Community Reports Highlight Improvements in Quality Metrics, but the Effects of COVID-19 on Primary Care Remain to be Seen

2019 Kentuckiana Community Report

In April, the Kentuckiana Health Collaborative sent private reports to nearly 450 group practices throughout Kentucky and Southern Indiana. Soon after, the KHC released its annual community reports, featuring highlights of where the community performs well and where there are gaps in care.

On Thursday, the KHC held a webinar introducing the 2019 community reports and diving into some of those highlights. If you missed it, you can access the recording here. As a community, Kentuckiana and the Commonwealth have seen an improvement in historical trouble spots, we have new information on opioid prescribing, and there are opportunities for growth and exploration in some new measures.

IMPROVEMENTS IN DIABETES CARE AND VACCINATIONS, OPPORTUNITIES FOR GROWTH IN NUTRITION COUNSELING

I encourage you to go to our website and look through the reports yourself. Once you account for age stratifications or multiple rates per measure – such as antidepressant medication, which has two rates, for acute period and continued period of treatment – there are 73 total measures to have fun with. You can access the full reports here.

Retinal eye exams for individuals is an area where we have traditionally fallen woefully short. Left unmanaged, diabetes can lead to serious complications, including blindness. In Kentucky, diabetes is the leading cause of blindness. For more than the last decade, Kentucky fell in the low-40% range, far below national averages, which tended to be in the mid to high 50s. The KHC has done quality improvement projects in the past on this critical aspect of care, as have many organizations across the state.

But in the last couple of years, as you can see, we have improved pretty spectacularly. In fact, we are above national rates for commercial AND Medicaid!

Comprehensive Diabetes Care: Retinal Eye Exams (2012-2018)

This is a perfect example of why we need quality reporting like this. Without knowing where we stand, we wouldn’t be able to know where to focus our efforts and resources. Additionally, we are often surprised when we assume we do well in things that the data tells us the opposite, and vice versa!

Another area that Kentucky continues to improve is in a relatively new focus area of HPV vaccination. This measure only became part of the HEDIS program in 2017 (using 2016 data), and the Kentucky Core Healthcare Measures Set committee selected it as a high priority, recognizing that Kentucky has the highest rate of HPV-related cancers.

Adolescent Immunizations: HPV (2016-2018)

Unsurprisingly, when our first baseline year of data came in, Kentucky and Kentuckiana fell below the national rates. But in our third year of reporting, Kentucky has made double digit improvements. Anecdotally, it seems like providers are getting more and more comfortable talking to patients and patients’ parents about HPV and making it a part of routine adolescent immunizations.

As you might be aware, a big focus in the past few years has been appropriate opioid use, as part of a partnership with the Kentucky Opioid Response Effort, as part of a SAMHSA Grant awarded to the Kentucky Cabinet for Health and Family Services. We have two new measures related to this work – use of opioids at high dosage and use of opioids from multiple prescribers.

For all opioid measures, lower is better. So the graph below that shows regional and state rates lower than national commercial and Medicaid rates is a good thing. A smaller proportion of Kentucky’s patients received high dosages of opioids in 2018 than the rest of the nation.

Use of Opioids at High Dosage (2018)

Another new measure to this year’s reports you will notice is all over our “areas for improvement” section at the top of the reports: Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents.

There are three rates in this measure – BMI percentile documentation, counseling for nutrition, and counseling for physical activity. This was a huge topic of discussion for the Pediatric Committee on the core measures set team. While any measure that includes counseling can be tough for a provider to “get credit for,” the committee, about half of whom were pediatricians, felt strongly that this is the crux of the work they do – providing the foundation for a lifetime of healthy habits – and wanted it included, despite the challenges.

Since many of these pediatricians felt like they were doing this well to begin with, they saw it as an opportunity to “get credit for” the good work they’re already doing. By focusing on documentation improvements and practice flow, they feel we can make great progress as a state in this measure.

The last measure I wanted to highlight to you actually will not see on the 2019 KHC Community Reports. Part of the Comprehensive Diabetes Care set, that includes eye exams, foot exams, and HbA1c poor control, Blood Pressure Control is a measure new to the Kentucky Core Healthcare Measures Set, so this year was the first year we collected data for it.

