How Registries Gain Momentum and Achieve Lasting Value

Here at ArborMetrix, we’re focused on creating and delivering powerful product roadmaps that align with the industry and the needs of our clients and partners. These roadmaps help prioritize work, set expectations, and point us ever forward, toward our long-term vision.

But, roadmaps aren’t simply our own internal tools. We often provide roadmaps to our customers for their clinical registries. These plans outline how to take their data and software assets to the next levels for their populations. To be effective long term, your registry must continually evolve to address the growing needs of your clinician and patient populations.

Clinical registries exist on a scale of momentum that spans three stages:

  1. Foundational
  1. Intermediate
  1. Advanced

We guide our registry partners through each stage and set a strategic plan to help them progress to their ultimate goals.

Foundational Registry Momentum: Data Submission, Data Quality Review, Standard Reporting

Foundational registry momentum is defined by the compelling business and market needs that drive a registry’s framework. Often the impetus is collecting data for regulatory or post-market reporting, with features that include:

  • Collecting data through a variety of channels and formats.
  • Ensuring data is high quality through a robust data dictionary and supporting validation logic.
  • Standard report sets that support participation incentives – such as member performance through MIPS reporting, or device performance through post-market surveillance activities, among many others.

The Foundation stage is important because it serves to get data in the registry and drives membership and participation from affiliated organizations and clinicians. Most new registries achieve these goals within the first six months of launch.

However, if your registry launched a few years ago and you are feeling like your momentum is “stuck” or “limited” by not progressing past the Foundational stage, you’re not alone. This is a common situation that you can remedy with the right approach and technology.

Let’s continue with MIPS reporting as an example. Data required to support MIPS is not very rich, and users do not need to interact with a MIPS registry more than a few times a year. This process must be simple and convenient for users but does not drive deep engagement.

To get past this, identify new or additional goals and programs that your registry can achieve and support. This will move your registry forward and expand its value.

Intermediate Registry Momentum: Clinician Performance, Quality Improvement, Patient Engagement

The momentum of your registry is truly unleashed when it builds deeper engagement.

This begins when it is used to highlight and change behavior. Our registry product and services are purpose-built for deep analytics and actionable insights related to measurable clinician and device performance, quality improvement, and patient engagement.

  • Clinicians and industry stakeholders engage when the registry can be used to highlight their performance relative to peers and within their health system or specialty.
  • Quality improvement is realized when the registry can indicate areas where treatments and interventions can be improved, and where guideline adherence is tracked and analyzed for impact.
  • Patients engage when they are given the opportunity to safely share their health and quality of life related to diagnoses, treatments, and interventions, and know that data can be used in shared decision making.

Most of our clients spend a significant portion of their registry’s lifecycle building and growing these intermediate assets. This starts with our goals-oriented implementation process. These features can propel the momentum into new and relevant measurement areas and reporting domains that keep a registry fresh and engaging over time.

Advanced Registry Momentum: Publish and Predict

Finally, let’s talk about the hallmark of registry success: The ability to use it as a platform to publish research and clinical practice guidelines, and to predict outcomes. Advanced registries also expand their scope of participation and achieve sustainability through data commercialization.

Here’s how they reach this level. Registries arm us with trusted insights on clinician and device performance and quality improvement in care delivery. They also inform the patient experience through patient-reported outcomes. Registry owners and stewards share this knowledge and insights with the broader community to extend its impact.

Clinical Research and Practice Guidelines

Our customers have published a rich portfolio of registry-based research. Importantly, we help them achieve rapid-cycle research. On average, our customers publish their first peer-reviewed publication using registry data within a year of launch.

This is not just within scientific and medical journals, but also with the creation and publication of new clinical practice guidelines. The rigorous scientific process that we apply to registry data makes it ideal for evaluating the standards of care and long-term outcomes that impact patients.

