Day 2: May 9, 2018 |
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8:30 AM |
Breakfast for Workgroup Members |
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9:00 AM |
Welcome |
| Harold Pincus, Adult Workgroup Co-Chair
Marissa Schlaifer, Adult Workgroup Co-Chair
Richard Antonelli
Lindsay Cogan
Debjani Mukherjee
Review objectives for joint discussion
Share relevant highlights from previous day
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9:10 AM |
Introductions of Workgroup Members and Disclosures of Interest for the MAP Adult Workgroup Members |
| Elisa Munthali
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9:20 AM |
NQF Medicaid Workgroup Overview |
| Harold Pincus
Miranda Kuwahara, Project Manager, NQF
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9:30 AM |
Key Considerations from CMS |
| Karen Matsuoka, PhD, CMCS Chief Quality Officer and Director, Division of Quality and Health Outcomes
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10:00 AM |
State Medicaid Presentation |
| Jeff Schiff, MD, MBA Medical Director, Minnesota Health Care Programs, Department of Human Services
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10:40 AM |
Break |
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10:55 AM |
Strengthening the Core Sets – Alignment of Measures |
| Richard Antonelli
Debjani Mukherjee
Discuss methodological issues such as alignment (alignment within Medicaid Core Sets and other programs)
Workgroup discussion on issues at state level
Recommendations to HHS/CMS regarding ways to incorporate and promote alignment
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11:30AM |
Issues of Shared Importance: Adult and Child Continuum of Care: Looking at Behavioral Health Measures (Depression) across the Core Sets |
| Lindsay Cogan
Marissa Schlaifer
Shaconna Gorham
Lead Discussant: Harold Pincus
Identify measures to fill gap areas in the Child and Adult Core Sets
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11:30AM |
Measures Recommended for Addition |
| Behavioral health and integration with primary care |
| Measures for Discussion and Voting
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- NQF #0711: Depression Remission at Six Months
- NQF #0710e: Depression Remission at Twelve Months
- NQF #1884: Depression Response at Six Months- Progress Towards Remission
- NQF #1885: Depression Response at Twelve Months- Progress Towards Remission
- NQF #0712e: Depression Utilization of the PHQ-9 Tool
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12:30 PM |
Opportunity for Public Comment |
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12:40 PM |
Continue Issues of Shared Importance: Adult and Child Continuum of Care: Looking at Behavioral Health Measures (Depression) across the Core Sets |
| Lindsay Cogan
Shaconna Gorham
Vote on recommendations regarding inclusion of measures in Child Core Set, if any, and relative priority for addition based on previous discussion
Rank measures selected for potential recommendation for addition to and removal from the Child Core Set
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1:00 PM |
Lunch and Medicaid Child Workgroup Dismissal |
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1:30 PM |
Continue Issues of Shared Importance: Adult and Child Continuum of Care: Looking at Behavioral Health Measures (Depression) across the Core Sets |
| Marissa Schlaifer
Shaconna Gorham
Vote on recommendations regarding inclusion of measures in Adult Core Set, if any
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2:00 PM |
Overview of Meeting Materials and Key Points from Staff Review of Adult Core Set |
| Miranda Kuwahara
Charge of the Medicaid Adult Workgroup
Core set measure updates (maintenance, loss of endorsement, new endorsement)
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2:30PM |
Measure-Specific Recommendations on Strengthening the Adult Core Set |
| Harold Pincus
Shaconna Gorham
Lead Discussant: Julia Logan
What do we know about states’ uptake of measures?
What do we know about states’ performance on measures?
