Table of Contents

1. Table of Contents Title Overview of presentation CCME background National Quality Strategy Strategy Goals Multi-task approach Primary data source Physician data SNF/HHA data Hospital data Flu map Hospital reports Contact info Community map

2. Heather Jones, PTA, MHA, CPHQ Interim Director, AQIN-SC October 2016 Data Knowledge AcademyUsing QIO Data to Improve the Health and Healthcare of the Medicare Beneficiary Population *

3. Overview Quality Improvement Organization background National Quality Strategy Goals 11SOW Data for quality improvement activities *

4. The Carolinas Center for Medical Excellence (CCME) • Centers for Medicare and Medicaid Services (CMS) Quality Improvement Organization (QIO) for South Carolina • Member of Atlantic Quality Innovation Network (AQIN) • New York, District of Columbia and South Carolina • 11th Statement of Work (SOW) • August 2014 – July 31, 2019 • Medicare Fee for Service population *

5. National Quality Strategy BetterCare Goal for Payment Reform: 85% of all Medicare Fee For Service payments tied to quality of care by the end of 2016 increasing to 90% by the end of 2018 Healthier People, Healthier Communities SmarterSpending *

6. 2016 Quality Strategy Goal 1: Make care safer by reducing harm caused in the delivery of care Goal 2: Ensuring that each person and family is engaged as partners in their care Goal 3: Promoting effective communication and coordination of care Goal 4: Promoting the most effective prevention and treatment practices, focusing on leading causes of mortality - cardiovascular disease Goal 5: Working with communities to promote wide use of best practices to enable healthy living *

7. Multi-task Approach to Population Health *

8. Primary Data Source CMS Claims • Medicare Fee For Service (FFS) claims • Medicare Part A • Medicare Part D data is used in Medication Safety initiative • 6 month lag in availability due to CMS validation • Data is not risk adjusted *

9. Physician Data Physicians/eligible providers • CMS Physician Quality Reporting System (PQRS) • Submissions • Payment adjustments • CMS FFS claims data • Ex: Immunization rates – influenza/pneumonia *

10. Skilled Nursing Facility/Home Health Data Skilled Nursing Facilities • CMS quality measures (Minimum Data Set Casper reports) • Ex: Anti-psychotic medication usage, falls/mobility, infections • National Healthcare Safety Network (NHSN) • C. Difficile (36 participating facilities) • CMS FFS claims data • 30-Day All Cause Readmissions to hospitals Home Health Agencies • CMS quality measures - Home Health Quality Initiative – Outcome and Assessment Information Set (OASIS) reports • CMS FFS claims data • 30-Day All Cause Readmissions back to hospitals *

11. Hospital Data CMS – Inpatient Payment System - Value Based Purchasing reports CMS FFS Claims Data • Readmissions • Potential adverse drug events (pADE) and adverse drug events (ADE) • High risk medications – Opioids, Anticoagulatants, Hypoglycemic medications - Medicare Part A and Part D *

12. Improving Health for the Medicare Population Physician Data: CMS FFS claims for immunization rates *

13. Improving Health for the Medicare Population Hospital • Annual Value Based Purchasing reports • Medicare Spending Per Beneficiary • Quarterly readmission reports • Physician visits 7 and 30 days post discharge • Readmission Reduction Program (AMI, COPD, PNEU, CHF, THA/TKA, CABG, 30-Day All Cause) • Additional readmission discharge diagnoses • Readmissions by race/ zip code • Readmission rates for discharges to SNF, HHA, and Home • Community of practice reports *

14. For more information Heather Jones PTA, MHA, CPHQ Interim Director, AQIN-SC (803) 212-7584 Hjones@thecarolinascenter.org The Carolinas Center for Medical Excellence 12040 Regency Parkway Suite 100 Cary, NC 27518 www.atlanticquality.org *

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