Predictive Analytics and Outcomes Calculators

Predictive analytics is when data science principles are applied to model and forecast outcomes and risks at the point of care. This allows clinicals to make treatment decisions with better insight and, ultimately, avoid complications and negative outcomes.

The most advanced registries we support utilize outcomes calculators. These are built on complex data and models that combine foundational data assets with longitudinal patient data. Outcomes calculators provide powerful tools for shared decision-making between providers and patients and provide long-term registry value.

Predictive Analytics Registry Example

One example of an advanced registry using predictive calculators is the Michigan Bariatric Surgery Collaborative (MBSC). MBSC aims to advance the science and practice of bariatric surgery.  Registry data is used to feed the MBSC Predictive Outcomes Calculator, which is publicly available for clinicians to use to predict a patient’s weight loss, comorbidity resolution, and complication rate after bariatric surgery.

Specifically, the tool:

  1. Predicts weight loss at years 1, 2, and 3 for five different procedures using patient information on demographics, comorbidities, and risk factors.
  2. Predicts the likelihood of resolving weight-related comorbidities.
  3. Predicts the likelihood of minor and major complications.

Notably, the predicted rates for weight loss, comorbidity resolution and potential complications are patient-specific, using risk-adjusted, real-world outcome data from similar patients.

These tools and other quality improvement initiatives helped MBSC and its members decrease rates of VTE by 43% and decrease post-surgical death rates by 67%.

Achieve Lasting Value with Your Registry

It’s important to remember that registry momentum happens over varying spans of time.

Some registries have been around for many years, and their momentum has been focused on providing foundational value to its members. Other registries are only getting started and are already looking at how they can propel their programs by quickly predicting outcomes and publishing results.

Whatever stage in which your registry exists, we have both the vision and the delivery model to help you build momentum and achieve lasting value.

If you have any questions or would like to learn more about our clinical data registry solutions, contact me, Chrystal Price, M.S. at cprice@arbormetrix.com.


QCDR Value in 2021 and Key Updates to the MIPS Program

QCDR Value in 2021 and Key Updates to the MIPS Program

QCDR Value in 2021 and Key Updates to the MIPS Program

Many medical organizations and an overwhelming majority of eligible physicians choose to participate in the Centers for Medicare & Medicaid Services (CMS) Merit-based Incentive Payment System (MIPS).

Through MIPS, clinicians and other medical organizations have the opportunity to earn higher payments for high-quality care. For many, reporting performance data to CMS for the MIPS program means participating in a clinical registry.

A clinical registry that supports MIPS reporting, whether through a qualified registry (QR) or a qualified clinical data registry (QCDR), is one piece of a comprehensive solution that facilitates quality improvement. Additionally, because so many clinicians participate in MIPS, QCDRs and QRs are valuable tools that medical specialty societies can offer to their members. Clinicians who participate in QCDRs drive their own success with quality reporting, and they also optimize their reimbursement, understand how to improve, and take control of their performance.

QCDRs continue to provide a major mechanism for quality reporting, with 57 registries approved for 2021.  [1] Notable national QCDRs include the American Society of Clinical Pathologists’ National Pathology Quality Registry and the American College of Mohs Surgery MohsAIQ registry.

The MIPS program has had its ups and downs since its inception, but the program is here to stay, and the stakeholders involved have learned how to improve the effectiveness and efficiency of the program. Read on for a quick refresher on QPP, MIPS, and QCDRs, and an overview of the MVP program. We will provide a breakdown of the MIPS performance categories and how your technology can best support each one. Finally, we’ll end with the key takeaways from the 2021 MIPS Final Rule — including a change in performance category weights to emphasize cost — and what it all means for your organization and your registry.