Review measures with low uptake
Feasibility of states collecting and reporting the measure
Discuss potential measure removals
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2:30PM |
Measures Recommended for Removal |
| Care of Acute and Chronic Conditions Domain |
| Measures for Discussion and Voting
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- NQF #0275: Chronic Obstructive Pulmonary Disease (COPD) or Asthma in Older Adults Admission Rate (PQI 05)
- Description: Admissions with a principal diagnosis of chronic obstructive pulmonary disease (COPD) or asthma per 1,000 population, ages 40 years and older. Excludes obstetric admissions and transfers from other institutions.[NOTE: The software provides the rate per population. However, common practice reports the measure as per 100,000 population. The user must multiply the rate obtained from the software by 100,000 to report admissions per 100,000 population.] (Measure Specifications)
- NQF #0277: Congestive Heart Failure Rate (PQI 08)
- Description: Admissions with a principal diagnosis of heart failure per 100,000 population, ages 18 years and older. Excludes cardiac procedure admissions, obstetric admissions, and transfers from other institutions.[NOTE: The software provides the rate per population. However, common practice reports the measure as per 100,000 population. The user must multiply the rate obtained from the software by 100,000 to report admissions per 100,000 population.] (Measure Specifications)
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3:15 PM |
Opportunity for Public Comment and Break |
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3:35 PM |
Continue Measure-Specific Recommendations on Strengthening the Adult Core Set |
| Harold Pincus
Shaconna Gorham
Vote on recommendations regarding removal of measures from Adult Core Set, if any
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4:00 PM |
Measure-Specific Recommendations on Strengthening the Adult Core Set |
| Marissa Schlaifer
Shaconna Gorham
Lead Discussants: Kim Elliott, Lisa Patton, Harold Pincus, Diana Jolles
Review and select measures to fill gap areas
Discuss potential recommendations regarding measure additions
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4:00 PM |
Measures Recommended for Addition |
| Behavioral health and integration with primary care |
| Measures for Discussion and Voting
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- NQF #0104e: Adult Major Depressive Disorder (MDD): Suicide Risk Assessment
- NQF #0028: Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
- NQF #2152: Preventive Care and Screening: Unhealthy Alcohol Use: Screening & Brief Counseling
- Description: Percentage of patients aged 18 years and older who were screened for unhealthy alcohol use using a systematic screening method at least once within the last 24 months AND who received brief counseling if identified as an unhealthy alcohol user (Measure Specifications; Summary of NQF Staff Preliminary Analysis)
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4:00 PM |
Measures Recommended for Addition |
| Patient Experience of Care |
| Measures for Discussion and Voting
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- NQF #0726: Patient Experience of Psychiatric Care as Measured by the Inpatient Consumer Survey (ICS)
- Description: The Patient Experience of Psychiatric Care as Measure by the Inpatient Consumer Survey (ICS) was developed to gather patient's evaluation of their inpatient psychiatric care. The survey is composed of the following six individual measures or domains: Measure #1: Outcome of care- The receipt of mental healthcare services should enable patients to effectively deal with their illness and with social situations. Patient's report of the effectiveness of the organization in enabling this improvement is an important dimension of the quality of care of the organization. The following questions of the ICS pertain to the Outcome of care domain: Q1.I am able to deal with crisis.; Q2. My symptoms are not bothering me as much.; Q4. I do better in social situations.; and Q5. I deal more effectively with daily problems.Measure #2: Dignity- The provision of mental healthcare services should be in an atmosphere where patients feel respected and treated with dignity. Patient's report of the effectiveness of the organization in providing this respectful exchange is an important dimension of the quality of care of the organization. The following questions of the ICS pertain to the Dignity domain: Q6. I was treated with dignity and respect.; Q7. Staff here believe that I can grow, change and recover.; Q8. I felt comfortable asking questions about my treatment and medications.; and Q9. I was encouraged to use self-help/support groups. Measure #3: Rights- The provision of mental healthcare services should be in an atmosphere where patients feel that they can express disapproval with conditions or treatment and receive an appropriate response from the organization. Patient's