But you won’t see it on the reports, because we are still establishing a baseline for that data and seeking to understand what the data is telling us. Information for this measure is usually recorded by providers in the medical record data and typically not administrative data. If a provider bills a CPT code that is <140/90, the data could be captured administratively but that does not typically occur. So that’s why we see a wide range of results. We are looking into how to best use this data and work on this measure. Stay tuned for more information!

COVID-19 AND ITS IMPACT ON QUALITY MEASUREMENT

Already, there have been major changes to the 2020 NCQA HEDIS program reporting requirements, and it seems like every day, more things are changing. Much is unknown right now. NCQA has a webpage dedicated to the pandemic that I encourage everyone to visit for more information. Of course, while HEDIS is the program we most closely work with at the KHC, it certainly isn’t the only one. CMS’s Medicare quality reporting programs have granted a variety of exceptions and extensions to providers for reporting.

However, despite all of these changes, we don’t expect a delay in our KHC 2020 reports. Changes to the HEDIS program primarily affect hybrid measures, measures that combine administrative claims data and medical chart reviews, and the measures that the KHC collects use just administrative data. We’ve been having one-on-one meetings with our health plan partners, as well as our KHC Measurement Strategy Team, and haven’t heard of any concerns for submitting data for the KHC annual reports.

It is still too early to tell, but I expect big changes in measurement programs for next year. Preventive care has already seen a big impact, as has medication access and adherence for chronic conditions, etc. Efforts around telehealth services and behavioral health services, which were already large areas of focus, have been a big area of discussion. Many expect these efforts to be ramped up in response to the pandemic. Health plan partners have also been addressing social determinants of health, such as food insecurity, as a result. Again, these plans were already working in these areas, but have been forced to scale those programs and pilots in a compressed time span.

Kentuckiana Health Collaborative Releases Community Measurement Reports, Collects Data on Opioid Prescribing

The Kentuckiana Health Collaborative is pleased to release the 2018 Community Measurement Reports, which also includes opioid prescribing data as part of the KHC’s partnership with the Kentucky Opioid Response Effort (KORE).

For the last 15 years, the KHC has led the way in healthcare quality measurement and transparency through Consolidated Measurement Reports, which allows for comparison to local and state averages and benchmark scores on the quality of care patients receive on a variety of ambulatory care indicators. The KHC is the only organization that combines Commercial, Medicaid, and Medicare Advantage data for quality reporting. The data also allows us to see where we have improved – or not – as a community in these key indicators of quality healthcare.

For the second year, the measures on the reports include all of the 2019 Kentucky Core Healthcare Measures Set for which there was available data and features a highlight of where the community performs well and where there are gaps in care. To access the full reports, click here.

OPIOID PRESCRIBING DATA SHOWS REGION AROUND THE NATIONAL AVERAGE

This year’s Community Measurement Reports feature two new measures related to opioid prescribing: Use of Opioids from Multiple Providers and Use of Opioids at High Dosage. The first measure looks at the proportion of patients who are getting opioids from multiple prescribers, multiple pharmacies, or both. Use of Opioids at High Dosage looks at the number of patients who received prescription opioids at a high dosage for great than or equal to 15 days during the year.

The information was collected as part of the KHC’s partnership with the Kentucky Opioid Response Effort (KORE), in which the KHC has partnered with national data leaders to explore opioid use trends for Kentucky’s residents. In November, the KHC partnered with IBM Watson Health to develop benchmarks for key metrics related to the prevention, treatment, and recovery of opioid misuse and opioid use disorder. The results were discussed in a November webinar. If interested in learning more detail about this data and key takeways, a recording of our November webinar can be viewed here.

When we look at the KHC Community Measurement Report measures for opioid-related care, similar to the IBM Watson data, Kentucky and Kentuckiana fall near national averages.

Kentucky data shows opioid prescribing similar to national averages.

