It's All About the Data
Oversight for the Nation's Most Vulnerable
David Wright, director the CMS Quality and Safety Oversight Group for the Center for Clinical Standards and Quality, ascended the podium at the start of day 2 of the 2020 CMS Quality Conference with a fresh gash on his forehead and a story to match.
"Let's get this out of the way right now," Wright began. "Let's talk about my face."
Sans helmet, Wright had taken a turn too quickly while riding a scooter to the conference earlier that morning.
"Should you scooter before giving a presentation to a couple of thousand people? Probably no. Did I get back on the scooter and continue, face bloodied, to get here? Yes, I did.
"I'm not a hero," Wright continued, as the audience laughed sympathetically. "I just felt that you all deserved the best video playback session this conference had to offer, and I wasn't going to shirk from that duty."
Kidding aside, Wright reflected with the audience of health care quality improvement professionals on the roles of the CMS Quality and Safety Oversight Group and the CMS Safety and Operations Group in their enforcement and oversight of Medicare and Medicaid-certified nursing homes and hospitals.
The groups oversee 60,000 on-site surveys on top of 15,000 annual nursing home surveys, as well as 3,500 hospital complaint investigations each year. That's why accountability to Medicare quality and safety standards is so important among accrediting organizations, Wright said, because these organizations certify more than 82 percent of accredited hospitals.
Wright called on conference attendees to unleash their passion, innovation, and creativity to "fulfill our commitment to those who are relying on us day-in and day-out to do our jobs. And when we do our jobs well, we safeguard the people we care about most in our life."
Data to Drive Value in the Medicaid and CHIP Program
Calder Lynch, center director of the Center for Medicaid and CHIP Services (CMCS), noted that Medicaid remains the foundation of our nation's safety net, serving 71 million Americans. A complete picture of program performance, results and costs is essential to inform policy decisions that affect millions of vulnerable beneficiaries.
More high-quality Medicaid data is available than ever before. The Medicaid and CHIP Scorecard uses this data to summarize the performance of state programs. In addition, Medicaid analytics files are now available to the research community to help answer questions about the program's performance. For example, a substance use disorder data book was one of the first products the Center produced to inform federal and state responses to the opioid crisis.
The Center is also using its data to develop a Quality Rating System for the Managed Care Organizations (MCOs) that deliver most Medicaid services. This system will help states and Medicaid beneficiaries understand the quality and outcomes of the MCOs available to them.
Better Medicaid Data in Action
Until 2009 and 2010, with the creation of the child and adult core sets of quality measures, "we couldn't tell you how many of our [Medicaid and CHIP] beneficiaries had hypertension, much less how many of them had their blood pressure under control," said Karen Matsuoka, CMCS chief quality officer and division director, Division of Quality and Health Outcomes. "These are some of the most vulnerable individuals in our nation. And yet we didn't know this very basic information for the first 12 years of CHIP and the first 50 years of Medicaid."
More and more of these measures are being voluntarily reported by state Medicaid and CHIP agencies each year. These measures inform the Medicaid and CHIP Scorecard.
"Not only do we now know how many of our beneficiaries have hypertension, we can tell you what percentage have their blood pressure under control, and we can now hold ourselves and our state partners accountable to doing better," Matsuoka said.
How Oklahoma's Health Information Exchange Supports Value-based Payment Models
Dr. David Kendrick, chair of the Department of Medical Informatics at the University of Oklahoma School of Community Medicine and director of the MyHealth Health Information Exchange (HIE) in Oklahoma, explained how MyHealth uses digital quality measures at the community level to bring claims and clinical data together. Among its benefits, the HIE has used a mobile phone-based program to screen 400,000 people in Oklahoma for social needs. Since 2018, nearly 50 percent and more than 25 percent of Oklahoma Medicaid and Medicare patients, respectively, have received support for the social determinants of health.
The Effective Use of Data to Drive Value
"Value means improved cost and quality, and we need to be looking at the data performance of both to continuously examine our performance and improve our care," said Dr. Michelle Schreiber, CMS director of the Quality Measurement and Value-Based Incentives Group, CCSQ.
A transition to digital quality measures is a cornerstone of Meaningful Measures 2.0. To support this effort, CMS is developing a path to using Fast Healthcare Interoperability Resources (FHIR). FHIR will eliminate the need to maintain multiple data standards and enable automated data exchange through application program interfaces (APIs).
Fireside Chat: Value-based Care Showcase
Daniel Tsai, assistant secretary for MassHealth and Medicaid Director for the Commonwealth, led a discussion on balancing the independence of the states and territories in the adoption of value-based care models with establishing federal standards. Brad Smith, deputy administrator and director of the CMS Center for Medicare and Medicaid Innovation and Calder Lynch, director of CMCS, declared their commitment to creating consistent federal standards among value-based care models for Medicare, Medicaid and other payers.