During the last week of January, over 3,000 people gathered in Baltimore for the 2019 CMS Quality Conference. Every year, CMS convenes its contractors and stakeholders to explore innovations in health care quality improvement and discuss new strategic directions and priorities. This year, a few key themes emerged around prioritizing cross-cutting issues, a continued commitment to innovation, dedication to data and analytics, and an emphasis on high-cost, high-risk groups.
Focus on Cross-cutting Issues
The attention to cross-cutting subjects like rural populations, health equity, and patient and family engagement suggested a stronger call to recognize important constituencies. A common concern in the quality community is that these are more or less unfunded mandates. Many organizations want to rally around these priorities, but in a crunch it’s all too easy for the focus to go to the numbers and measures. The renewed attention made me wonder if we will see these issues explicitly funded and measured in future contract requirements. I was encouraged to see that CMS staff are on the road taking time to listen to providers and patients. Their input is critical for contractors, too, and it’s the right thing to do.
Commitment to Innovation
Adam Boehler, the new Center for Medicare and Medicaid Innovation director, followed Seema Verma. He spoke about finding and reducing variation, the transition from volume to value, addressing social determinants of health, and focusing on high-risk and costly populations like ESRD. His comments were salient at a time when many quality improvement organizations are working to close the divide between the priorities and direction set five years ago in their federal contracts and a rapidly evolving health care landscape where diverse state-based priorities have taken root and blossomed. As we near the end of our contract, Adam’s talk felt relevant and gave many hope for the next five years of work.
CMMI is in the business of pilots that today only peripherally affect the QIOs. Nevertheless, Adam himself — a former startup CEO who talked about “blowing up” the volume-based payment system — was the signal that resonated most with me. I was left thinking about the power of operating a quality improvement organization more like a product development shop — aware of the literature but not constrained by it and with an agile infrastructure. It could create new solutions in response to customer needs and quickly move on from ineffective strategies, all while maintaining a clear awareness of the big goals. I see a lot of potential in that kind of approach.
Dedication to Data and Analytics
I am a data evangelist. I believe that QIOs have a real and meaningful role to play in advancing the nation’s adoption of HIT and in using data to improve health. But CMS’s session on data and analytics left me — along with many other attendees — confused and conflicted. Where CMS succeeded in other domains in painting a clear picture of the “why” and creating a call to action about the “how,” they levied a surprising amount of tactical advice on the data front. In some sense, the concept of real-time data in itself is a tactic (as opposed to saying: show us how you’re tracking with your progress on your initiatives and demonstrating ROI).
My fear is that the emphasis on real-time data capture and, specifically, portals will lead every QIN-QIO to lean into an approach that will place yet more burden on physician practices (as MCOs, health systems, payers and the government all further fragment the system with calls for reporting using slightly different mechanism and definitions) without delivering commensurate results. This is at a moment when at a national level we’re shifting toward a really positive conversation around interoperability and APIs that offer a lot of promise for scale and burden reduction – though the infrastructure requires time to mature. I applaud the emphasis on outcomes, but also believe this is a time to be cautious about any approach that leads to more burden for providers.
Emphasis on High-cost, High-risk Groups
CMS’s urgency around high-risk, high-cost groups was apparent. For too long, end-stage renal disease — affecting more than 700,000 people in the U.S. — has been relegated as topic for attention by just a segment of the quality community. At this year’s conference, however, the message came through loud and clear that tackling chronic kidney disease is everyone in the community’s challenge to face. Opioids, unsurprisingly, also dominated the conversation. I appreciated Travis Rieder’s clear take, focused on prescribing appropriately, helping patients wean off prescriptions and training the next generation.
This may seem like a lot to take on, but it’s nothing out of the ordinary for quality improvement organizations. We thrive on finding solutions to difficult problems, and these are the kinds of challenges we face every day in our mission to improve the quality of health care delivery and health outcomes. We’re also here because we care. The Quality Conference was a wonderful opportunity to reflect on our work, connect with our peers and refresh our energy and excitement for the new scope of work.