A Learning Series From NCQA

Since the onset of the pandemic, telehealth utilization has experienced an upward trend, and industry experts are advocating for it to be a permanent option. Join NCQA and top industry experts to highlight practices that are using telehealth/remote care delivery to successfully drive improvements in care.

This 3-day series includes panel discussions about the evolution of telehealth, best practices in care delivery, its impact on the quality improvement experience and its use for chronic conditions such as behavior health and cardio rehabilitation.

Day 1: Virtual kick-off event featuring keynote from NCQA President Peggy O’Kane.

Since the onset of the pandemic, telehealth utilization has experienced an upward trend, and industry experts are advocating for it to be a permanent option. Join NCQA and top industry experts to highlight practices that are using telehealth/remote care delivery to successfully drive improvements in care.

This 3-day series includes panel discussions about the evolution of telehealth, best practices in care delivery, its impact on the quality improvement experience and its use for chronic conditions such as behavior health and cardio rehabilitation.

Day 2: How telehealth supports quality improvement and how it is measured.

Since the onset of the pandemic, telehealth utilization has experienced an upward trend, and industry experts are advocating for it to be a permanent option. Join NCQA and top industry experts to highlight practices that are using telehealth/remote care delivery to successfully drive improvements in care.

This 3-day series includes panel discussions about the evolution of telehealth, best practices in care delivery, its impact on the quality improvement experience and its use for chronic conditions such as behavior health and cardio rehabilitation.

Day 3: An exploration of care needs and telehealth best practices in behavioral health and cardio rehabilitation.

For the last four years, the South Carolina Office of Rural Health (SCORH) Practice Transformation team has worked with multiple partners to close the gap in health status and life expectancy between rural and urban communities in the Palmetto State. As part of this work, SCHRH has partnered with the SC Department of Health and Environmental Control’s (DHEC) Best Chance Network and other community partners to improve breast and cervical cancer screening rates throughout rural SC. Rural practices are engaged and supported in integrating evidence-based interventions that fit the needs of their patient population and the operational needs of the practice. This webinar will explain the core components of the Best Chance Network Program, identify the mechanisms of the partnership between a state health department and a Practice Transformation team within an Office of Rural Health and explain how clinical data can inform population-based care decisions.

Payers and providers often face challenges regarding appropriate clinical documentation, authorization request turnaround times and basic information exchange (interoperability) between EHR and utilization management systems. Ultimately, the quality of member/ patient care is affected by these challenges. Implementing informed and effective care strategies and tools to speed processes and reduce administrative burden of authorizations supports the goal of a successful health care journey for patients and  providers.

MultiCare Connected Care, Regence Health plan and MCG Health—three member organizations of the HL7 Da Vinci Project—implement real-world examples for improved interoperability by combining FHIR standards with AI technology to improve the member/patient experience and achieve better clinical outcomes. Technology leaders from these organizations will discuss their journeys and what they learned along the way, and will share successful strategies to help other payers and providers on the same path. This session focuses on real-world implementation of the HL7® Da Vinci Project’s FHIR® standards and AI to drive point-of-care authorization decisions. Speakers will show how these approaches can promote payer-provider collaboration, encourage health IT innovation and improve member/patient outcomes while reducing unnecessary costs.

After battling COVID-19 for almost 2 years, health systems have made tremendous gains in testing, treatment and protective measures such as masks, social distancing and vaccines. Even as the pandemic continues, our health care systems strive to deliver safe, efficient, coordinated, quality, cost-effective care, and are incorporating metrics and algorithms to measure effectiveness. But what would we find if we looked beyond metrics and algorithms and saw health care through the eyes of an actual patient? Have you ever wondered what lessons you could learn and insights you could gain from examining our health care design from the patient’s perspective? This session discusses the COVID-19 journey of one patient: the presenter. It begins with the COVID diagnosis in the ED, through hospitalization and discharge to a “hospital at home” monitoring program, and concludes with a primary care follow-up visit. Ms. Ali shares lessons learned and insight gained through retrospective reflection and analysis of events as a patient and health care professional. She highlights how efficient quality processes, care coordination and remote monitoring (telehealth) contributed to her recovery as she engaged with two health systems.

Research and literature demonstrates the positive impact of nutrition as intervention. Nutrition is a lever deployed in oncology, with recent expansion to other chronic diseases, as a primary intervention for symptom management, resulting in high levels of engagement, utilization and satisfaction; reduced ED visits, inpatient admissions and unnecessary resource utilization; improved survival and quality of life; and reduced symptom burden. Given that we must eat to live, nutrition represents a key interventional lever that is already incorporated into our daily lives, but the clinical benefits are often not maximized.

