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NCQA Selects Payer for Patient-Reported Outcomes Measures Project

NCQA has selected the first payer to participate in its patient-reported outcomes measures demonstration project.

patient-reported outcomes measures PROMs

Source: Thinkstock

By Sara Heath

- The National Committee for Quality Assurance (NCQA) is putting $2.1 million behind a demonstration project that explores best practices for integrated patient-reported outcomes measures (PROMs) into clinical quality measures.

The project, the Person-Driven Outcome Measurement demonstration, will specifically look at how different healthcare organizations or payers can implement PROMs as an assessment of clinical quality.

PROMs are patient assessments of how a certain treatment or procedure improved the patient’s life. PROMs look at a patient’s ability to carry groceries into the house or walk a few blocks, for example. These measures are important for looking at patient function and quality of life after care, as well as other functional status indicators that determine whether at treatment was truly effective.

Additionally, PROMs are useful because they take a patient-centered approach and look at factors that are important to patients.

The Community Health Plan of Washington (CHPW) has been selected as one of the first payers to implement PROMs as a clinical quality measure. The payer, which serves as the state of Washington’s only non-profit health plan offering managed care to Apple Health and Medicare beneficiaries, will launch the demonstration project to determine PROMs best practices.

READ MORE: Revamping Patient-Reported Outcomes for Medicare Advantage Plans

Specifically, CHPW will look into different strategies that organizations can use to collect PROMs. Currently, most healthcare experts agree that PROMs are useful and present a key window into the patient experience. However, very few organizations are using PROMs because they don’t know how to collect the data.

The CHPW work, alongside eventual participation from three other payers, aims to overcome that knowledge barrier.

Using NCQA frameworks, CHPW will look at the importance, reliability, validity, and usability of certain PROMs and quality measures. The payer anticipates more than 200 of its members in Washington to participate in its demonstration, yielding a breadth of information about clinical quality and patient preference.

“Existing care measures often may not accurately reflect what is most important to people, particularly adults with complex care needs and we hope to change that,” Erin Giovannetti, Senior Research Scientist at the NCQA, said in a statement. “Community Health Plan of Washington brings a unique approach and we look forward to the findings from this project.”

The demonstration project is more than just an opportunity to gain better clinical quality measures, although that goal is important, representatives from CHPW suggested. The project will also help empower the payer’s beneficiaries, allowing them to reflect on their care and their functional status following the conclusion of treatment.

READ MORE: Overcoming the Top Patient-Reported Outcomes Measures Challenges

“Traditional care management may not proactively consider a member’s life and social determinant factors and priorities, but those factors can have a significant impact on that person’s health and overall life stability,” said Patty Jones, Chief of Health Services at CHPW. “We’re enthused to be part of this pilot and test these approaches to developing person-driven care outcomes. This approach is at the core of our mission and the pilot focuses on the vulnerable and complex populations that we work with every day.”

The demonstration project will take place at different facilities throughout Washington. An NCQA representative and an expert from CHPW will be in charge of coordinating logistics among the three participating facilities, HealthPoint, Yakima Neighborhood Health Services, and the Southwest Area Agency on Aging and Disabilities of Southwest Washington.

As noted above, the $2.1 million from NCQA will be split among four healthcare groups, including CHPW. These groups will offer a representative view of healthcare, patient outcomes, and data collection needs. Ideally, this will help NCQA develop strategies for implementing PROMs collection.

NCQA developed the program in partnership with The John A. Hartford Foundation and the SCAN Foundation.

Medical experts generally agree that PROMs provide important insight into the patient experience and outcomes of care. However, few providers and payers use PROMs to assess clinical quality.

READ MORE: Using Patient-Reported Outcomes Measures to Improve Engagement

A 2016 Health Catalyst survey found that only about one-fifth of hospitals use PROMs to better understand patient health. Those who do not use PROMs largely do not because they don’t have the technology to support data collection or are unsure of what data points will be most relevant.

Other payers are feeling the pressure to incorporate PROMs into their quality measures. A 2018 report from the Government Accountability Office (GAO) asserted that including PROMs into data collection could improve Medicare Advantage plans. Specifically, PROMs could help CMS calculate risk adjustments necessary for Medicare Advantage plans that serve a patient population with lower functional status.

“Risk adjustment accuracy could be improved by accounting for functional status, thereby reducing financial disadvantages that may exist for MA plans that enroll and care for beneficiaries with functional limitations,” GAO explained. “However, the extent of improvement that could result from accounting for functional status would depend on factors such as how functional status is measured, as well as how data are collected and incorporated into the model.”

However, limited knowledge about data collection again gets in the way. More solutions will be necessary before organizations can easily incorporate PROMs into their clinical quality data collection.

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