Advancing Quality
in Women’s Health
Sarah Hudson Scholle, MPH, DrPH
Assistant Vice President, Research
June 25, 2010
Agenda
• NCQA
• Policy
P li Opportunities
O
t iti
• Measurement Priorities
– Pregnancy Care
– Well Woman Care
• Issues & Future Directions
Penn State
May 3, 2010
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NCQA: A Brief Introduction
• Private, independent
p
non-profit
p
health care quality oversight
organization founded in 1990
• Committed to measurement,,
transparency and accountability
• Unites diverse groups around common
goal: improving
g
p
g health care q
quality
y
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May 3, 2010
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Quality in Health Care Reform
• Health Insurance Exchanges
– Covers 32 Million More Nonelderly People
– Accreditation and pay for performance requirements
• Establish a national strategy for quality
improvement by 2011
– Create benchmarks and report
– Align public and private payers
• Delivery system reform
– Medical home
– Accountable care organizations
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May 3, 2010
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New Policy Directions
• Child Health Insurance Program
R
Reauthorization
th i ti
Act
A t
– encourages
g state q
quality
y reporting
p
g and new
measure development, including pregnancy
care
• American Recovery and Reinvestment
Act (ARRA) legislation
– authorizes payment for meaningful use of EHR
( d th
(and
then penalties)
lti )
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May 3, 2010
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Proposed CHIPRA Core Measures:
Women & Adolescents
• Adolescent Well Visits
• Adolescent Immunizations
• BMI Documentation
• Chlamydia Screening
• Timeliness of Prenatal Care
• Frequency of Ongoing Prenatal Care
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May 3, 2010
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Proposed Meaningful Use Measures
OB-GYNs



Prevention

 Screening Mammography
 Body Mass Index (BMI)
 Cervical Cancer Screening
 Chlamydia screening
 Prenatal Screening for Human
Immunodeficiency Virus (HIV).
 Prenatal Anti-D Immune

Globulin.
Overuse
 Hysterectomy
y
y rates
 Cesarean Rate for low-risk
first birth women
Safety