WEBINAR PLANNED FOR MAY 21

For more information on the opioid measures, as well as all the results of the 2019 Community Measurement Reports, register for a complementary KHC Webinar on May 21. The event will include an overview of these reports, the data, and a chance to ask the KHC questions. You can find more information about the webinar here.

KHC’s Stephanie Clouser Named to Core Quality Measures Collaborative Implementation Team

KHC Data Scientist Stephanie Clouser

Continuing the KHC’s work both regionally and nationally in healthcare quality measurement alignment, KHC data scientist Stephanie Clouser has been named to the Core Quality Measures Collaborative (CQMC) Implementation Roster. She has also previously participated in the CQMC Primary Care and Gastroenterology workgroups.

CQMC, a partnership between the National Quality Forum, Centers for Medicare and Medicaid Services, and America’s Health Insurance Plans, develops core sets of quality measures for implementation across both commercial and government payers. The CQMC relies on workgroups to select measures for the core sets, guide the development and refinement of materials used to update the core sets, and prioritize gaps and areas for future core set development.

Regionally, Clouser leads the KHC’s measurement alignment work to identify the measures that reduce measurement burden, improve focus, and ultimately measure what matters most to key stakeholders. A public-private committee of the experts convened by the KHC has finalized the Kentucky Core Healthcare Measures Set (KCHMS), with 38 core primary care measures. The measures listed on the KCHMS are included in KHC annual reporting.

Also named to the CQMC Implementation Workgroup was KHC member Faith Green, Director, Office of the Chief Medical Officer, Humana. Green has also participated on other CQMC workgroups and the KCHMS committee.

As members of the Implementation Workgroup, Clouser and Green will be charged with developing an implementation guide that addresses:

  • Guidance on technical aspects of core set implementation for payment and quality reporting purposes
  • Strategies to encourage buy-in among clinicians, provider facilities, and consumers
  • Strategies to increase core set adoption to raise awareness and increase stakeholder knowledge

Measurement Alignment Efforts First Step Towards Driving Health Improvements in the Commonwealth

Stephanie Clouser

Healthcare quality measurement is not sexy. Or at least that’s what my boss, KHC Executive Co-Director Randa Deaton, has said.

As the KHC Data Scientist, I disagree. And judging by the attendance at this month’s KHC Community Health Forum, “Driving Health Improvements Through Measurement Alignment,” I’m not the only one who disagrees. On September 10, we spent the morning with a full house of attendees to learn from national and local experts in healthcare measurement and measurement alignment.

The two-hour Forum highlighted national and local measurement alignment efforts aimed at reducing measurement burden, improving focus, and ultimately measuring what matters most to patients. This included:

  • The Core Quality Measure Collaborative (CQMC), a broad-based coalition of health care leaders convened by America’s Health Insurance Plans, Centers for Medicare and Medicaid Services (CMS), and the National Quality Forum (NQF)
  • Louisville-headquartered Humana’s journey to align their measures across product lines
  • The Kentucky Core Healthcare Measures Set, convened by the KHC
  • A panel of regional experts on the current landscape and future of healthcare measurement in the Commonwealth

Packed Agenda Highlighted Measurement Alignment Opportunities and Challenges

Norton Healthcare’s Dr. Joshua Honaker, Chief Medical Administrative Officer for Norton Medical Group, kicked off the morning with an introduction to the “measurement mayhem” that contributes to physician burnout and high administrative costs, highlighting the need for the streamlining of measures and incentives.

The morning’s keynote speaker, Chinwe Nwosu, America’s Health Insurance Plans, discussed the advancement of quality measurement and improvement through core measures sets. Nwosu, the project manager for the Core Quality Measures Collaborative (CQMC), a broad-based coalition of health care leaders convened by AHIP, CMS, and NQF. In her talk, Nwosu noted several challenges to the adoption of national core measures sets, including lack of interoperability, small sample sizes, and lack of alignment with state Medicaid and commercial measurement efforts. Some proposed strategies included standardization of measure implementation across payers, alignment of CMS reporting requirements with the core measures, identification of high-impact measures with strong relationships to outcomes, and increased data capacity of electronic health records and interoperability between registries.

