KHC Joins Coalitions Across the Country to Address Healthcare Affordability

Kentucky, like the rest of the United States, has a problem. Healthcare costs continue to rise. However, paying more for healthcare does not mean we get better healthcare services, and it does not mean we are healthier as a result. We pay too much for care and it is causing financial, emotional, and clinical harm to individuals, businesses, and communities.

The current situation is unsustainable; harder choices are coming. There are proven approaches to make headway, but we have to work together to achieve success. We can’t blame the current state of affordability on any individual group of people. We all created the situation. It will take all of us working together to solve it.

Healthcare costs continue to rise. However, paying more for healthcare does not mean we get better healthcare services, and it does not mean we are healthier as a result.

The KHC has long been a trusted partner in reporting healthcare quality performance data. But you can’t address quality without also looking at value. Solving one issue in isolation does not achieve the healthcare affordability goal. Healthier populations use fewer healthcare resources. Healthier populations create more productive communities. Unnecessary services are causing clinical, emotional, and financial harm. Administrative waste is a financial burden on patients and providers while also burning out providers.

To begin the conversation locally around healthcare affordability, the KHC has joined the Network for Regional Healthcare Improvement (NRHI) and other regional coalitions across the country to bring healthcare affordability to the forefront of healthcare transformation efforts. The movement is focused on health, price, and waste — the three drivers of affordable healthcare. In joining this effort, NRHI and its coalitions like KHC will leverage their collective strengths on efforts to improve affordability while preserving and improving quality. In addition, partnering with other national entities committed to solving the healthcare affordability problem will strengthen the effectiveness and reach of these efforts.

The campaign, called Affordable Care Together, is an approach that puts communities at the center of the solution; the movement is led by neutral, non-profit conveners who build on existing, multi-stakeholder efforts to improve health, reduce price, eliminate waste, and collectively create greater awareness and solutions.

As part of Affordable Care Together, myself and KHC leaders Teresa Couts, Randa Deaton, Emily Beauregard, Don Lovasz, and Amanda Elder will join leaders from every segment of the U.S. healthcare system at the Ronald Reagan Building in Washington, D.C. for a day-long summit next week, addressing our country’s healthcare affordability crisis. We will bring back the lessons and ideas that we learn and put them to use, hosting a Community Health Forum in December called “The Path to Affordable Healthcare.” The half-day event will bring together key healthcare stakeholders and like-minded local change agents, who will help develop a community action plan to address healthcare affordability in our community.

Look in coming weeks for more content on healthcare affordability, including reflections from the summit in Washington, D.C. There are ways we can work together to change the system and make it sustainable for current and future generations. By working together, we can make a difference.

 Learn more about Affordable Care Together

KY Core Measures Set Reflects Diversity of Thought, Collaboration

This week, I listened to a recent episode of one of my favorite podcasts, NPR’s Hidden Brain, which explores the unconscious patterns that drive human behavior. This particular episode was about research that suggests that assembling people into groups that are diverse produces more creative results.

As I listened to the episode, I thought of the Kentucky Performance Alignment Committee (PMAC), the measures alignment initiative the KHC led with the Kentucky Department for Medicaid Services. Consisting of more than 70 experts from across the Commonwealth of Kentucky, there was no shortage of diversity in the oversight committee and four subcommittees.

I think our results reflect that diversity.

The final core measures set includes 32 unique measures, focused in the areas of prevention, pediatrics, chronic and acute care management, behavioral health, and cost/utilization. The PMAC team includes expert volunteers from varying backgrounds and geographic regions. These various stakeholders, some of which have competing priorities, have spent the last several months engaging in consensus-based discussions, often coming to some surprising agreements. Because we created a “limited” set, to reduce complexity and improve focus, committee members had to make tough decisions to select only the measures that have significant impact.

Many of the measures are ones that anyone with a healthcare measurement background would quickly recognize. But our PMAC committee also chose a few “stretch measures” that might have a few more challenges to them but ultimately are important to impacting the health of Kentuckians. One or two of these measures I thought for sure would get thrown out early in the process, but I think were included as a direct result of getting diverse minds at the same table, which elevated the results. I’m proud of our core set of measures, and I hope that PMAC members feel the same way.

I was also struck by the enthusiasm and passion that was exhibited by PMAC members. Each of the members answered questions about their interest and involvement in healthcare measurement as part of the application process. I am inspired and humbled by some of their responses, which reflect their commitment to healthcare quality in the Commonwealth.

PMAC members will be sharing their own reflections in upcoming weeks. We have already published a piece by Michael Hagen, MD, about his experience serving on PMAC.

