Implementing Quality Measures
for Accountability in
Community-Based Care
for People with Serious Illness
PROCEEDINGS OF A WORKSHOP
Laurene Graig, Sylara Marie Cruz, and Joe Alper, Rapporteurs
Roundtable on Quality Care for People with Serious Illness
Board on Health Care Services
Board on Health Sciences Policy
Health and Medicine Division
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
This activity was supported by the Gordon and Betty Moore Foundation. Annual support for the roundtable’s activities is provided by Aetna Inc., Altarum Institute, American Academy of Hospice and Palliative Medicine, American Cancer Society, American Geriatrics Society, Anthem, Inc., Ascension Health, Association of Professional Chaplains, Association of Rehabilitation Nurses, Blue Cross and Blue Shield of North Carolina, Blue Cross Blue Shield Association, Blue Cross Blue Shield of Massachusetts, The California State University Institute for Palliative Care, Cambia Health Solutions, Cedars-Sinai Health System, Center to Advance Palliative Care, Centers for Medicare & Medicaid Services, Coalition to Transform Advanced Care, Common Practice, Excellus BlueCross BlueShield, Federation of American Hospitals, The Greenwall Foundation, The John A. Hartford Foundation, Hospice and Palliative Nurses Association, Kaiser Permanente, Susan G. Komen, Gordon and Betty Moore Foundation, National Coalition for Hospice and Palliative Care, National Hospice and Palliative Care Organization, National Institute of Nursing Research, National Palliative Care Research Center, National Patient Advocate Foundation, National Quality Forum, The New York Academy of Medicine, Oncology Nursing Society, Patient-Centered Outcomes Research Institute, Sentara Healthcare, Social Work Hospice and Palliative Care Network, Supportive Care Coalition, UnitedHealth Group, and the National Academy of Medicine. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-48207-3
International Standard Book Number-10: 0-309-48207-0
Digital Object Identifier: https://doi.org/10.17226/25202
Additional copies of this publication are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.
Copyright 2018 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America
Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2018. Implementing quality measures for accountability in community-based care for people with serious illness: Proceedings of a workshop. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/25202.
The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president.
The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. C. D. Mote, Jr., is president.
The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.
The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.
Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org.
Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task.
Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies.
For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo.
PLANNING COMMITTEE FOR A WORKSHOP ON IMPLEMENTING QUALITY MEASURES FOR ACCOUNTABILITY IN COMMUNITY-BASED CARE FOR PEOPLE WITH SERIOUS ILLNESS1
AMY KELLEY (Co-Chair), Associate Professor, Icahn School of Medicine at Mount Sinai
AMY MELNICK (Co-Chair), Executive Director, National Coalition for Hospice and Palliative Care
STEVE CLAUSER, Program Director, Improving Healthcare Systems, Patient-Centered Outcomes Research Institute
LAURA HANSON, Professor and Director, University of North Carolina Palliative Care Program
PAMELA S. HINDS, Director of Nursing Research and Quality Outcomes, Children’s National Health System
REBECCA A. KIRCH, Executive Vice President of Healthcare Quality and Value, National Patient Advocate Foundation
MURALI N. NAIDU, Vice President, Chief Clinical Officer, Sentara Healthcare
WENDY PRINS, Senior Advisor, Quality Innovation, National Quality Forum
CHRISTINE RITCHIE, Professor, University of California, San Francisco, School of Medicine
JOAN TENO, Professor of Medicine, Oregon Health & Science University
Project Staff
LAURENE GRAIG, Director, Roundtable on Quality Care for People with Serious Illness
SYLARA MARIE CRUZ, Research Assistant
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
SHARYL NASS, Director, Board on Health Care Services, and Director, National Cancer Policy Forum
ANDREW M. POPE, Director, Board on Health Sciences Policy
Consultant
JOE ALPER, Consulting Writer
ROUNDTABLE ON QUALITY CARE FOR PEOPLE WITH SERIOUS ILLNESS1
LEONARD D. SCHAEFFER (Chair), Judge Robert Maclay Widney Chair and Professor, University of Southern California
JAMES A. TULSKY (Vice Chair), Chair, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute; Chief, Division of Palliative Medicine, Brigham and Women’s Hospital; Professor of Medicine and Co-Director, Center for Palliative Care, Harvard Medical School
JENNIFER BALLENTINE, Executive Director, The California State University Institute for Palliative Care
ROBERT A. BERGAMINI, Medical Director, Palliative Care Services, Mercy Clinic Children’s Cancer and Hematology, representing the Supportive Care Coalition
AMY J. BERMAN, Senior Program Officer, The John A. Hartford Foundation
PATRICIA A. BOMBA, Vice President and Medical Director, Geriatrics, Excellus BlueCross BlueShield
SUSAN BROWN, Senior Director, Health Education, Susan G. Komen
GRACE B. CAMPBELL, Assistant Professor, Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, representing the Association of Rehabilitation Nurses
STEVE CLAUSER, Program Director, Improving Healthcare Systems, Patient-Centered Outcomes Research Institute
JEFF COHN, Medical Director, Common Practice
PATRICK CONWAY, President and Chief Executive Officer, Blue Cross and Blue Shield of North Carolina
DAVID J. DEBONO, National Medical Director for Oncology, Anthem, Inc.