In this post we will cover:

  • MIPS and QCDRs: A Refresher
  • MIPS Performance Categories
  • Key Highlights of the 2021 MIPS Program and Final Rule, including APPs and MVPs

MIPS and QCDRs: A Refresher

Value-based payment programs take many forms, from episode-specific Medicare payment bundles (such as for knee replacements) to accountable care organizations. All of these programs have the same goal: increase care quality while reducing costs. One extremely popular value-based payment program is MIPS; in fact, in 2019, 97% of eligible providers participated in the program. [2]

So what exactly is MIPS, and how can a healthcare provider or organization participate? Let’s start by reminding ourselves of the basics.

The world of value-based payment (and healthcare in general) is full of acronyms. Download our printable MIPS Acronym Reference Card — you’ll never be stuck Googling letters again.

What Are MACRA and QPP?

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was passed by Congress to help modernize the healthcare reimbursement system while also financially incentivizing quality improvement. To that effect, MACRA established the Quality Payment Program (QPP), which rewards high-performing Medicare caregivers with higher payments while also decreasing payments to low-performing clinicians. [3] The goal of QPP is to improve the quality of patient care while also reducing costs.

Through QPP, clinicians can access quality-based reimbursement via the Merit-based Incentive Payment System (MIPS) or through Advanced Alternative Payment Models (AAPM). Clinicians choose one of the two tracks based on factors such as the size of their organization or the makeup of their patient populations.

What Are MIPS and MVP?

The Merit-based Incentive Payment System (MIPS), also established by MACRA, launched in 2017, and it financially incentivizes improving care quality. It is one of two tracks clinicians can use to receive quality-incentivized Medicare reimbursement under QPP.

Clinicians participating in MIPS receive performance-adjusted payments for Medicare Part B services. Payments are adjusted based on how clinicians measure up in four performance categories—discussed in greater detail below—which are each weighted differently. The resulting final MIPS score, which is measured on a scale from 0 to 100, ultimately determines whether a clinician’s payment adjustment is positive, neutral, or negative. [4]

Beginning in Performance Period 2022, the MIPS Value Pathways (MVP) program will promote further integration of the MIPS categories by streamlining clinician participation through a hybrid approach. MVP will measure clinicians on a unified set of measures and activities around a clinician condition or specialty and are intended to be a pathway to advanced alternative payment models. Read “MIPS Value Pathways: What You Need to Know” to learn more about the changes coming to the MVP program and how you can prepare your registry and clinicians for what’s ahead.

What Is a QCDR?

A Qualified Clinical Data Registry (QCDR) is an entity approved by CMS that aims to improve care quality. Many healthcare organizations, including health systems, medical specialty societies, and quality collaboratives, run QCDRs.

These specialized registries collect data from clinicians and report this data to CMS on their behalf for MIPS. QCDRs offer eligible clinicians a single way of participating in all aspects of MIPS.

A QCDR can therefore serve as a MIPS reporting solution while also supporting individual clinician and specialty-wide performance improvement.

Specifically, a QCDR can:

  • Facilitate quality improvement, patient safety initiatives, and research.
  • Report on the right measures to optimize future CMS reimbursement.
  • Allow clinicians to spend time delivering care instead of documenting it.
  • Help clinicians know where they stand and what to do to improve.

While clinical data registries provide the framework for quality improvement in many healthcare settings, QCDRs are uniquely positioned to drive robust engagement by specialist physicians.

By offering relevant, specialty-specific quality measures, QCDRs can be used to satisfy MIPS reporting requirements. The most effective quality measures in this context are those that seamlessly integrate into clinician workflow, have low barriers for data collection, fairly attribute outcomes to the proper clinician, and measure performance gaps in a manner that allows for feedback and subsequent improvement.

What Is a QR?

A qualified registry (QR) also collects data from clinicians, which it then reports to CMS. The main difference between QRs and QCDRs is that QCDRs can collect and report specialty-specific measures that are not part of the MIPS measure set. Because QRs and QCDRs are so similar, they offer many of the same benefits, with the caveat that QCDRs are often more useful for specialist physicians.

