A Learning Series From NCQA

Health care providers were hit with an unprecedented challenge in 2020: Enhance–or create–telehealth programs practically overnight to provide care to their communities while reducing unnecessary exposure for patients and staff. Some organizations got their programs off the ground easily, but many are still searching for a smooth experience that both staff and patients would willingly choose over the “old way.” This course will share best practices for telehealth workflows collected from organizations across the country, including how to increase patient telehealth virtual (not telephone) visit volume, reduce patient telehealth cycle times, improve patient access through the “digital front door,” schedule optimally for hybrid in-person and telehealth systems, address quality metrics and reduce staff and provider burnout, even across the “digital divides” that exists for many patients who do not have access to reliable internet.

This course presents a panel discussion about the telehealth experiences of a provider and patient/patient advocates, from when an appointment is made through the after-visit follow-up. The panel will discuss how telehealth has improved their health care experience and how to overcome obstacles that prevent easy access to care, and will identify strategies for avoiding the glitches that frustrate patients and providers.

The COVID-19 pandemic created a need for primary care practices to pivot quickly toward telehealth to improve access to care. This course will include strategies for implementing a phased approach to telehealth, starting with infants and expanding to other age groups, that can serve as a resource for practices initiating or expanding delivery of telehealth.

As a Federally Qualified Health Center, Greater Portland Health (GPH) provides primary medical, behavioral and dental health services to Greater Portland’s most vulnerable residents, including low-income individuals and families, the homeless, immigrant/refugee/asylum-seekers, children, elderly and the under-/uninsured. Its primary goal during the COVID-19 pandemic has been to remain fully operational and continue to support patients while keeping staff safe. This has required staff to implement telehealth services–something never used before at GPH.

This course features USofCare policy and research and community engagement staff, as well as a member of USofCare’s Founder’s Council or Voices of Real Life, sharing their perspective from the community. Panelists will explain their people-centered policy design and showcase findings on barriers that diverse communities face when accessing virtual care, and policy solutions to overcome those barriers. Panelists will share their mixed-methods approach for listening to people about their experiences with virtual care (listening sessions, focus groups, 1:1 conversations, public opinion, commissioning research) to learn about their needs, desired outcomes and potential policy solutions. The discussion will also cover how quantitative knowledge is paired with research evidence and expert opinion to ensure an equitable approach to virtual care.

On March 17, 2020, Walden Behavioral Care began providing telehealth treatment for ambulatory clients, in an unprecedented attempt to avoid disruption of treatment of eating disorders during the COVID-19 crisis.

This course is an introduction to eating disorders, diagnosis, assessment and interventions, and summarizes what Walden has learned over the past year of providing ambulatory care for people with eating disorders via telehealth.

Federal rules require state Medicaid managed care programs to develop a quality strategy that includes a plan to “identify, evaluate, and reduce… health disparities based on age, race, ethnicity, sex, primary language, and disability status.” This work may be delegated to managed care entities that might be technically and operationally unprepared to take it on. Without assistance, health care program leaders may have difficulty figuring out where and how to start. Using data from the Michigan Medicaid agency, four quality of care measures were stratified by race/ethnicity and county for measurement years 2018-2020. Results indicate that racial/ethnic disparities exist for most measures, in all counties, in all years. And although there are differences in performance across counties, there are also clear trends.

This course examines treatment for opioid use disorder (OUD) from a clinical and research perspective. It will review approved medications and their pharmacology, efficacy and safety. Panelists will discuss these lifesaving medications (currently underutilized), describe characteristics of Medicare beneficiaries with OUD and highlight disparities and gaps in access to medications for treating OUD among underserved Medicare populations. The course will close with a discussion of successful models for implementation of primary care-based treatment of OUD.

Behavioral health continues to be at the forefront of health care, affecting quality of life and health outcomes, and the pandemic’s impact has increased the number of patients who could benefit from behavioral health integration in primary care practices. NCQA Distinction in Behavioral Health Integration provides guidance for practices to establish solid and effective processes for ensuring that patients continue to get the right care at the right time, whether it’s primary care or a behavioral health intervention. This special Quality Innovation Series course lets participants hear directly from clinicians who have embraced NCQA’s Distinction in Behavioral Health Integration. Their success stories will resonate with and inspire any practice interested in taking the next steps toward providing coordinated care between behavioral health and primary care clinicians.

This course is an opportunity to learn how the Care Transformation Collaborative of Rhode Island helped integrated behavioral health (IBH) practices respond to COVID by tele-IBH implementation and earn Behavioral Health Distinction. Areas of focus include working with state and payers to align expectations across the health care system for IBH and sustainability; developing and implementing a 12-month tele-IBH learning collaborative that gives PCMH practices an opportunity to test tele-IBH workflows while working toward earning Behavioral Health Distinction; and developing practical tools to strategically approach earning Behavioral Health Distinction.