CHRISTOPHER M. DEZII, Lead, Quality and Measure Development, State and Federal Payment Agencies, U.S. Value, Access and Payment, Bristol-Myers Squibb Company
ANDREW DREYFUS, President and Chief Executive Officer, Blue Cross Blue Shield of Massachusetts
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
CAROLE REDDING FLAMM, Executive Medical Director, Blue Cross Blue Shield Association
MARK B. GANZ, President and Chief Executive Officer, Cambia Health Solutions
ZIAD R. HAYDAR, Senior Vice President and Chief Clinical Officer, Ascension Health
PAMELA S. HINDS, Director of Nursing Research and Quality Outcomes, Children’s National Health System
HAIDEN HUSKAMP, 30th Anniversary Professor of Health Care Policy, Harvard Medical School
KIMBERLY JOHNSON, Associate Professor of Medicine, Senior Fellow in the Center for the Study of Aging and Human Development, Duke University School of Medicine
CHARLES N. KAHN III, President and Chief Executive Officer, Federation of American Hospitals
REBECCA A. KIRCH, Executive Vice President of Healthcare Quality and Value, National Patient Advocate Foundation
TOM KOUTSOUMPAS, Co-Founder, Coalition to Transform Advanced Care
SHARI M. LING, Deputy Chief Medical Officer, Center for Clinical Standards and Quality, Centers for Medicare & Medicaid Services
BERNARD LO, President and Chief Executive Officer, The Greenwall Foundation
JOANNE LYNN, Director, Center for Elder Care and Advanced Illness, Altarum Institute
DIANE E. MEIER, Director, Center to Advance Palliative Care
AMY MELNICK, Executive Director, National Coalition for Hospice and Palliative Care
JERI L. MILLER, Chief, Office of End-of-Life and Palliative Care Research, National Institute of Nursing Research, National Institutes of Health
R. SEAN MORRISON, Director, National Palliative Care Research Center
MURALI N. NAIDU, Vice President, Chief Clinical Officer, Sentara Healthcare
BRENDA NEVIDJON, Chief Executive Officer, Oncology Nursing Society
HAROLD L. PAZ, Executive Vice President and Chief Medical Officer, Aetna Inc.
SHARON SCRIBNER PEARCE, Vice President, Policy, National Hospice and Palliative Care Organization
JUDITH R. PERES, Long-Term and Palliative Care Consultant, Clinical Social Worker and Board Member, Social Work Hospice and Palliative Care Network
PHILLIP A. PIZZO, Founding Director, Stanford Distinguished Careers Institute; Former Dean, and David and Susan Heckerman Professor of Pediatrics and of Microbiology and Immunology, Stanford School of Medicine
WENDY PRINS, Senior Advisor, Quality Innovation, National Quality Forum
THOMAS M. PRISELAC, President and Chief Executive Officer, Cedars-Sinai Health System
JOANNE REIFSNYDER, Executive Vice President, Clinical Operations and Chief Nursing Officer, Genesis Healthcare, representing the Hospice and Palliative Nurses Association
JUDITH A. SALERNO, President, The New York Academy of Medicine
DIANE SCHWEITZER, Acting Chief Program Officer, Patient Care Program, Gordon and Betty Moore Foundation
KATRINA M. SCOTT, Oncology Chaplain, Massachusetts General Hospital, representing the Association of Professional Chaplains
KATHERINE SHARPE, Senior Vice President, Patient and Caregiver Support, American Cancer Society
JOSEPH W. SHEGA, Regional Medical Director, VITAS Hospice Care, representing the American Geriatrics Society
CHRISTIAN SINCLAIR, Outpatient Palliative Oncology Lead, Division of Palliative Medicine, University of Kansas Health System, representing the American Academy of Hospice and Palliative Medicine
TANYA STEWART, Senior Medical Director, UnitedHealthcare Retiree Solutions
SUSAN ELIZABETH WANG, Regional Lead for Shared Decision-Making and Advance Care Planning, Southern California Permanente Medical Group, Kaiser Permanente
Roundtable on Quality Care for People with Serious Illness Staff
LAURENE GRAIG, Director, Roundtable on Quality Care for People with Serious Illness
SYLARA MARIE CRUZ, Research Assistant
PATRICK BURKE, Financial Associate
SHARYL NASS, Director, Board on Health Care Services, and Director, National Cancer Policy Forum
ANDREW M. POPE, Director, Board on Health Sciences Policy
Reviewers
This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.