report of the effectiveness of the organization in providing this respectful exchange is an important dimension of the quality of care of the organization. The following questions of the ICS pertain to the Rights domain: Q13. I felt free to complain without fear of retaliation.; Q14. I felt safe to refuse medication or treatment during my hospital stay.; and Q15. My complaints and grievances were addressed.Measure #4: Participation in treatment- Patient's involvement in the treatment process and the coordination of discharge planning with their doctors or therapist from the community are enabling activities that strengthen patient's ability to care for themselves. Patient's report of the effectiveness of the organization in supporting this level of involvement is an important dimension of the quality of care of the organization. The following questions of the ICS pertain to the Participation in treatment domain: Q16. I participated in planning my discharge.; Q17. Both I and my doctor or therapist from the community were actively involved in my hospital treatment plan.; and Q18. I had the opportunity to talk with my doctor or therapist from the community prior to discharge.Measure #5: Hospital environment - The provision of mental healthcare services should be in an environment conducive to patients feeling safe and enabling patients to focus on recovering from their illness. The following questions of the ICS pertain to the Hospital environment domain: Q19. The surroundings and atmosphere at the hospital helped me get better.; Q20. I felt I had enough privacy in the hospital.; Q21. I felt safe while in the hospital.; and Q22. The hospital environment was clean and comfortable. Measure #6: Empowerment - The provision of mental healthcare services should be in an atmosphere where patients feel that they, interactively with their doctors and therapist, learn more about their illness and about their treatment options and are encouraged to determine their best plan to recovery. Patient's report of the effectiveness of the organization in enabling this respectful, compassionate, and supportable encounter among patients and healthcare professionals is an important dimension of the quality of care of the organization. The following questions pertain to the Hospital empowerment domain: Q25. I had a choice of treatment options.; Q26. My contact with my doctor was helpful.; and, Q27. My contact with nurses and therapist was helpful.Question 28, ""If I had a choice of hospitals, I would still choose this one"", is considered as the anchor item utilized to measure overall satisfaction with the mental healthcare service received. This question does not pertain to any of the six measures/domains of the ICS.Each measure is scored as the percentage of patients (adolescents aged 13-17 and adults aged 18 and older) at time of discharge or at annual review who respond positively to the domain on the survey for a given month. Survey questions are based on a standard 5-point Likert scale, evaluated on a scale from strongly disagree to strongly agree.As a note, the words domain and measure are used interchangeably during the application. (Measure Specifications; Summary of NQF Staff Preliminary Analysis)
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4:30 PM |
Opportunity for Public Comment |
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4:40 PM |
Continue Measure-Specific Recommendations on Strengthening the Adult Core Set |
| Marissa Schlaifer
Shaconna Gorham
Lead Discussants: Kim Elliott, Lisa Patton, Harold Pincus, Diana Jolles
Vote on recommendations regarding inclusion of measures in Adult Core Set, if any
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5:00 PM |
Summarize Progress and Adjourn for the Day |
| Harold Pincus
Marissa Schlaifer
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Day 3: May 10, 2018 |
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8:00 AM |
Breakfast for Workgroup Members |
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8:30 AM |
Welcome |
| Harold Pincus
Marissa Schlaifer
Debjani Mukherjee
- Review the day’s objectives
- Share relevant highlights from previous day
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8:40 AM |
CMS Presentation |
| Kirsten Beronio, JD, Senior Policy Advisor on Behavioral Health Care
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8:55 AM |
State Medicaid Presentation |
| David Kelley, MD, MPA Chief Medical Officer, Office of Medical Assistance Programs, Pennsylvania Department of Human Services
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9:35 AM |
Break |
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9:50 AM |
Measure-Specific Recommendations on Strengthening the Adult Core Set |
| Marissa Schlaifer
Shaconna Gorham
Lead Discussants: Kim Elliott, Lisa Patton, Janice Tufte, Diana Jolles, Harold Pincus, and Marissa Schlaifer
- Review and select measures to fill gap areas
- Discuss potential measure recommendations for addition to the Adult Core Set