Advances in the power, speed and affordability of technology have facilitated development of AI-based expert platforms that are bridging the nutrition-access gap in oncology and bringing evidence-based nutrition-as-intervention to patients via an SMS-based virtual “dietitian in your pocket” 24/7 “on demand.” This session will present a case study demonstrating how one organization used a virtual dietitian to identify issues sooner and provide immediate, personalized, clinically proven self-management guidance,  and referrals  to reduce costs, improve quality of care and the patient experience. By incorporating contextual data such as preferences, social determinants and other practical data, a more personalized, holistic patient experience resulted in higher engagement (65%), utilization (70%) and satisfaction (83%).

Knowing that people’s social risks and needs (having a safe place to live, nutritious food, and positive relationships) influence their health outcomes, Kaiser Permanente is building a “social health practice” that includes caring for members’ social well-being as well as their physical and mental health.

The social health practice aims to universally screen members for social risks and needs and connect them to resources in their communities. A multimodal approach normalizes screening as part of members’ care experience, creates choice, respects member preferences and ensures convenience, accessibility and privacy. It can also alleviate the burden on care providers, who might not feel comfortable having social health conversations with patients or who already feel pressured to cover everything expected of them during routine care visits. The goal is to screen a majority of Kaiser’s members within the next several years via a multimodal approach that includes:

Digital self-screening tools on the member portal and an online community resource directory that anyone can explore to find local community resources.
A toll-free phone line staffed by agents trained to assess callers’ social needs and match them to local resources. (It has helped more than 11,000 callers in May 2020.)
Standardized screening instruments integrated into Kaiser’s EHR system for routine assessment of members’ social needs and referral to community resources.
Potential use of tablets and automated telephone modalities.

In this session, presenters will share lessons learned that can be applied as strategies to improve health care quality by addressing social factors, and will raise critical questions about patient preferences and response biases by screening modality.

This course is a discussion about the expected return on investment for becoming a PCMH. Faculty will highlight different ways to define ROI through the eyes of various stakeholders, including patients, staff, funders and the community. Strategies will focus on critical criteria in the PCMH framework that can have the greatest impact on stakeholders, although some elective criteria are at the heart of the PCMH concept. This course will also cover strategies for making patient-centered processes a cultural practice and not just an annual task. Faculty will also describe how to ensure that PCMH is core to an organization’s quality program.

Expanded reimbursement for telehealth services has provided access to care that was not widely available to patients before the COVID-19 pandemic. With the rapid onset of social isolation and quarantine, primary care practices scrambled to implement virtual care delivery processes to meet patient needs and maintain visit volume. A year later, the availability of COVID-19 vaccines is returning in-person care to more typical levels, but telehealth remains a viable—and sometimes preferred—option for patients. Primary care practices must now reassess their existing services and develop long-term, sustainable processes to meet patients’ virtual care needs. This will require a full understanding of patient and provider preferences, and telehealth-oriented experience surveys are one way to gather feedback. This presentation takes a fresh look at how virtual services are delivered, and will provide participants with tools to assess and revise telehealth and other virtual care services in their practices. At the end of the session, participants will receive sample patient and provider telehealth experience surveys and recommendations for addressing patient concerns about completing surveys.

As a result of the recent racial unrest, DEI initiatives have become a hot topic across the country—and in the health care industry. As the call for representation across the medical staff and leadership resounds, many health systems are looking for ways to improve staff diversity. Although a focus on diversity ensures that the right people are at the table, health equity is an operational initiative to address the disparities that have plagued our nation. This presentation will explore using the lens of equity to address the business of health care and the services we offer. Critical to the work of health care leaders is an exploration of the opportunities for growth and expansion in our communities and how we can improve patient outcomes.

Practices and health plans alike recognize the importance of patient experience to the overall quality of health care and fulfillment of the quadruple aim. This session will explore how PCMH standards align with patient experience measures such as the CAHPS® survey, and how the standards contribute to a positive patient experience. We will crosswalk between the standards and CAHPS survey questions (access to care and care coordination) and look at activities that are not identified in the PCMH model but may affect patient experience; for example, wait times and doctor-patient conversations. We’ll also share ideas from practices that can contribute to a positive patient experience.

Despite the HPV vaccine’s effectiveness in preventing cancer, vaccination rates remain low. CenCal Health, a local Medicaid health plan in Santa Barbara, CA, identified a significant geographic health disparity in HPV vaccination rates among county Medicaid beneficiaries. CenCal Health partnered with a local Federally Qualified Healthcare Center to create a bilingual, digital educational program sponsored by the American Cancer Society to educate parents and guardians on the importance of HPV vaccination.
During this session, faculty will review how partnerships in communities across the continuum of care can improve health equity by using technology to educate patients.