Digital quality means many things to many people, but what do we at NCQA mean when we say digital quality? We want a digital quality framework that cuts waste and burden in quality reporting. We want it to foster measurement across levels of the health care system. We want it to accurately pinpoint the factors that lead to high-value care. And we want all of this to “set the table” for a learning health system that consistently provides timely data for more immediate action to improve care. Join NCQA for a digital quality primer that lays the groundwork for understanding the terms, methods, strategies and end-to-end process of the value chain surrounding digital quality guidelines, reporting solutions, performance solutions and more. This course also explores common misperceptions about digital quality and what organizations should be doing now to prepare for, accelerate and implement digital quality measurement.

This year, CMS signaled its plan for all quality measurement used across the agency to be fully digital by 2025. For several years, NCQA has worked with stakeholders to prepare them for the next generation of quality measurement. In this course, NCQA, policymakers and leading voices in health care reform will provide an overview of the federal policies supporting the move to digital measurement and discuss implications of a more digitally enabled health care system.

In this course, NCQA and industry thought leaders will discuss challenges and opportunities to develop, adopt and implement digital quality guidelines and measures, as well as implications for advancing digital quality. Learn what industry leaders are already doing in this space and where the future is taking them. This is a great opportunity to benchmark your organization to others in digital quality transformation and learn what has worked well (and what hasn’t) for the trailblazers.

Organizations that are beta-testing a new method of consuming HEDIS digital measures will share their motivations for and benefits of moving to the new methodology, along with an overview of their experiences, challenges and early learnings. NCQA will share more about the solution and our vision for how digital measurement will evolve.

NCQA is embarking on a mission to enhance quality measurement by enabling technical specifications to use standardized electronic clinical data captured during care delivery and exchanged using standard formats and measure logic. In this course, we discuss the path forward for leveraging electronic clinical data for measurement and care improvement.

In 2018, UPMC Health Plan set a strategic goal to move to prospective, year-round HEDIS review for hybrid measures, across Medicare, Medicaid and SNP business lines. To support this strategic goal, the UPMC Health Plan Quality team worked with technology innovators at UPMC Enterprises to apply Natural Language Processing to HEDIS hybrid abstraction. Working together, UPMC teams developed a unique technology platform that markedly increases abstractor efficiency in closing gaps. The system is currently in production use at UPMC Health Plan across 12 measures and 3 lines of business. This course discusses the use of natural language processing for HEDIS, as well as lessons learned after introducing NLP into real-world HEDIS workflows.

This course examines structured models for advancing community-based programs in population health. Purpose-interrelated topics include future quality and value-based care pathways, social determinants of health, a deep dive into the implications of COVID-19 and emerging health care trends.

This course includes highlights from the recently developed NCQA guide on social determinants of health–a resource for health plans, clinically integrated networks and clinicians to design and implement strategies that address SDOH for commercially insured populations. NCQA staff will facilitate a discussion of strategies, NCQA programs and in-the-field examples to improve SDOH interventions.

This session shares how a health provider prioritized a subset of quality measures targeted at high risk patients for action. Through tools revamping, operational teams were equipped to shift from their traditional outreach program to fully implement new work driven by the “Vital Few” measures. Results show an appreciable impact in reducing disparities in quality outcomes for the target measures and population.

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) sought input and collaboration from a “coalition of the willing” key stakeholders to address inequities in its members’ health care and in the state as a whole. This course highlights development of a Health Care Equity Index–a tool to help identify opportunities to improve health equity in a health plan, monitor progress toward closing disparities and help communities and the state meet health care equity goals–as well as challenges and lessons learned.

This session defines the future role of the community health worker in bridging the health equity gap in the clinical setting. This course includes applied methods and analytic tools for assessing social determinants of health at the community level.

Health care quality cannot exist without equity. NCQA is committed to building, measuring and promoting equity through all our programs. Empowering HEDIS to speak directly to these goals is a central part of this effort. Join NCQA staff for an overview of our equity measurement strategy and learn more about how we are evolving HEDIS to build toward better transparency and action. This course will include a review of new race and ethnicity stratifications, next steps for a more inclusive HEDIS and a preview of a new measure concept for social needs screening.

Hospital at Home is an innovative patient care model that picked up traction during the COVID-19 pandemic. It is growing in the U.S. and internationally, and is part of the expanding movement to deliver health care in people’s homes. While early success with the model shows feasibility, improved outcomes and lower costs for certain patients with select conditions and building consensus across providers, payers and policymakers is key for ensuring long-term success for this emerging model. Join NCQA and Hospital at Home experts for a 90-minute roundtable discussion of early successes and emerging policies and infrastructure considerations. Faculty include policymakers, private industry representatives and researchers.

Swope Health Services serves a vulnerable underserved patient population that has many high-risk factors for complications of diabetes. Using PCMH principles, it built an EMR (e clinical works) tool for effective previsit planning—even in an open access setting—and linked it to other electronic tools, such as in-office retinal exam devices, to improve diabetes outcomes and focus on tertiary prevention.

