Top Takeaways from ASH: Improved quality measures, new collaboration key to success in value-based models

A special symposium on quality at the ASH Annual Meeting and Exposition offered hematologists new insight on meaningful measures and accountability, as well as how their practices stand to be affected by value-based reforms and their personal roles in the process.

Presentations on the evolution of quality reporting and remuneration, along with the evidence for pay-for-performance models of care, left attendees considering the importance of improved data collection and understanding the rapidly-changing payment environment.

Quality measures and reporting

The worth of quality measures rests in whether the information being gleaned can show opportunities for progress, according to presenter Helen Burstin, MD, MPH, chief scientific officer of the non-profit National Quality Forum in Washington, DC.

Helen Burstin

“We’re looking at what practicing hematologists would get back and actually want to benchmark against each other and use to drive improvement, and how we go beyond some of what might at this point feel like things we measure because they’re measurable,” Burstin told HemOnc Today.

She highlighted the role of gathering patient-reported outcomes, including symptoms and function, is an important part of building hematologic care.

“Increasingly, we’re going to be looking more at care that is longitudinal across a patient episode,” Burstin said. “That would logically move us toward outcome measures, rather than some of the process measures we tend to check now.”

Referring to comments by Lemeneh Tefera, MD, MSc, of the Center for Clinical Standards & Quality at the Centers for Medicare and Medicaid Services, Burstin emphasized that arriving at measures reflective of what patients and clinicians care about is a “tall order.”

She also noted the utility of clinical registries, such as those by both ASH and ASCO, in leveraging electronic health records to incorporate key data needed to drive outcomes measurement going forward — not just for patients but more broadly.

“There are some really important issues around appropriateness of treatments, survival for some of the hematologic malignancies and cross-cutting areas where we need more measurement and sharing — like care coordination and safety,” she said.

As the community moves toward value-based payment models, Burstin emphasized the need for clinicians to consider the costs associated with care and how the numbers are incorporated with measures in a meaningful way, as well as offer feedback.

“Quality measurement is a means to an end — it is not the end in itself,” she said. “A really important piece of this is hearing from practicing hematologists and getting their perspectives on what they are currently being held accountable for.”

Shifts in remuneration

This collection of new data around quality and performance measures is the foundation for CMS’s push for value-based payment reforms, according to presenter Andrew Ryan, PhD, associate professor, School of Public Health, University of Michigan, Ann Arbor.

Andrew Ryan

“The whole concept behind alternative payment models is that our system for a long time has been uncoordinated — that patients receive care from lots of difference physicians but no one’s in charge and no one’s accountable,” Ryan told HemOnc Today.

The dearth of responsibility in this fee-for-service payment model lends to lack of regard for costs and quality outcomes, he noted.

“The idea of these new alternative payment models is to say that someone — some group of physicians, the accountable unit, the accountable care organization — is responsible for a defined group of patients.”

Although the evidence for whether the programs work is “not that strong,” Ryan said the efforts are already rolling out and stand to affect hematologists in a variety of ways.

“They have the potential to change payment rates for hematologists, particularly when the legislation starts to take effect in 2019,” he said. “They could really encourage different organizational arrangements.”

Physicians will have an option, Ryan explained, of being subject to payment adjustments based on their performance on quality and cost measures or opting into an alternative payment model and “being paid more advantageously.”

He agreed that it is essential for hematologists to be involved and highlighted the new legislation will comprise new incentives for specialists to engage with these models.

“It might mean developing new relationships with different types of systems. It might mean developing new health information technology to better coordinate care. It might mean developing different contracting arrangements.”

Ryan underscored physicians need to create new forms of collaboration and management of patients across clinical and organizational settings to “thrive” under the new payment models.

It is yet to be determined what types of involvement will be most advantageous for clinicians and patients with “a lot of potential moving parts,” he said.

But with the developments in the diagnosis and treatment of blood diseases “vastly exceeding” the quality performance measurements today, Ryan said the need for continued improvement is clear.

“It speaks to the importance of developing and using quality measures that are reflective of the state-of-the-art and encourage best practice and further advancements — rather than ensuring that the lowest common denominator care is delivered. Quality measurement should never be a barrier to further progress.” – by Allegra Tiver

Reference: Exploring the Promise and the Pitfalls of Quality Measures and Pay-for-Performance. Presented at: ASH Annual Meeting and Exposition; Dec. 5-8, 2015; Orlando, Fla.

Disclosures: Burstin and Ryan report no relevant financial disclosures.