Value Based Care: Which Measures are the Best Fit?
Value Based Care: Which Measures are the Best Fit?
Quality measurement is an intrinsic component of value-based purchasing, yet the quality measures used in VBP are usually derived from measures built for other purposes. In order to shift the health care reimbursement system in the United States to paying for value, quality measures should be vetted as “fit for purpose” and defined by their impact on providers, patients, the provider-patient relationship and what matters to patients. “Fit for purpose” quality measures should focus on improving value in delivery of health care and create a culture of value in the health care system. Presenters define five dimensions of quality measures necessary to link the actions of providers and patients.
• Health care professionals
• Health care decision makers
• Health plans
• Health systems
• Population health organizations
- Summarize why quality measures that are “Fit for Purpose” are necessary for transitioning our payment system from paying for quantity of care to paying for value of care.
- Define a measurement framework containing 5 attributes necessary for developing quality measures that are “Fit for Purpose” for value-based programs (VBPs).
- Discuss initial CMS forays into quality measures that are a better fit for VBPs.
- Outline changes and future directions necessary to build quality measures that will lead to success in VBPs.
Sheila Roman, MD, MPH
Sheila Roman, MD, MPH is an Independent Healthcare Consultant with a unique understanding of the health care system from the various perspectives of a clinician, quality professional, and health policy maker. She possesses expertise in quality measurement and management, patient safety, clinical transformation and value-based care and value-based payment models. She is board-certified in Internal Medicine and Endocrinology and Metabolism and maintains a part-time faculty position at Johns-Hopkins Medical Institutions. She is a member of the NQF All-Cause Admissions & Readmissions Standing Committee and participated on many technical expert panels currently the CMS Hospital Harm TEP.
Dr. Roman served as Senior Medical Officer at CMS from 2001 to 2014, initially working in the Center for Clinical Standards and Quality where she stood up the Compare Sites and subsequently for the Center for Medicare where she participated in the formulation of Medicare payment policy. In January 2010 she was recruited to the Performance-based Payment Policy Group in the Center for Medicare, a new group established to implement the alternative payment models mandated in the Affordable Care Act. When she left CMS in 2014, she was the clinical lead on the Physician Feedback/Value-based Payment Modifier which was folded into the Physician Quality Payment Program.
Previously she spent over 15 years on the faculty of the Mount Sinai School of Medicine where she was Associate Professor of Medicine and Health Policy, Director of Health Care Evaluation and Quality Management in the Department of Medicine and Chief of the Adult Diabetes Program. During her tenure at Mount Sinai Hospital, she received over ten years of New York State funding to research the social and medical determinants of disparities in diabetes care in underserved and minority patients in NYC. In this capacity she established and directed the East Harlem Regional Diabetes Center of Excellence.
Catherine Major, BA, MBA
Ms. Major is a Senior Associate at Booz Allen Hamilton where she leads efforts in health care quality, performance measurement, and payment reform. At Booz Allen, she has worked with Federal agencies and non-profits on quality measure development and harmonization and payment reform. Prior to joining Booz Allen, she was Director of Programs at The Leapfrog Group where she led development and implementation of the Leapfrog Hospital Rewards Program and supported Leapfrog’s stakeholder engagement efforts. Ms. Major holds a BA in Philosophy, Politics and Economics from the University of Pennsylvania and a MBA from The Wharton School at the University of Pennsylvania.
This live course grants 1.0 Continuing Education Unit (CEU) points for PCMH Certified Content Experts.
* Please note – You must attend the entire program to be eligible for total number of contact hours.
Disclosure of Relevant Financial Relationships
The National Committee for Quality Assurance (NCQA) endorses the Standards of the Accreditation Council for Continuing Medical Education which specify that sponsors of continuing medical education activities and presenters at and planners for these activities disclose any relevant financial relationships either party might have with commercial companies whose products or services are discussed in educational presentations.
For sponsors, relevant financial relationships include large research grants, institutional agreements for joint initiatives, substantial gifts, or other relationships that benefit the institution. For presenters or planning committee members, relevant financial relationships include the receipt of research grants from a commercial company, consultancies, honoraria, travel, or other benefits, or having a self-managed equity interest in a company; or having an immediate family member or partner with such a relationship.
Disclosure of a relationship is not intended to suggest or condone bias in any presentation but is made to provide participants with information that might be of potential importance to their evaluation of a presentation.
Relevant financial relationships exist with the following companies/organizations:
Sheila Roman: None
Catherine Major: None
Additional Planning Committee Members:
Tammy Donnelly: None
This program was developed in part by NCQA staff.
This program received no commercial support.
- 1.00 Participation
- 1.00 PCMH CCE