There is broad agreement that individuals’ priorities and health goals should guide their care, but existing quality measures do not effectively evaluate what is most important to individuals, particularly older adults with multiple chronic conditions, serious illness or frailty. Current health care quality measures use a “one-size-fits-all” approach that does not work when individuals face complex trade-offs in determining the right course of treatment or when they need services and supports beyond traditional medical care. The person-driven outcomes approach individualizes measurement based on what people identify as most important. Quality measures created on this approach have the potential to fill a critical gap in the current system of value-based payment. This course will discuss implementating person-driven outcomes in clinical practice and incorporating the patient voice into quality measurement.

Electronic health records have the potential to improve quality of care and patient safety, but key quality data is often spread over multiple locations in the electronic chart, necessitating extensive, time-consuming reviews in order to obtain a complete and timely picture of a patient. The time required to perform a comprehensive chart review results in less time spent in direct face-to-face patient care, diminished clinical efficiency and increased risk of provider burnout, which in turn can have a detrimental impact on quality of care.

In health care, as in other industries, disaster often inspires innovation. By April 23, 2020, Dallas, Texas, had 2,763 cases of COVID-19 and 72 deaths. The hospital in-patient and ER were strained. To contain the spread of the virus in the community, the Parkland Health & Hospital System team, in partnership with PCCI, developed a multi-prong, technology-based solution. To date, over 500,000 upcoming clinical encounters have been prescreened for risk, resulting in relatively early detection and treatment of cases and decreasing potential exposure to the health system.

During this course, NCQA staff share updates to measures for HEDIS MY 2021 and discuss key dates for data collection.

For so long, the goal to improve health care has focused on primary care quality and overlooked the significance of specialist care’s contributions toward that goal. The path to improving quality measurement lies in greater acquisition and analysis of clinical data.

Join NCQA measure champions as they discuss the rationale behind development of new measures, changes to existing measures and overall volume 2 updates for HEDIS MY 2022.

NCQA staff will share HEDIS MY 2020 first-year analysis results and reporting results for domains of measures gaining attention, including 11 measures collected via Electronic Clinical Data Systems and 4 national measures of Long-Term Services and Supports reported by health plans and community-based organizations. Staff will also share what’s in the measurement pipeline for HEDIS MY 2023.

This course focuses on assessing and establishing robust QI practices across a diverse network of providers to advance the network as a performance-driven organization, with a focus on collaboration around defined behavioral health priority measures, using individualized agency support to drive implementation and practice change. Panelists will describe the evolution of quality improvement efforts, creation of data visualization to support informed decision making and development of common processes based on shared best practices, and will also discuss their efforts to build on this foundation to sustain practices at the agency and network levels.

During this session, NCQA staff will review and discuss Audit and Data Collection updates for HEDIS MY 2021 and provide a glimpse of Data Collection updates to come for MY 2022.

This course examines the changing relationships between patients, physicians, hospitals, insurers, employers, communities and government in the current value-based care landscape.

This course examines opportunities for implementing a networkwide QI program through a population health lens, with a focus on behavioral health. Speakers share considerations for value-based payment contracts with payers, including managed care organizations, on behalf of clinically integrated provider networks, to provide health care and related social services.

This course will highlight recently-developed tools and resources related to enhancing the quality of chronic kidney disease (CKD) care including the Office of Minority Health and NCQA’s CKD Disparities: Educational Guide for Primary Care, Bayer and NCQA’s Kidney Health Toolkit, and a new performance measure on kidney health evaluations for people with diabetes. The course will also feature a panel discussion with input from patient, health plan, and provider perspectives on how to improve CKD care and outcomes.

During this course, we assess population health improvement opportunities and interventions for rural communities. In a state-based collaborative, practices are guided to choose a track/focus for increasing capacity and providing resources to patients for diabetes, hypertension and hyperlipidemia. Tracks include the ability to implement or connect to programs such as the National Diabetes Prevention Program, diabetes self-management education and incorporating clinical pharmacists and other clinical team members into the care team. Other improvement strategies include team-based care, EHR optimization, quality data and developing workflows and protocols that closely align with the PCMH model.

The transition to value-based care is fixed on payment models, with scarce attention to stewarding a culture of value within the care setting. However, clinicians are uniquely positioned to champion high-value care initiatives and to increase peer engagement. In this course, we discuss a peer-mentoring model dedicated to clinical decisions focused on value-based care delivery.

Drug developers no longer have FDA approval as their top concern. Now payer coverage, access and reimbursements are the primary concern. Payer resistance to pay for treatment failures is growing when individual patient specialty drug therapy costs are $200k-$2+m. Meanwhile, specialty pharmaceuticals are expected to increase to >50% of total US drug expenditure by 2022. How has value-based contracting been impacting this high stakes challenge and what is in store for the future?