Faith Green, Humana, talked about her organization’s journey to align their measures across product lines, including the lessons learned from their process, which reduced their number of metrics from 1,116 to 208. I then talked about the 2019 Kentucky Core Healthcare Measures Set (KCHMS), created by experts across the Commonwealth of Kentucky and convened by the KHC. The 2019 KCHMS, the second iteration of the core measures set, was released in August. The morning ended with an expert panel discussion about the current landscape and future of healthcare measurement in the Commonwealth.

Path Forward is Challenging but Promising

If the energy at our KHC Community Health Forum was any indication, the future of measurement alignment in the Commonwealth is a promising one. Much like the AHIP/CMS/NQF Core Quality Measures Collaborative, we are now at the point where we have a core set of key quality indicators that is ready for implementation among Kentucky’s various stakeholders.

From the beginning, more than two years ago, we have been truly overwhelmed by the response that we have gotten around this initiative. With the current state of healthcare work today, it is often challenging to get volunteers to commit to “one more thing” in addition to their already overextended workload. However, we were approached – enthusiastically, I might add – by individuals from all backgrounds to serve on this project, which speaks to the importance of this work.

What we have launched is not a small lift. Healthcare measurement alignment is tough work, and it’s not for the faint of heart. It isn’t easy to sift through hundreds of measures to identify the ones that will give us the greatest insight into how our healthcare systems are performing, while also continuing to honor the various reporting standards given by dozens of other organizations. However, while the daunting quality of the work has the potential to be a deterrent, it is important to push for reduction and alignment around meaningful measures that ultimately drive change in our community, reduce measurement burden, and improve adherence to evidence-based medicine and health outcomes.

Creating a core set of healthcare measures to focus and align priorities is just the first step toward aligning incentives around the things that matter. The Kentucky Core Healthcare Measures Set brings together the priorities of consumers, providers, payers, and purchasers specifically with the needs of the Commonwealth in mind. We need to push in the coming months to get this core measures set in use by our payers, providers, and purchasers. I feel a bit like a broken record, but as always, I want to finish with this thought: By focusing on everything, we focus on nothing. But by focusing on the right things, we can drive improvements.

Did you miss the KHC Community Health Forum, “Driving Health Improvements Through Measurement Alignment”? Click here to see the agenda and slide decks from the event.

Kentucky Core Healthcare Measures Set Expands to 38 Adult and Pediatric Primary Care Measures

Stephanie Clouser

After a summer of deliberations by committees, the 2019 Kentucky Core Healthcare Measures Set has been finalized, increasing the number of core measures from 34 to 38.

The final vote resulted in the removal of three measures, addition of seven measures, and the upgrade of two measures from “standard” priority to “high” priority. Measures added include opioid treatment agreement, progress towards depression remission, diabetes blood pressure control, childhood and adolescent well care visits, HPV immunization, and patient experience. Measures related to diabetes and cardiovascular disease medication adherence and bronchitis antibiotic avoidance have been removed.

This year’s update ensures that the measures on the core measures set are current, relevant, and sound. The Kentucky Performance Alignment Committee – or PMAC – and its subcommittees have spent the last months reviewing the current measures set, examining potential measures for addition, and confirming or questioning the current measures’ relevance.

The core measures set was developed and released through a public-private partnership with the goal of creating a core measures set for Kentucky stakeholders to align to. The core measures set is focused in the areas of prevention, pediatrics, chronic and acute care management, behavioral health, and cost/utilization.

MEASURE UPDATES INCLUDE ‘STRETCH’ MEASURES TO DRIVE HEALTH OUTCOMES IN THE COMMONWEALTH

In 2018, the PMAC team chose a few “stretch measures” that might have had a few more challenges to them but ultimately were important to impacting the health of Kentuckians. This year, the committee and subcommittees chose a few more of those stretch measures, including Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents and Depression Response at Twelve Months – Progress Towards Remission. The data extraction required of these measures makes them more challenging to measure.