We thank the following individuals for their review of this proceedings:
MAUREEN HENRY, National Committee for Quality Assurance
TED LONG, NYC Health + Hospitals
DEBRA SALIBA, University of California, Los Angeles, JH Borun Center for Gerontological Research
ERIC SCHNEIDER, The Commonwealth Fund
LEANNE YANNI, Bon Secours Palliative Medicine
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by KATHRYN McDONALD, Stanford School of Medicine. She was responsible for making certain that an inde-
pendent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.
Acknowledgments
The National Academies of Sciences, Engineering, and Medicine’s Roundtable on Quality Care for People with Serious Illness wishes to express its sincere gratitude to Planning Committee Co-Chairs Amy Kelley and Amy Melnick for their valuable contributions to the development of this workshop. The roundtable also wishes to thank all of the members of the planning committee, who collaborated to ensure a workshop complete with informative presentations and rich discussions. Finally, the roundtable wants to thank the speakers and moderators, who generously shared their expertise and their time with workshop participants.
We are grateful to the Gordon and Betty Moore Foundation for its sponsorship of this workshop. Ongoing support from the many annual sponsors of the roundtable is critical to its work. The roundtable’s sponsors include Aetna Inc., Altarum Institute, American Academy of Hospice and Palliative Medicine, American Cancer Society, American Geriatrics Society, Anthem, Inc., Ascension Health, Association of Professional Chaplains, Association of Rehabilitation Nurses, Blue Cross and Blue Shield of North Carolina, Blue Cross Blue Shield Association, Blue Cross Blue Shield of Massachusetts, The California State University Institute for Palliative Care, Cambia Health Solutions, Cedars-Sinai Health System, Center to Advance Palliative Care, Centers for Medicare & Medicaid Services, Coalition to Transform Advanced Care, Common Practice, Excellus BlueCross BlueShield, Federation of American Hospitals, The Greenwall Foundation,
The John A. Hartford Foundation, Hospice and Palliative Nurses Association, Kaiser Permanente, Susan G. Komen, Gordon and Betty Moore Foundation, National Coalition for Hospice and Palliative Care, National Hospice and Palliative Care Organization, National Institute of Nursing Research, National Palliative Care Research Center, National Patient Advocate Foundation, National Quality Forum, The New York Academy of Medicine, Oncology Nursing Society, Patient-Centered Outcomes Research Institute, Sentara Healthcare, Social Work Hospice and Palliative Care Network, Supportive Care Coalition, UnitedHealth Group, and the National Academy of Medicine.
Contents
Quality Measures for Accountability in Community-Based Serious Illness Care
Organization of Workshop and Proceedings
THE PATIENT–FAMILY PERSPECTIVE
GAPS, CHALLENGES, AND OPPORTUNITIES IN IMPLEMENTING QUALITY MEASURES FOR ACCOUNTABILITY
Challenges in Implementing Quality Measures for Serious Illness Care
Lessons from Blue Shield of California’s Palliative Care Program
Aspire Health’s Model of Home-Based Palliative Care
MEASURE REVIEW AND ENDORSEMENT REDESIGN AT THE NATIONAL QUALITY FORUM
Meaningful Measures Initiative at CMS
Caring for Patients with Chronic Complex Illnesses at the U.S. Department of Veterans Affairs
FUTURE USE OF QUALITY MEASURES FOR ACCREDITATION TO SUPPORT ACCOUNTABILITY FOR HIGH-QUALITY CARE
Accreditation and Certification at The Joint Commission
Measurement in the Context of Hospice and Home Health Care
Challenges of Quality Improvement
SUPPORTING CLINICAL COMMUNITIES FOR QUALITY AND ACCOUNTABILITY
A Health Care Information Technology Company’s Approach to Support Accountability
Boxes and Figures
BOXES
3 Measures Drive Improvement If . . .
FIGURES
1 A nested population model of serious illness
2 Simulation of various approaches to identify patients with serious illness
4 NQF’s prioritization initiative process
5 NQF’s measure prioritization criteria
6 Focus areas for the CMS Meaningful Measures Initiative
7 2016 survey results of high-risk PIM and PACT patients
8 Percentage of Medicare beneficiaries hospitalized or deceased in 2015 by 2014 high-need status
Acronyms and Abbreviations
CAHPS | Consumer Assessment of Healthcare Providers and Systems |
CHIP | Children’s Health Insurance Program |
CMS | Centers for Medicare & Medicaid Services |
EHR | electronic health record |
HCBS | Home- and Community-Based Services |
IOM | Institute of Medicine |
MDS | Minimum Data Set |
MedPAC | Medicare Payment Advisory Commission |
MIPS | Merit-Based Incentive Payment System |
MRI | magnetic resonance imaging |
NCQA | National Committee for Quality Assurance |
NQF | National Quality Forum |
PACT | Patient Aligned Care Team |
PCQN | Palliative Care Quality Network |
PIM | PACT Intensive Management |
POLST | physician’s orders for life-sustaining treatment |
PTCD | pontine tegmental cap dysplasia |
UCSF | University of California, San Francisco |
UNC | University of North Carolina at Chapel Hill |
VA | U.S. Department of Veterans Affairs |
VHA | Veterans Health Administration |