I’m excited for the next steps in this initiative: selecting a community-level opioid measure, securing letters of support, and establishing an ongoing review process.

PRESS RELEASE: Kentucky Core Healthcare Measures Set Announced

Louisville, Kentucky, July 26, 2018: Kentucky now has an agreed upon set of healthcare measurement priorities. The Kentucky Core Healthcare Measures Set (KCHMS) was developed through a public-private partnership between the Kentucky Department for Medicaid Services (KDMS), within the Cabinet for Health and Family Services (CHFS), and the Kentuckiana Health Collaborative (KHC). The Commonwealth becomes one of the first states in the nation to enact a healthcare measurement set.

The purpose of this effort is to get Kentucky’s health plans and employers to reward primary care and pediatric providers on a shared set of relevant measures to drive improved health, quality of care, and value, to reduce administrative complexity, and to align healthcare organizations to have a shared focus.

For the last year, over 70 experts that provide, pay, purchase, and consume healthcare across Kentucky met as members of the Kentucky Performance Measures Alignment Committee (PMAC). They identified Kentucky’s current measurement situation is as follows:

  • Insurers and government programs define quality differently and are often unaligned in scope and focus
  • Primary care providers are incented on too many quality measures, 89 in 2018
  • Providers and their teams are overwhelmed with the burden of state, federal, and commercial measurement requirements

The new core measures set contains 32 measures, less than half of the number of 89 currently incented measures in Kentucky by various state and national programs. Measures are focused in the areas of prevention, pediatrics, chronic and acute care management, behavioral health, and cost/utilization. The PMAC team is currently requesting letters of support from key healthcare organizations

“It has been truly inspiring to see Kentucky’s various stakeholders come together for the good of Kentucky’s residents to drive improvements in health,” said Stephanie Clouser, KHC Data Scientist and PMAC coordinator.

“The Kentucky Medicaid team, which includes not only state government representation, but also partners from nationally prominent health insurance corporations, is committed to ensuring that every citizen can access health care that is proven in terms of quality and patient experience,” concluded Chief Medical Officer for Kentucky Medicaid, Gil Liu, MD, MS. “We look forward to building on this highly collaborative work of developing a core set of measures, to go forward and successfully accomplish measurably better health outcomes.”

The full list of measures can be found here. A public webinar will be held on Thursday, July 26, from 12 p.m. to 1 p.m. EST, to give an overview of the initiative and give Kentucky’s healthcare stakeholders a chance to ask questions of PMAC Chairs Gil Liu, KDMS, and Randa Deaton, KHC.

About the KHC: The Kentuckiana Health Collaborative (KHC) is a non-profit organization comprised of representatives who have a major stake in improving the health status and the healthcare delivery system in Greater Louisville and Kentucky. The KHC creates a space for multiple stakeholders to work collaboratively toward the Triple Aim goals of Better Health, Better Care, and Better Value. For more information on the KHC, visit www.KHCollaborative.org.

About CHFS: The Cabinet for Health and Family Services is home to most of the state’s human services and healthcare programs, including the Department for Medicaid Services, the Department for Community Based Services the Department for Public Health, the Department for Aging and Independent Living and the Department for Behavioral Health, Developmental and Intellectual Disabilities. CHFS is one of the largest agencies in state government, with nearly 8,000 full- and part-time employees located across the Commonwealth focused on improving the lives and health of Kentuckians.

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PMAC Participants Use Objective and Methodical Process to Select Core Measures

Michael D. Hagen

(Note: This guest post was written by Michael D. Hagen, MD, FAAFP, Professor, Department of Family and Community Medicine, University of Kentucky College of Medicine, and retired Senior Vice President, American Board of Family Medicine. )

I had the privilege to serve on and participate in both the Preventive Measures subcommittee and the Performance Measures Alignment Committee of the Kentuckiana Health Collaborative. I served both as a representative of primary care providers in my role as Senior Vice President of the American Board of Family Medicine (ABFM), and as a medical educator in my role as a Professor in the Department of Family and Community Medicine in the University of Kentucky College of Medicine (while I retired from the ABFM in January 2018, I believe that perspective remains valid and appropriate to the task). In both roles, I hoped to inform discussions on the real and perceived burdens primary care physicians express in meeting oftentimes duplicative and contradictory performance measures. I hoped to contribute to a parsimonious and harmonious set of measures that payors and other constituents could accept as sufficiently comprehensive to meet reporting needs while minimizing the burden of reporting.