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9:50 AM |
Measures Recommended for Addition |
| Behavioral health and integration with primary care |
| Measures for Discussion and Voting
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- NQF #1934: Diabetes Monitoring for People With Diabetes and Schizophrenia (SMD)
- NQF #1927: Cardiovascular Health Screening for People With Schizophrenia or Bipolar Disorder Who Are Prescribed Antipsychotic Medications
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9:50 AM |
Measures Recommended for Addition |
| New chronic opiate use (45 days) |
| Measures for Discussion and Voting
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- NQF #3175: Continuity of Pharmacotherapy for OUD
- NQF #2950: Use of Opioids from Multiple Providers in Persons Without Cancer
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9:50 AM |
Measures Recommended for Addition |
| Treatment outcomes for behavioral health conditions and substance use disorders |
| Measures for Discussion and Voting
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- NQF #2600: Tobacco Use Screening and Follow-up for People with Serious Mental Illness or Alcohol or Other Drug Dependence
- Description: The percentage of patients 18 years and older with a serious mental illness or alcohol or other drug dependence who received a screening for tobacco use and follow-up for those identified as a current tobacco user. Two rates are reported.Rate 1: The percentage of patients 18 years and older with a diagnosis of serious mental illness who received a screening for tobacco use and follow-up for those identified as a current tobacco user.Rate 2: The percentage of adults 18 years and older with a diagnosis of alcohol or other drug dependence who received a screening for tobacco use and follow-up for those identified as a current tobacco user.Note: The proposed health plan measure is adapted from an existing provider-level measure for the general population (Preventive Care & Screening: Tobacco Use: Screening & Cessation Intervention NQF #0028). This measure is currently stewarded by the AMA-PCPI and used in the Physician Quality Reporting System. (Measure Specifications; Summary of NQF Staff Preliminary Analysis)
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12:20 PM |
Opportunity for Public Comment |
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12:30 PM |
Lunch |
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1:00 PM |
Continue Measure-Specific Recommendations on Strengthening the Adult Core Set |
| Harold Pincus
Shaconna Gorham
Lead Discussants: Kim Elliott, Lisa Patton, Janice Tufte, Diana Jolles, Harold Pincus, and Marissa Schlaifer
- Review and select measures to fill gap areas
- Discuss potential measure recommendations for addition to the Adult Core Set
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1:00 PM |
Measures Recommended for Addition |
| Promotion of Wellness |
| Measures for Discussion and Voting
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- NQF #0421: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
- Description: Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous six months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous six months of the encounter Normal Parameters:Age 65 years and older BMI >= 23 and < 30 kg/m2Age 18–64 years BMI >= 18.5 and < 25 kg/m2" (Measure Specifications; Summary of NQF Staff Preliminary Analysis)
- NQF #0541: Proportion of Days Covered (PDC): 3 Rates by Therapeutic Category: Renin Angiotensin System (RAS) Antagonists, Diabetes Medications, Statins
- Description: The percentage of patients 18 years and older who met the proportion of days covered (PDC) threshold of 80% during the measurement year. A performance rate is calculated separately for the following medication categories: Renin Angiotensin System (RAS) Antagonists, Diabetes Medications, Statins.A higher score indicates better quality. (Measure Specifications; Summary of NQF Staff Preliminary Analysis)
- Treatment of Chronic Hepatitis C: Completion of Therapy
- Description: The percentage of individuals 18 years and older who initiated antiviral therapy during the measurement year for treatment of chronic Hepatitis C, and who completed the minimum intended duration of therapy with no significant gap(s) in therapy. (A higher rate indicates better performance.) (Measure Specifications; Summary of NQF Staff Preliminary Analysis)
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1:00 PM |
Measures Recommended for Addition |
| Beneficiary-reported outcomes |
| Measures for Discussion and Voting
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- NQF #2967: CAHPS® Home and Community Based Services (HCBS) Measures
