Maximize quality improvement and performance on measures

VBP Toolkit Menu

• 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.

(1)Rubin I., Israel J. (2022) The Case for Aligning Quality Measurement, Health Affairs Forefront, https://www.healthaffairs.org/content/forefront/case-aligning-quality-measurement

(2) https://www.ncqa.org/blog/hedis-2022-see-whats-new-whats-changed-and-whats-retired/

(3) https://www.qualityforum.org/CQMC_Meeting_Summaries.aspx