At last week’s Kentucky Medical Group Management Association fall conference, the Kentucky Department for Medicaid Services (KDMS) unveiled Medicaid’s newly created set of quality measures with 23 measures that meet the quality reporting standards for MIPS. Secretary of the Kentucky Cabinet for Health and Family Services Vickie Yates Brown Glisson kicked off the presentation and also announced that a private-public partnership to align healthcare quality improvement measures in the Commonwealth had been created as a part of this work (if you missed the announcement, see a replay here).

Kentuckiana Health Collaborative’s Teresa Couts, Randa Deaton, and Stephanie Clouser were onstage with Glisson as she announced this effort. What Glisson introduced – although not by name – is called the Kentucky Performance Measures Alignment Committee (PMAC), a public-private partnership between KDMS and the KHC. Members of PMAC, made up of individuals from all healthcare stakeholder types, will help form recommendations for measure prioritization in one of five key areas of focus:

Pediatrics

Acute Care

Chronic Care

Preventive Health

Behavioral Health

The goals of the core healthcare measurement set are to establish broadly agreed upon priority quality measures that improve the quality and value of care, reduce provider reporting complexity, and align Kentucky’s healthcare organizations. The final measures chosen will be included on a core healthcare measure set. Ultimately, the expectation is for the measure set to be adopted by public and private organizations to better focus improvement efforts toward shared areas.

Measurement alignment work and the reduction of reporting complexity is important. A 2013 National Quality Forum (NQF)-commissioned analysis from Bailit and Associates identified 1,367 quality measures in use across 48 different state and regional programs. Of these measures, 509 were distinct and the remaining 800+ measures overlapped or had similar focus, with one or more variations in the specifications. A common saying is that more information is better information, but that is not necessarily the case in healthcare quality measurement. Too many measures can create noise that hides what the key measures are telling us, measures that are “topped out” don’t provide meaningful information about variation between sources of care, and the cost in time and money for measures that aren’t very helpful are not worth that cost.

A core measure set can be used by providers to align their selection of MIPS measures, by health plans to measure and incent the healthcare quality of providers, and by purchasers to contract with plans and providers. All sectors can use a core measure set to improve adherence to evidence-based medicine and health outcomes.

Kentucky PMAC will oversee the measurement alignment work and determine the final core measurement set. Each of the five subcommittees will identify a recommended set of core measures for their area of focus. Each subcommittee will make their recommendations to the PMAC group for inclusion in the core measure set. Both PMAC and its subcommittees are made up of experts from all stakeholder types.

It is estimated that this work will take about 12 months. Currently, subcommittee members are being finalized and between November 2017 to March 2018, each subcommittee is expected to meet four to five times. They will then give their recommendations to the large committee, which will make final decisions and have a public comment period. The measure set is expected to be finalized in July 2018.

Anyone interested in the project can keep up with updates on the KHC website.

KHC Selected for National Opioid Stewardship Action Team

It’s no secret that opioid addiction is a problem in Kentucky and Southern Indiana. Kentucky is third in drug overdose deaths and writes the fourth most prescriptions for opioids in the nation. Nearly half of all Kentuckians who enter treatment for substance abuse do so for opioid misuse – the eighth highest proportion in the U.S. Earlier this year, Louisville made national headlines when a shocking 151 overdoses occurred in just four days.

Addressing addiction is such a priority for the KHC that our annual conference in March will focus on connecting behavioral and physical health, including addiction treatment strategies. We have recently added Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (IET) to our yearly reports to reflect that focus. As a multi-stakeholder coalition, our members’ time and time again have identified mental health and opioid abuse as priorities for their organizations. Public health professionals, employers, providers, plans, and citizens are all reeling from this opioid epidemic and are anxious to work together to find solutions.

As another effort to address Kentucky’s – and the nation’s – opioid use crisis, I am pleased to share that the KHC has been selected to be part of a 40-member opioid action team that will identify strategies and tactics for opioid addiction prevention and collaborate to accelerate and amplify current efforts going on across the country.

National Quality Partners (NQP) Opioid Stewardship Action Team, a program by the National Quality Forum, will ultimately publish a playbook that focuses on improving prescribing practices and identifying strategies and tactics for managing care of individuals who are at high risk of becoming dependent on opioids, while building on current public- and private-sector efforts to address the opioid epidemic. The playbook will be released in March 2018. NQP will model the Playbook after other successful efforts to tackle national healthcare priorities, including National Quality Partner’s Playbook: Antibiotic Stewardship in Acute Care, which has become an essential resource to help physicians, pharmacists, and healthcare organizations implement strategies to promote the appropriate and safe use of antibiotics. That playbook has been downloaded more than 30,000 times.

I will represent KHC on this Action Team, and I will join individuals from organizations across the country, many of which have launched innovative programs to address the opioid crisis. The Action Team is chaired by Christina Mikosz, MD, MPH, Medical Officer at Centers for Disease Control and Prevention, and Paul Conlon, PharmD, JD, Senior Vice President, Chief Quality and Patient Safety, Trinity Health.

For more information on the NQP Opioid Stewardship Action Team, click here. The following organizations have representatives on the Action Team:

Aetna

Agency for Healthcare Research and Quality

American Academy of Orthopaedic Surgeons

American Academy of Physical Medicine and Rehabilitation

American Nurses Association

American Physical Therapy Association

American Society of Health-System Pharmacists

Appriss Health

BlueCross BlueShield Association

Centers for Disease Control and Prevention

Centers for Medicare & Medicaid Services

Council of Medical Specialty Societies

Dental Quality Alliance

Elevating Home

GeisingerHealth System

Harborview Medical Center

Health Resources and Services Administration

HealthPartners

Henry Ford Hospital

Heron Therapeutics

Hospice and Palliative Nurses Association

Hospital Corporation of America

IBM Watson Health

Institute for Behavioral Healthcare Improvement

Institute for Healthcare Improvement

Kaiser Permanente

Kentuckiana Health Collaborative

Magellan Health, Inc.

Mayo Clinic

Memorial Sloan-Kettering Cancer Center

Partners Behavioral Health Management

Patient & Family Centered Care Partners, Inc.

Pharmacy Quality Alliance

Premier Healthcare Alliance

Press Ganey Associates

Substance Abuse and Mental Health Services Administration

Trinity Health

U.S. Pharmacopeial Convention

Veterans Health Administration

Vizient, Inc.