 30 Readmission Rate
following deliveries
Primary Care (Examples)
Prevention
o Inquiry Regarding Tobacco Use
o Body Mass Index (BMI)Screening and Follow-Up
o Cervical Cancer Screening
o Screening Mammography
o Colorectal Cancer
o Influenza Immunization for Patients >= 50 Years
Chronic Care
o Controlling High Blood Pressure.
o Diabetes: Hemoglobin A1c Poor Control
o Ischemic Vascular Disease: Complete
p
Lipid
p Profile, Low
Density Lipoprotein (LDL-C) Control,
o Depression: Effective Acute Phase Treatment
Overuse
o Low back pain: use of imaging studies.
o Appropriate Testing for Children with Pharyngitis
o Use of appropriate meds for people with asthma.
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May 3, 2010
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Priorities for Women’s Health
• Patient and Family
Engagement, to provide
patient-centered,
i
effective
ff
i
care
• Build on influence women
have on the well-being and
health care decision-making
ii
i
of women/families
• Population Health, to bring
greater focus on wellness
and prevention starting in our
communities
• Examine the content of care of
age/life-stage appropriate
preventive care rather than
counting up visits
• Care Coordination, to
provide patient-centered,
high-value care
• Address women’s use of
multiple providers for genderspecific and gender-neutral
needs
• Overuse, to remove waste,
encourage appropriate use,
and achieve effective,,
affordable care
• Assess overuse of tests and
procedures,, both for maternity
p
y
care and other services
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May 3, 2010
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Improving Quality Measurement
for Women’s
Women s Preventive Care Project
• Phase 1: Convene working meeting to
prioritize measurement opportunities
–
Supported by CDC and HRSA
(Completed in December 2009)
• Phase 2: Develop and test measures
–
PCPI/NCQA/ACOG joint work group on
pregnancy care measures
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May 3, 2010
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Key Areas of Concern
• Identification and management of health
risks
i k
• Coordination of care across settings and
time
• Patient
P ti t Engagement
E
t
• Overuse
• Outcomes
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May 3, 2010
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Measurement Opportunities: Well Woman
Identification and 1. Screening
management of
• Cancer
health risks
• STDs
2. BMI Assessment & Follow-up
3. Behavioral Health Risk Assessment & Follow-up
p
/
/ p g with change
g
• Depression/stress/coping
• Substance abuse and tobacco use
4. Reproductive health
• Family/reproductive life plan
• Pregnancy readiness)
Coordination
1. Coordination for chronic disease
Patient
Engagement
1. Decision support/shared decision-making
1
decision making
2. Patient access to own records
3. Health literacy
O
Overuse
N proposed
No
d measure
Outcomes
No proposed measure
Penn State
May 3, 2010
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Measurement Opportunities: Prenatal Care
Identification and 1. Prenatal testing & treatment
management of
• HIV
health risks
• RH
• Genetic
• Gestational diabetes
p
2. BMI Assessment & Follow-up
3. Behavioral Health Risk Assessment & Follow-up
• Depression/stress/coping with change
• Substance abuse and tobacco use
Coordination
1. Planning and Care Coordination
• Breastfeeding plans
• Family planning
• Pediatric care
Patient
Engagement
1. Decision support/shared decision-making
Overuse
No proposed measure
Outcomes
pp p
Weight
g Gain
1. Appropriate
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May 3, 2010
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Measurement Opportunities: Labor & Delivery
Identification and 1. Appropriate Medication During Management of Premanagement of
term Labor
health risks
2. Delivery at site with appropriate level of care
available
3. Prophylactic Antibiotic prior to Cesarean delivery
Coordination
Patient
Engagement
1 Prenatal record available at labor and delivery
1.
No proposed measure
Overuse
1. Elective Delivery Before 39 Weeks
2. Episiotomy
3. Cesarean delivery
y for low-risk women
Outcomes
1. Incidence of potentially preventable maternal or
fetal serious adverse events during delivery
2. Normal childbirth
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May 3, 2010
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Measurement Opportunities: Postpartum
Identification and 1. Breastfeeding
management of
2. Family planning/reproductive life plan
health risks
3. Behavioral Health Risk Assessment & Follow
Follow-up
up
• Depression/stress/coping with change
• Tobacco use
Coordination
1. Planning and Care-coordination
• Follow up of risks identified in pregnancy
• Hand-off for chronic disease management
g
Patient
Engagement
No proposed measure
Overuse
No proposed measure
Outcomes
No proposed measure
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May 3, 2010
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Barriers to Improved Quality
• Patient engagement
– Common
C
definition
d fi iti
off “
“wellll woman””
– Views about what is a “healthy normal” birth
• Silos in health care system
– Lack of service integration
– Challenge of linking data
• System issues
– Liability reform
– Reimbursement
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May 3, 2010
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Medical Home
• Model of care that provides patientcentered,
t
d comprehensive,
h
i
accessible,
ibl
and coordinated care and a systemsbased approach to quality and safety
• First articulated in pediatrics in 1960s
• Joint Principles adopted by primary care
physician groups in 2008
• NCQA
NCQA’ss PCMH tool is most widely used in
demonstration programs with payment
reform
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May 3, 2010
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PCMH 2011 Overview (6 standards/24 elements)
1
1.
Access and Continuity
A.
B.
C
C.
D.
E.
F.
Access During Office Hours
Access After Hours
Electronic Access
Continuity (with provider)
Patient/Family Partnership
Culturally/Linguistically Appropriate
Services
G. Practice Organization
2.
Self Management Support
Self-Management
A. Self-Care Process
5.
Track/Coordinate Care
A. Test Tracking and Follow
A
Follow-Up
Up
B. Referral Tracking and Follow-Up
C. Coordination with Facilities/Care
Transitions
D. Referrals to Community Resources
6. Performance Measurement
Identify/Manage Patient Populations
/Quality Improvement
A.
B.
C.
D
D.
3.
4
4.
Basic
i Data
t
Searchable Clinical Data
Comprehensive Health Assessment
Using Data for Population Management
Plan/Manage Care
A.
B
B.
C.
D.
Guidelines for Important Conditions
Care Management
Medication Management
Electronic Prescribing
A.
B.
C.
D.
E.
Measures of Performance
Patient/Family Experience
Reporting Performance
Quality
i Improvement
Electronic Reporting
Optional Patient Experiences
Optional Performance Measurement
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May 3, 2010
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PCMH and Women’s Health
• ACOG: “women’s health homes”
• Ob/gyns are seeking PCMH designation
• NCQA
NCQA’ss tool is silent on specialty
– Open for public comment through Monday
6/28 5pm
5
Eastern
E t
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May 3, 2010
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Issues
• Leadership
• Consumer demand
• Evidence
E id
base
b
• Feasibility
y
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May 3, 2010
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For more information:
Sarah Hudson Scholle,
Scholle MPH
MPH, DrPH
scholle@ncqa.org
202 955 1726
www.ncqa.org
Penn State
May 3, 2010
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