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.

Over the last decade, the coming shortage of health care workers has been an unquestionable concern. A Schools of Public Health article released in 2008 that stated over 250,000 additional health care workers would be necessary to meet health care needs in 2020. In 2017, the Association of American Medical Colleges projected a deficit of over 100,00 physicians across specialties by 2030. Reduced volume of education programs, escalation of chronic diseases, an aging population and more health care workers approaching retirement all contribute to the shortage.

The COVID-19 pandemic and the 2020 “Great Resignation” have also increased the inadequate number of professionals in the health care industry. The conversation has shifted from the coming shortage to determining how to deliver effective care with limited staffing now. The majority of healthcare organizations must face the reality of staffing limitations while aiming to deliver quality care. In this session, faculty will define and discuss the collaborative practice team and strategies for analyzing organizational system waste, promoting the highest standards of care and building capacity contingency plans.

Patient experience is becoming increasingly important in the transition to value based health care. A positive patient experience with effective communication contributes to better engagement and overall better health outcomes for patients.

This presentation uses real-life examples to discuss effective inclusion of patients in quality improvement, understanding the patient perspective and leveraging data to drive improvement.

In 2022, NCQA launched its inaugural Digital Quality Solutions pilot, a software product development project with six trailblazing health plans, delivery systems and health information technology firms. In this session, NCQA staff will provide an overview of the pilot. NCQA staff members will summarize thematic needs from the pre-pilot assessment. Also, pilot participants will share their motivations and expected outcomes through their participation.

This session will review the implementation and outcomes of a Collaborative Drug Therapy Management (CDTM) program at a large public health care system in the United States. Clinical pharmacists are uniquely trained to address key issues surrounding management of diabetes, including the pharmacotherapy management, diabetes self-management education and medication adherence. CDTM allows pharmacists to co-manage patients under a collaborative practice agreement with a patient’s primary care physician.

Managed care organizations are uniquely positioned to amplify health equity efforts and contribute to meaningful, sustainable change in their communities by leveraging their members, providers, skilled staff and other aspects to play a significant role in that change. This presentation will break down a four-step, data-driven health equity improvement model that transforms a public health framework into managed care and integrates quantitative and qualitative data to identify barriers and design initiatives across the member, provider and community levels. Concepts related to implementation and scaling across states will be highlighted, with real world examples of the model and outcome in action.

Lung cancer is the main cause of cancer deaths in the United States. Given the maturity and strength of evidence supporting its impact, implementation of lung cancer management programs should be a priority in early detection efforts. This program will discuss the expanded USPSTF recommendations, changes in the reimbursement landscape, including the recent change in the Medicare National Coverage Determination. Speakers will discuss their own experiences with lung cancer screening and management, describing other modalities of early detection and the importance of a coordinated, multi-disciplinary approach. The program will conclude with a call to action for providing optimal care and driving early detection of lung cancer to save more lives.

This program was supported by a medical education grant from AstraZeneca.

Alliance Medical Ministry (AMM) has a patient population that faces an array of social risks (low income, uninsured, language barrier, low health literacy). An interdisciplinary care team of social work, counseling, nursing and primary care providers work in concert with patients to lower barriers to care. Nearly 60% of AMM’s patients only speak Spanish and a large percentage have uncontrolled diabetes. Low health literacy and therapeutic inertia were targeted in this group by creating the Diabetes Care Management model, which allows a social worker and nurse to closely follow patients with uncontrolled diabetes. With frequent contact between the care manager, patient and primary care clinician, patients can gain better glycemic control in a shorter amount of time. The addition of donated continuous glucose monitoring devices provides even more information, to better assist patients with uncontrolled diabetes.

Research has shown that primary care practices embracing a “performance improvement champion” (PIC) model have better health outcomes for patients. Leveraging person-driven outcomes and the use of standardized measurement have been shown to be key factors of this success. Join faculty for a discussion about the PIC model and clinical performance differences between PIC and non-PIC practices, as well as benefits associated with operationalizing person-driven outcomes and standardized measurement.

Join NCQA for a roundtable discussion led by Wendy Talbot and a variety of Data Aggregator Validation program participants for a conversation about program process, value and real-world implications. Speakers will share their motivations for, and the benefits of, moving to this process, along with an overview of their experiences, challenges, lessons learned and more.

Focusing on the health of entire populations is important to the advancement of both medical care and research. The clinical pharmacy team at the Southwest Community Health Center in Butte, Montana, implemented a population health management protocol to identify and provide resources for patients with hypertension and diabetes. The goal is to improve the quality of care, improve outcomes and reduce health care costs these patients. Similar programming could be extrapolated to additional patient populations.