- Description: CAHPS Home- and Community-Based Services measures derive from a cross disability survey to elicit feedback from adult Medicaid beneficiaries receiving home and community based services (HCBS) about the quality of the long-term services and supports they receive in the community and delivered to them under the auspices of a state Medicaid HCBS program. The unit of analysis is the Medicaid HCBS program, and the accountable entity is the operating entity responsible for managing and overseeing a specific HCBS program within a given state. (For additional information on the accountable entity, see Measures Testing form item #1.5 below.)The measures consist of seven scale measures, 6 global rating and recommendation measures, and 6 individual measures:Scale Measures 1. Staff are reliable and helpful –top-box score composed of 6 survey items 2. Staff listen and communicate well –top-box score composed of 11 survey items 3. Case manager is helpful - top-box score composed of 3 survey items 4. Choosing the services that matter to you - top-box score composed of 2 survey items5. Transportation to medical appointments - top-box score composed of 3 survey items6. Personal safety and respect - top-box score composed of 3 survey items7. Planning your time and activities top-box score composed of 6 survey itemsGlobal Ratings Measures8. Global rating of personal assistance and behavioral health staff- top-box score on a 0-10 scale 9. Global rating of homemaker- top-box score on a 0-10 scale10. Global rating of case manager- top-box score on a 0-10 scaleRecommendations Measures11. Would recommend personal assistance/behavioral health staff to family and friends – top-box score on a 1-4 scale (Definitely no, Probably no, Probably yes, Definitely yes)12. Would recommend homemaker to family and friends –– top-box score on a 1-4 scale (Definitely no, Probably no, Probably yes, Definitely yes)13. Would recommend case manager to family and friends– top-box score on a 1-4 scale (Definitely no, Probably no, Probably yes, Definitely yes)Unmet Needs Measures14. Unmet need in dressing/bathing due to lack of help–top-box score on a Yes, No scale15. Unmet need in meal preparation/eating due to lack of help– top-box score on a Yes, No scale16. Unmet need in medication administration due to lack of help– top-box score on a Yes, No scale 17. Unmet need in toileting due to lack of help– top-box score on a Yes, No scale 18. Unmet need with household tasks due to lack of help– top-box score on a Yes, No scale Physical Safety Measure19. Hit or hurt by staff – top-box score on a Yes, No scale (Measure Specifications; Summary of NQF Staff Preliminary Analysis)
- NQF #1892: Individual engagement measure derived from the individual engagement domain of the C-CAT
- NQF #2483: Gains in Patient Activation (PAM) Scores at 12 Months
- Description: The Patient Activation Measure® (PAM®) is a 10 or 13 item questionnaire that assesses an individual´s knowledge, skill and confidence for managing their health and health care. The measure assesses individuals on a 0-100 scale. There are 4 levels of activation, from low (1) to high (4). The measure is not disease specific, but has been successfully used with a wide variety of chronic conditions, as well as with people with no conditions. The performance score would be the change in score from the baseline measurement to follow-up measurement, or the change in activation score over time for the eligible patients associated with the accountable unit.The outcome of interest is the patient’s ability to self-manage. High quality care should result in gains in ability to self-manage for most chronic disease patients. The outcome measured is a change in activation over time. The change score would indicate a change in the patient´s knowledge, skills, and confidence for self-management. A positive change would mean the patient is gaining in their ability to manage their health. A “passing” score for eligible patients would be to show an average net 3-point PAM score increase in a 6-12 month period. An “excellent” score for eligible patients would be to show an average net 6-point PAM score increase in a 6-12 month period." (Measure Specifications; Summary of NQF Staff Preliminary Analysis)
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1:00 PM |
Measures Recommended for Addition |
| Patient Experience of Care |
| Measures for Discussion and Voting
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- NQF #0008: Experience of Care and Health Outcomes (ECHO) Survey