The full list of changes is as follows:

  • Add Documentation of Signed Opioid Treatment Agreement
  • Add Adolescent Well-Care Visits
  • Add Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents
  • Add Comprehensive Diabetes Care: Blood Pressure Control
  • Add Depression Response at Twelve Months – Progress Towards Remission
  • Add CG-CAHPS
  • Modify Immunizations for Adolescents to break out HPV
  • Upgrade Comprehensive Diabetes Care: Eye (Retinal) Exam to high priority
  • Upgrade Comprehensive Diabetes Care: Nephropathy to high priority
  • Remove Medication Adherence for Diabetes
  • Remove Medication Adherence for Cardiovascular Disease
  • Remove Antibiotic Avoidance in Adults with Acute Bronchitis.

You can find the complete list of 2019 KCHMS measures here. For more information on the core measures set, click here.

COMMUNITY HEALTH FORUM WILL HIGHLIGHT NATIONAL AND REGIONAL ALIGNMENT EFFORTS

The 2019 KCHMS will be rolled out at a KHC Community Health Forum on September 10, “Driving Health Improvements Through Measurement Alignment.” The Forum will highlight national and local measurement alignment efforts aimed at reducing measurement burden, improving focus, and ultimately measuring what matters most to patients.

Chinwe Nwosu, America’s Health Insurance Plans, will discuss the advancement of quality measurement and improvement through core measures sets. Nwosu, the project manager for the Core Quality Measures Collaborative (CQMC), a broad-based coalition of health care leaders convened by America’s Health Insurance Plans (AHIP) starting in 2015. It includes Centers for Medicare and Medicaid Services (CMS), the National Quality Forum (NQF), health insurance providers, medical associations, consumer groups, purchasers (including employer group representatives), and other quality collaboratives. The KHC joined this collaborative in recent months. CQMC members work to identify Core Measure Sets – parsimonious sets of scientifically sound measures that efficiently promote a patient-centered assessment of quality and should be prioritized for adoption in value-based purchasing and alternative payment models.

Faith Green, Humana, will also talk about her organization’s journey to align their measures across product lines. KHC’s Stephanie Clouser will introduce the 2019 KCHMS. The morning will end with an expert panel discussion about the current landscape and future of healthcare measurement in the Commonwealth and will include:

  • Jenny Goins, Commissioner, Department of Employee Insurance, Kentucky Personnel Cabinet
  • Michael Hagen, Professor, Dept of Family and Community Medicine, University of Kentucky
  • Amy Mattingly, Provider Collaboration Director, Anthem Blue Cross and Blue Shield of Kentucky
  • Angela Parker, Director, Program Quality and Outcomes, Department for Medicaid Services
  • Rachelle Seger, Community Health Research Officer, Foundation for a Healthy Kentucky

The Forum will take place from 7:30 a.m. to 10 a.m. on Tuesday, September, 10. As always, registration is free for individuals who work for a KHC member organization and $35 for anyone else. For more information on the Forum, click here.

More information on the core measures set, including future areas of development, will be shared in the future.

Call for Public Comment: Proposed Changes to KY Core Healthcare Measures Set

2018 KY Core Healthcare Measures Set

Modifications are being made to the Kentucky Core Healthcare Measures Set (KCHMS), and healthcare stakeholders throughout the Commonwealth are invited and encouraged to review and comment on those submissions during a public comment period that will run through August 9.

In 2018, the core measures set was developed and released through a public-private partnership with the goal of creating a core measures set for Kentucky stakeholders to align to. The 2018 core measures set includes 34 unique measures, focused in the areas of prevention, pediatrics, chronic and acute care management, behavioral health, and cost/utilization.

This year’s update will ensure that the measures on the core measures set are current, relevant, and sound. The Kentucky Performance Alignment Committee – or PMAC – and its subcommittees have spent the last months reviewing the current measures set, examining potential measures for addition, and confirming or questioning the current measures’ relevance.

This week, the subcommittees presented their final recommendations to the PMAC Oversight Committee, which will finalize the 2019 KCHMS measures on August 20.

If all recommendations are accepted, the core measures set will increase from 34 measures to 39. Measures that would be added include opioid treatment, depression treatment, diabetes blood pressure control, childhood and adolescent well care, and patient experience measures. Measures related to medication adherence and antibiotic avoidance would be removed.