MIPS Performance Categories

Physician organizations and health systems use QCDRs for MIPS reporting to efficiently collect and organize the clinical data they need to demonstrate improvements in quality of care and easily report their MIPS performance measures. Many medical specialty societies and associations have also established QCDRs to demonstrate improvement in care quality.

There are four reporting categories for MIPS:

  • Quality: Clinicians are measured based on the quality of the care they provide.
  • Promoting Interoperability: Healthcare organizations are measured based on how they facilitate and deploy electronic health records (EHRs). By using EHRs, clinicians and health organizations can more fully engage patients in their own care by making their health information more readily accessible.
  • Improvement Activities: Healthcare organizations are assessed on how they go about making improvements to their care processes.
  • Cost: Healthcare organizations are assessed on their cost of care.

Medical organizations that make the right performance measures available through their QCDR can drive increased registry performance and value. Performance measures can be created in a way that minimizes workflow disruption and eliminates the perceived burden of registry participation, or refined to meet high-priority, specialty-specific needs.

QCDRs have accomplished this with quality MIPS reporting solutions that:

  • Report on the right measures. Providers who optimize QCDR performance measures can uncover valuable insights and demonstrate improvements in the quality of care. This simplifies MIPS reporting and optimizes future CMS reimbursement.
  • Reduce the amount of time spent dealing with data. Busy physicians have little time to spend on data collection. A quality reporting solution simplifies the documentation process and frees up more time to deliver care.
  • Provide clear outputs. A strong QCDR will include a layer of data analysis that provides clear outputs for providers so they know where they stand and how they can improve in the future.

There are many valuable uses for registries beyond acting as QCDRs for MIPS reporting, but for registries that have solid quality improvement and research objectives, engaging a QCDR is an effective strategy to add even more practical day-to-day value to your registry.

Key Highlights of the 2021 MIPS Program and Final Rule

The MIPS program changes slightly every year and will shift how healthcare providers and systems leverage their QCDRs. Forward-thinking groups should be aware of annual changes and be prepared to adjust their data collection and reporting accordingly. For clinicians reporting traditional MIPS in 2021 (for payment in 2023), the new MIPS rules stipulate that while the performance threshold of 60 points will not change, the weights of the performance categories will shift slightly to reflect the rising importance of cost.

A solid QCDR will allow health providers, systems, and medical associations to adapt to changing requirements and continue to optimize reimbursement incentives.

CMS has announced new, focused efforts to improve its QCDR and QR partnerships in an effort to reduce reporting burden for clinicians. In light of the COVID-19 pandemic, CMS has limited the number of changes to the Quality Payment Program in the 2021 Final Rule.

In addition to adjusting the performance threshold and category weights for traditional MIPS, the 2021 QPP Final Rule fleshes out the framework for MVPs and introduces Alternative Payment Model Performance Pathways (APPs), which create more specific implications for QCDRs and QRs by aligning all MIPS performance categories into cohesive reporting mechanisms.

MVPs will function with population health and promoting interoperability measures as its basis. These measures are applicable to all value pathways within the program. MVPs will incorporate patient input, digital measure reporting, and subgroup reporting to create a simplified and holistic reporting system for both registries and clinicians.

APM Performance Pathways, intended for participants in MIPS APMs, are complementary to MVPs and will allow clinicians and groups to report on six quality measures centered on population health. APPs will incorporate measures in each performance category while factoring in cost at the individual APM level. QCDRs and QRs are integral in this program since three of the reported measures will be electronic clinical quality measures (eCQMs), MIPS clinical quality measures, or Medicare Part B claims measures.

These policies are still being finalized, but the Final Rule will allow QCDRs, QRs, and health IT vendors to support APPs this year and MVPs starting with the 2022 performance period. The Final Rule also introduces new validation requirements for QCDR and QR data and reporting measures.

Explore the ArborMetrix Complete Solution for CMS-Approved QCDRs

ArborMetrix has a long track record of providing comprehensive support for MIPS reporting with all of the requirements for CMS-approved QCDRs and QRs. We have successfully helped more than 30,000 providers report to CMS via QCDRs, supported several organizations through the annual QCDR self-nomination process, and maintained thousands of measures for our clients.