OnDemand

Blue Cross Blue Shield of Massachusetts (Blue Cross) shared the results of a new analysis of racial and ethnic inequities in health care and became the first health plan in Massachusetts to announce it will incorporate equity measures. Join Dr. Mark Friedberg, Senior Vice President, Performance Measurement & Improvement at Blue Cross and Shannon Welch, MPH, Senior Director at Institute for Healthcare Improvement, for an overview of Blue Cross’ plan to address health inequity and racial injustice, results from the recently released Health Equity Report and the launch of a new collaborative intended to assist physicians and hospitals in improving racial inequities in care. The cost of this event is $129. Click here to learn more and register.

Inappropriate antibiotic use is a long-standing public health issue. An estimated 30% of outpatient antibiotic prescriptions are inappropriate. Antibiotic stewardship aims to improve how antibiotics are prescribed by clinicians and used by patients. HEDIS® includes three measures that assess antibiotic prescribing for bronchitis/bronchiolitis, upper respiratory infection and pharyngitis – three conditions that drive significant levels of inappropriate prescribing in the U.S. These measures provide a framework for health plans to use their claims, pharmacy and clinical data to identify, prioritize and monitor antibiotic stewardship efforts.

Subject matter experts will provide an overview and updates on:

• Antibiotic stewardship
• Three HEDIS antibiotic measures
• HEDIS antibiotic measure performance

For HEDIS Measurement Year 2022,  NCQA released the Antibiotic Utilization for Respiratory Conditions measure. The measure can help health plans more closely monitor antibiotic use and assist with stewardship efforts. It tracks antibiotic prescriptions across both appropriate and inappropriate respiratory conditions. Tracking antibiotic prescribing for all respiratory conditions will provide context about a health plan’s overall antibiotic use when viewed with three HEDIS measures of appropriate testing and inappropriate prescribing.

Dr. Eddie Stenehjem, Senior Medical Director of Medical Specialties and past Medical Director of Antimicrobial Stewardship at Intermountain Healthcare, will join NCQA to describe Intermountain’s ambulatory antibiotic stewardship platform and how Intermountain monitors antibiotic utilization to support antibiotic stewardship efforts.

The purpose of this session is to provide an overview of the new HEDIS antibiotic measure and highlight its use in the field. Participants will be able to ask questions of researchers to learn directly from them about their work.

Dr. Sharon Tsay, Medical Officer at the Centers for Disease Control and Prevention, will discuss current research and findings in the field of antibiotic stewardship. She will talk specifically about how the COVID-19 pandemic and recent telehealth trends may be impacting antibiotic prescribing.

Join NCQA for a discussion about the integration of social and behavioral science principles into antibiotic stewardship. Speakers will highlight the impact of social factors on antibiotic prescribing and share practical, evidence based, real-world strategies that address these factors. This session will highlight a novel antibiotic stewardship program to improve clinician communication practices to address patient expectations for antibiotics.

Participants will learn the importance of considering the social and behavioral drivers of antibiotic prescribing in the design and implementation of improvement interventions. They will learn about evidence-based communication strategies clinicians can use to avoid inappropriate antibiotic prescribing and increase satisfaction with care.  Participants will be able to ask live questions about these topics.

Shawn Trivette, Senior Research Associate, NCQA Research & Analysis, will set the stage for this webinar by presenting data on health plan performance on HEDIS® antibiotic measures in Measurement Year 2020. Then, a panel of high-performing health plans will share best practices and lessons learned for improving antibiotic measure performance and antibiotic stewardship in general.

Participants will hear about the importance of antibiotic stewardship, in addition to quality improvement efforts and strategies to improve measure performance, from the perspective of high-performing commercial, Medicare, and Medicaid plans. Participants will have the opportunity to interact with health plan representatives to learn about successes, challenges, best practices and more.

In September 2021, Blue Cross Blue Shield of Massachusetts (Blue Cross) began to publicly share its analyses on racial and ethnic inequities in health care experienced by members, and became the first health plan in the nation to announce it will incorporate equity measures—differences in the quality of care across racial and ethnic groups—into its contracts and payment programs with clinicians who care for Blue Cross members.

In this session, the presenters will give an overview of the methodological challenges to measurement-based efforts to improve health equity, and will explain how BCBSMA has addressed these challenges. Challenges have included collecting self-reported race and ethnicity data directly; assessing the accuracy of race and ethnicity data available from other sources; imputing missing race and ethnicity data and accounting for their measurement properties for reporting and accountability; and designing a pay-for-equity program that meets high validity and reliability standards.

Join this training and learn about the BCBSMA plan to help bridge the gap of systemic health inequity and racial injustice.