Any healthcare stakeholder is invited to provide feedback for the PMAC Oversight Committee on these recommendations. The public comment period will close August 9, and you can find details on the proposed changes and public comment form here.

Call for Applications – 2019 KY Performance Measures Alignment Committee

The Kentuckiana Health Collaborative is accepting applications for the 2019 Kentucky Performance Measures Alignment Committee (PMAC), which will select the 2019 Kentucky Core Healthcare Measures (KCHMS), 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 KCHMS was first released in June 2018 and includes 34 primary care measures in the areas of preventive care, behavioral health, chronic and acute care, pediatric care, and cost and utilization. The intent is to align measurement efforts toward shared areas of focus, making Kentucky one of the first states in the nation to create a healthcare measurement set.

PMAC, which selects the measures that are included in the core measures set, consists of an oversight committee and five subcommittees in the follow areas:

  • Behavioral Health
  • Chronic and Acute Care
  • Pediatrics
  • Preventive
  • Cost and Utilization

The 2019 PMAC team will consist of previous committee members and new applicants. Slots are limited and will reflect a diverse mix of payers, providers, purchasers, and consumers.

While the 2018 KCHMS timeline was approximately one year from conception to release, this year’s cycle will be more condensed and run from June 2019 to August 2019. Both subcommittee and oversight committee members will participate in an overview call in early June, each subcommittee will meet approximately twice in June and July, and the oversight committee will meet an anticipated two times in July and August. The 2019 KCHMS measures will be finalized by August 31, 2019.

For more information about the project, visit the KCHMS page on the KHC website. To apply for the oversight committee or subcommittee, click here.

Submissions are due by Friday, May 31. Any questions, please contact Stephanie Clouser at sclouser@khcollaborative.org.

Recent Studies Reveal Variation in Price and Quality Among Kentucky’s Hospitals

New Hospital Safety Grade state rankings by the nonprofit The Leapfrog Group shows Kentucky ranks 33rd in overall hospital safety, holding that spot for the second time in a row. This, when paired with the new study released last week by RAND Corp., reiterates that hospitals in the Commonwealth vary in both price and quality.

In the Spring 2019 Hospital Safety Grade rankings, Kentucky’s share of “A” hospitals was just 21%, down from nearly 24% in the Fall 2018 rankings. Leapfrog uses an easy-to-digest A-F grading scale, with “A” being the best. Nearly 70% of Kentucky’s 52 hospitals received a “C” or below rating, compared to the nationwide average of 43%. A new study released by The Leapfrog Group along with the state rankings showed that avoidable deaths due to errors, accidents, injuries, and infections have an 88% greater risk at “C” hospitals and 92% greater risk at “D” and “F” hospitals.

RAND STUDY SHOWS VARIATION IN PRICE, QUALITY IN KENTUCKY’S HOSPITALS

In addition to the Leapfrog safety rankings, Kentucky was one of 25 states that was included in last week’s RAND hospital price transparency report, which for the first time used actual payments by privately insured employers to report inpatient and outpatient prices by hospital. The report shows prices as a percent of what Medicare paid for the same services, thus making these relative prices comparable across the country. The study has been a hot news item in the healthcare world, featured in publications such as The New York Times, The Wall Street Journal, and Forbes.

Kentucky ranks fourth lowest in price of the 25 states in the RAND hospital price transparency study.

Overall, Kentucky came out favorably for its relative pricing to Medicare for private insurance in the report, well under the national average of the states in the study. Of the 25 states included in the data, Kentucky ranked fourth lowest in prices paid to hospitals, at 186% of Medicare compared to the national average of 241%. Similar to what the report illuminates nationally, there is large variation in price – inpatient, outpatient, and overall – among Kentucky’s facilities.

The RAND study looked at the CMS Hospital Compare five-star rating to highlight variation on quality, and that system illuminated similar trends as Leapfrog’s new results. Looking at the CMS ratings, which, like Leapfrog, puts hospitals into five levels of performance, more of Kentucky’s facilities named in the RAND study have poor to average ratings compared to the nation as a whole – 84% compared to the nation’s 51%. This means that just 16% of Kentucky’s hospitals are considered above average or excellent by CMS Hospital Compare.