- Description: The ECHO is a survey that includes 5 multiple item measures and 12 single item measures:Multiple Item Measures:Getting treatment quickly-Get treatment as soon as wanted when it was needed right away-Get appointments as soon as wanted-Get professional help by telephoneHow well clinicians communicate-Clinicians listen carefully-Clinicians explain things in an understandable way-Clinicians show respect-Clinicians spend enough time-Feel safe with clinicians-Patient involved as much as wanted in treatmentPerceived improvement-Compare ability to deal with daily problems to 1 year ago-Compare ability to deal with social situations to 1 year ago-Compare ability to accomplish things to 1 year ago-Compare ability to deal with symptoms or problems to 1 year agoGetting treatment and information from the plan-Getting new clinician-Delays in treatment while wait for plan approval-Getting necessary treatment -Understanding information about treatment in booklets or on the web-Getting help when calling customer service-Filling out paperworkInformed about treatment options-Told about self-help or consumer run programs-Told about different treatments that are available for conditionSingle Item Measures:-Overall rating of counseling and treatment (MCO and MBHO)-Overall rating of the health plan (MCO only)-Wait more than 15 minutes past appointment time to see clinician-Told about medication side effects -Talk about including family & friends in treatment-Given as much information as wanted about how to manage condition-Given information about rights as a patient-Patient feels that he or she could refuse a specific type of treatment-Was information revealed that should have been kept private-Cultural competence -Care responsive to language, race, religious, ethnic -Amount helped by treatment-Plan provides information about how to get treatment after benefits used upThe measures are based on reports of care experiences over the previous six months from adult (18 years of age or older) patients receiving behavioral health care (mental health and substance abuse treatment) and the organization that provides or manages their treatment and health outcomes. Each measure score is the mean of the responses to the survey questions from patients receiving care at a particular health plan or managed behavioral health organization More detail can be found at: http://www.ahrq.gov/cahps/surveys-guidance/echo/about/survey-measures.html" (Measure Specifications; Summary of NQF Staff Preliminary Analysis)
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1:00 PM |
Measures Recommended for Addition |
| Promotion of Wellness |
| Measures for Discussion and Voting
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- NQF #0061: Comprehensive Diabetes Care: Blood Pressure Control (<140/90 mm Hg)
- NQF #0055: Comprehensive Diabetes Care: Eye Exam (retinal) performed
- NQF #0575: Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Control (<8.0%)
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1:00 PM |
Measures Recommended for Addition |
| Workforce |
| Measures for Discussion and Voting
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- NQF #1888: Workforce development measure derived from workforce development domain of the C-CAT
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1:00 PM |
Measures Recommended for Addition |
| Polypharmacy |
| Measures for Discussion and Voting
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- NQF #0097: Medication Reconciliation
- Description: The percentage of discharges for patients 18 years of age and older for whom the discharge medication list was reconciled with the current medication list in the outpatient medical record by a prescribing practitioner, clinical pharmacist or registered nurse. (Measure Specifications; Summary of NQF Staff Preliminary Analysis)
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1:00 PM |
Measures Recommended for Addition |
| Care Coordination |
| Measures for Discussion and Voting
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- NQF #0326: Advance Care Plan
- Description: Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record or documentation in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan. (Measure Specifications; Summary of NQF Staff Preliminary Analysis)
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2:30 PM |
Opportunity for Public Comment and Break |
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2:40 PM |
Continue Measure-Specific Recommendations on Strengthening the Adult Core Set |
| Harold Pincus
Shaconna Gorham
Lead Discussants: Kim Elliott, Lisa Patton, Janice Tufte, Diana Jolles, Harold Pincus, and Marissa Schlaifer
- Vote on recommendations regarding inclusion of measures to the Adult Core Set, if any
- Rank measures selected for potential recommendation for addition to and removal from the Adult Core Set
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3:00 PM |
Promising Tools for Future Measure Development |
| Marissa Schlaifer
Debjani Mukherjee
Lead Discussants: Clarke Ross and David Hughes
- Personal Outcomes Measures
- National Core Indicators
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3:10 PM |
Prioritizing Remaining Measure Gap Areas |
| Harold Pincus
Debjani Mukherjee
- Set the stage for gaps review and/or guidance on development efforts
- Future opportunities to fill gap areas such as measure concepts
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3:50 PM |
Opportunity for Public Comment |
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4:00 PM |
Summarize Next Steps and Adjourn Meeting |
| Harold Pincus
Marissa Schlaifer
Debjani Mukherjee
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