If you have questions about MIPS reporting or would like to learn more about our QCDR solution, you can contact me at cprice@arbormetrix.com.

 

References

  1. https://qpp-cm-prod-content.s3.amazonaws.com/uploads/1230/2021%20QCDR%20Qualified%20Posting.xlsx
  2. https://www.aha.org/news/headline/2020-10-28-cms-releases-quality-payment-program-results-2019
  3. https://qpp.cms.gov/about/qpp-overview
  4. https://qpp.cms.gov/mips/reporting-options-overview


Designing Healthcare Analytics to Engage Clinicians

Designing Healthcare Analytics to Engage Clinicians

Designing Healthcare Analytics to Engage Clinicians

Healthcare analytics software enables the acquisition, validation, transformation, and visualization of robust data sets. Organizations use healthcare analytics for a wide variety of purposes, including:  

  • The business of healthcare that analyzes financial trends and access to services.
  • The delivery of healthcare aimed at driving improvements to the quality of care and care providers.
  • The monitoring of healthcare treatments like devices and pharmaceutical interventions.  

While the use cases are incredibly diverse, they all share a few common requirements:

  • A dedication to the strict adherence to standards that keep your data safe and secure.  
  • A streamlined process for collecting and blending disparate data sources into a unified whole.
  • A focus on improving access and outcomes for the most important stakeholder – the patient.  

In order to achieve these aims, healthcare data must be engaging and interactive to support key decisions. This is especially true for clinician users.

User engagement is a key indicator to help organizations understand how decision makers like clinicians are using healthcare data and applications. User engagement metrics tell us:

  1. The degree to which data-driven decision making is prevalent in an organization’s culture.
  2. The degree to which the healthcare analytics application facilitates simple and intuitive data exploration.

At ArborMetrix, we see it as our responsibility to facilitate delightful and engaging user experiences and ultimately to inspire and support a culture of data-driven decision making in healthcare.

User-Centered Design in Healthcare Analytics

When designing healthcare analytics software to drive clinician and end-user engagement, it is crucial to understand the value proposition for key user personas. These personas represent the types of users and stakeholders who will be interacting with the product.  

We leverage user-centered design principles to define personas and engage in best-practice research methods like focus groups, user observation sessions, and surveys.  

Every persona has high-value needs, and we focus on designing easy and intuitive user experiences to facilitate those needs. Some examples of personas for clinical registries include quality officers, administrators, clinicians, researchers, patients and caregivers.

We tailor our user interface and workflows to align with the needs of our users. We want to ensure that they have easy access to the information and tools that matter the most to them.

Designing Healthcare Analytics Tools for Clinician Engagement

Here are a few examples of high-value opportunities for engaging clinical personas:  

  • Easing the burden of regulatory reporting requirements.
  • Enabling meaningful benchmarks based on timely data.
  • Providing quick access to relevant measures with robust filtering for custom patient cohort comparisons.
Opportunities for Client Personas

For users tasked with providing data, we aim to make data acquisition seamless by utilizing electronic connections whenever possible. When manual data entry is necessary, product capabilities for intuitive smart forms with validation logic that are attune with user workflows are critical. This is to ensure high-quality data capture with minimal effort.

It is important to capitalize on the momentum from an initial rollout of new software and plan a product roadmap to maintain engagement with new high-value capabilities and insights. Planning for growth can include expanding the scope of measures available, growing the library of reports, adding support for new personas, and releasing new product features that align with high-priority user needs.

Healthcare analytics software, purpose-designed for your users, can help you go beyond understanding how you’re performing to exploring why. That’s what inspires data-driven action and measurable improvement.

To see our user-centered design in action and learn more about how we can help you meet your healthcare analytics and clinical registry needs, contact our team.