KHC BRINGS IN RAND STUDY LEADERS FOR COMMUNITY FORUM

These variations in price and quality in Kentucky’s hospitals will be the focus of the Kentuckiana Health Collaborative’s June 4 Community Health Forum, which will bring in the RAND study’s leaders to dive into the results and what this means for Kentucky.

Gloria Sachdev, President and CEO for Employers’ Forum of Indiana, which partnered with RAND on the study, will walk through the study results, focusing on Kentuckiana and Kentucky’s hospital prices and how they compare to the rest of the nation. We will also hear from an employer, Indiana University, that was part of that first-year study in Indiana to discuss how seeing hospital pricing information has impacted their benefit strategy.

Although hospital pricing is important to all stakeholders, this event will be particularly relevant to those interested in employee health benefits, health plan design, and provider payment. RAND is now recruiting more participants for the next iteration of the study, so any employer or health plan that is interested in participating is encouraged to attend and for more information on what is involved.

Register today to join the conversation at the UofL Shelby Campus Founders Union Building. As with most KHC Community Health Forums, attendance is free for KHC members and $35 for non-members, which includes the program, networking, and breakfast. If you are unsure if your organization is a member of the KHC, see the full list here.

Measure of the Month: Low Back Pain

This week, the KHC launched a project dedicated to healthcare affordability, in partnership with NRHI. The movement, called Affordable Care Together, is focused on health, price, and waste — the three drivers of affordable healthcare.

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. For the Measure of the Month in September, we are highlighting a measure of healthcare waste – Use of Imaging Studies for Low Back Pain.

Low back pain is among the most common causes of disability and lost productivity in the United States, and more than 80% of the population will experience low back pain in their lifetime. However, low back pain is usually not caused by something very serious. A very common cause of low back pain is strain of the muscles and ligaments. This type of low back pain is very common and usually gets better within a few days to a few weeks. Most people with low back pain don’t need to have imaging tests or visit a specialist, nor do they usually need surgery.

What is recommended care for Low Back Pain?

People 18-50 with low back pain should not receive an imaging study (an X-ray, CT scan, or MRI) within the first 28 days unless a “red flag,” which refers to a serious symptom or physical exam finding, is detected by their doctor. Here are some reasons why doctors are discouraged from recommending an imaging test too early in the process of your evaluation.

Imaging tests have some risks. X-rays and CT scans expose your body to radiation. Over time, repeated exposure to radiation may increase your chance of getting cancer. Having an X-ray series of your lower back gives you about as much radiation exposure as 65 chest X-rays. Having a CT scan of your lower back gives you about as much radiation exposure as 165 chest X-rays. Since MRIs use magnets rather than X-rays, there is no risk from radiation. However, having metal objects or implants in your body (such as pacemakers, artificial joints, screws, stents, plates or staples) can be a serious risk and interfere with the test.

For most cases of low back pain, an imaging test doesn’t give doctors much information that’s useful for diagnosis or treatment, because strain on muscles and ligaments do not show up on these tests.

Medical research shows people with low back pain who get imaging tests do not recover any better or faster than those who do not receive them.

Having an imaging test can lead to more care than you need — and expose you to more risks. Many things that show up on imaging tests are not serious and may not be the cause of your pain. However, once these things have been seen on a scan, there is a tendency to want to do something about it. Often, this results in more tests or procedures that can be harmful, such as back surgery.

How do we compare nationally?

The KHC has tracked the Use of Imaging Studies for Low Back Pain since 2007. Kentuckiana and Kentucky has not seen much improvement in appropriate testing for low back pain, and our region continues to lag behind nationally in its performance on this measure. In 2016, 55% percent of patients in the Kentuckiana region received appropriate testing, and just 51% percent of patients throughout the Commonwealth received appropriate testing, compared to national rates of 71% to 74%.

This data perhaps illuminates a gap in care for Kentucky and Southern Indiana patients that can be explored as part of 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.