Interestingly, I learned that other provider group representatives shared the same concerns! They all recognized that the plethora of available measures oftentimes fail to capture the value provided by primary care, and that many of these measures entailed significant reporting challenges (in terms of issues such as data accessibility and veracity.) Additionally, in spite of the growing call for patient-reported outcomes measures (PROM), the group recognized the challenges of collecting (e.g. cost, incorporating into workflow) and validating such indicators.

As we considered measures, the discussions included all of the above considerations, and, thankfully, all participants took an objective and unbiased view of each indicator…no outspoken, vociferous champions here! We looked at each measure from the standpoint of validity, accessibility of data, ease of reporting, and relationship to the Commonwealth’s healthcare challenges and needs. Interestingly, several areas that represent significant issues in Kentucky didn’t make the list: for example, low dose CT screening for early lung cancer in smokers. Lung cancer obviously represents a major problem in Kentucky, but the discussions highlighted a substantial concern with recommending the practice in the measures set: no validated available measures! While several committee members advocated strongly for the practice, the group held to its commitment to including only validated measures (we obviously all expressed the hope that such measures will become available in the near future!).

Responding to the multiplicity, overlap, and oftentimes contradictory definitions of measures, and challenges in data collection, have contributed to physician burnout. In spite of the energy expended in this endeavor, all this effort has yet to demonstrate substantial improvements overall in patient outcomes that matter. In particular, as insurers and payors move to value-based payment models, we need to assure providers that the measures used to establish payments represent valid assessments of the value that providers’ care adds to patients’ wellbeing. I hope that insurers and other stakeholders will recognize the careful consideration that went into creation of the recommended measures sets. These represent a parsimonious and carefully considered set of indicators that should support the needs of payors and providers alike.

Kentucky Core Healthcare Measures Set Finalized

Stephanie Clouser

Nine months. That’s how long it takes to develop and birth a baby.

It’s also how KHC co-director Randa Deaton has described the KHC’s initiative with Kentucky Department for Medicaid Services to create a core set of primary healthcare measures, which began approximately nine months ago and was completed last night.

Folks, reducing from 89 incented measures to a set of 32 definitely felt very much like birthing a baby.

The journey to create a core measures set for the Commonwealth of Kentucky began last summer, when KHC co-directors Randa Deaton and Teresa Couts met with then-Secretary of the Kentucky Cabinet for Health and Family Services Vickie Yates Brown Glisson and discovered a mutual interest in addressing measurement mayhem through alignment. Thus 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 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.

This spring, subcommittees presented their recommendations to a large oversight committee, which spent the next few months reviewing the recommendations and confirming the final set. The Kentucky Performance Measures Alignment Committee (PMAC) oversight committee and four subcommittees were made up of more than 70 expert volunteers from varying backgrounds and geographic regions. These various stakeholders, some of which have competing incentives, have spent the last several months engaging in consensus-based discussions, often coming to some surprising agreements. Because we created a “limited” set, to reduce complexity and improve focus, committee members have had to make tough decisions to select only the measures that have significant impact.

KENTUCKY CORE HEALTHCARE MEASURES SET

The resulting final set includes 32 primary care measures, 21 of which are considered high priority, focused in the areas of prevention, pediatrics, chronic and acute care management, behavioral health, and cost/utilization. This is less than half of the number of 89 currently incented measures in Kentucky by various programs. Many of the measures are ones that anyone with a healthcare measurement background would quickly recognize. But our PMAC committee also chose – wisely, in my opinion – a few “stretch measures” that might have a few more challenges to them but ultimately are important to impacting the health of Kentuckians.

This list of leading quality indicators is but a start toward driving meaningful measurement in Kentucky. PMAC members also got a chance to identify areas of development for future iterations of the measures set. Sometimes this involved listing existing measures that need improvement or establishment and sometimes these were blanket statements identifying the need to develop a measure in a particular area.

NEXT STEPS

The confirmation of the KCHMS is not the end of PMAC. Now that the set has been finalized, there is new work to be done. We have planned multiple events around Kentucky Core Healthcare Measures Set (KCHMS), including a webinar on July 26 and an employer forum in October. Additionally, we now begin the process of working with organizations to adopt this core measures set and utilize it in contracting. You can find all the news related to PMAC here.

Thank you to everyone who participated in this initiative, whether by serving on or chairing a committee, taking meetings with KHC staff members, securing meeting space, or providing expertise on measure nuances. Now let’s put this set to use. When we focus on everything, we focus on nothing. However, when we focus on the right things, we can drive meaningful change.

View the Kentucky Core Healthcare Measures Set

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