Maximize quality improvement and performance on measures

Performance measurement is central to VBP. Payers select metrics and set benchmarks and improvement targets. It is common to have little to no overlap in metrics across payers. To the extent possible, it is beneficial if you can negotiate for common metrics.

“When QMs are thoughtfully created and implemented, they can enhance medical care by focusing clinical efforts toward specific beneficial health outcomes. QMs can also, however, be overused. …when health insurance plans measure the performance of overly long lists of QMs in their contracts … clinicians’ attention is diverted away from patient-centered, outcomes-based care and toward “check-the-box” care, with time-consuming administrative tasks and data submission efforts. Similarly problematic are rarely used QMs, particularly QMs created and used by a single insurance plan.” (1)

In 2017, Massachusetts convened a volunteer body of consumer advocates, health insurers, provider organizations, quality measurement experts and state agencies to design an aligned quality performance measure set to be used by state public payers and by commercial market payers in value-based total cost of care provider contracts. The Quality Measure Alignment (QMA) Taskforce ultimately recommended a mix of “Core Measures” (measures to be used in every contract) and “Menu Measures” (measures to be used at the discretion of individual payer/provider contracting partners). Since that time the QMA Taskforce has annually updated the measure set. For 2023, it adopted six Core Measures and 23 Menu Measures. Voluntary adherence to the aligned measure set has been high – Massachusetts payers report that over 80% of their contract measures are in the aligned measure set. This is impressive given that many provider contracts are multi-year and the measure set changes a little each year. During 2021 and 2022, the QMA Taskforce added health equity-focused measures, and developed health equity data standards and a framework for introducing accountability for health equity into value-based contracts. For more information, visit the MA Aligned Measure Set website.

Design for equity by including equity focused measures

  • The National Committee for Quality Assurance (NCQA) introduced race and ethnicity stratifications to five HEDIS measures, such as colorectal cancer screening and controlling high blood pressure.(2)
  • The National Quality Forum (NQF) has identified 19 disparity-sensitive measures, such as depression response at 12 months in primary care and functional status assessments for congestive heart failure in cardiology.(3)
  • Stratify any metrics you can by REALD and develop a QI plan including addressing disparities.

Keep quality improvement efforts to no ore than 10 metrics at a time

  • Review and modify this top ten list at least annually depending upon the opportunities for improvement and for additional VBP earnings.
  • Specifically identify metrics where you see significant variation between the highest performing providers and the lowest performing providers and metrics where your organization overall is performing below VBP benchmarks.
  • Take advantage of technical assistance, webinars and trainings related to sharing best practices, clinically and operationally.

Establish processes and tools that measure quality of your organization and individual clinicians

  • Use data and VBP performance dashboards to identify and act on performance when it differs from established VBP targets.
  • Identify areas where variability in clinical practice exists within and across your organization and where gaps between current practices and knowledge can be closed.
  • Multiple levels of VBP dashboards can be created depending on available resources, payer support, the size and complexity of the provider entity and the breadth of your VBP arrangements. Different levels of VBP dashboards could include: 1) provider entity performance overall and across payers, 2) practice-level dashboards and 3) peer clinician-level dashboards.

Focus on metrics used in VBP arrangements. Examine how you can offer clinicians and practices ready information to understand care gaps at the point of care or during morning routines so that progress is being made toward improving outcomes when patients are seen. Consider changes to your information technology approaches and your manual processes to support improvement in targeted VBP metrics.

VBP performance meetings

  • Establish regular, substantive meetings on VBP performance and provide transparency on performance regarding the extent to which each practice/clinician is meeting expected performance levels for quality, efficiency, or other priority measures.
  • Use internal and payer data, including available VBP performance dashboard(s), to support these discussions.
  • In advance of these VBP meetings, identify specific performance areas to be discussed, the process and timeline for reviewing performance in the future and specific performance goals.
  • Set annual improvement goals, including baseline, mid-cycle and final evaluation periods to track improvement gains at the provider entity and clinician level.
  • Scheduled and structure VBP performance-focused meetings with key practices/clinicians and senior executives on at least a semi-annual basis.
  • Consider the size of your provider entity and how often senior leaders will meet with practices and/or clinicians individually and in small groups to discuss VBP performance expectations, challenges and trends.

Think creatively about how to develop and implement incentives and supports to reward high-performing clinicians and practices. Create non-financial and financial incentives that clinicians and practices can see relatively quickly, even if payer VBP financial incentive payments have a significant lag. One example of a non-financial incentive could be monthly awards to recognize practices with increased reporting of targeted preventive and primary care. In addition, encourage practices to offer suggestions for how to allocate VBP rewards, including ranking priorities for re-investing VBP earnings to increase your collective ability to continue to improve the delivery of cost-effective, quality care.

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