Physician-Payer Quality Collaborative | MSMS

As health care transitions away from traditional fee-for-service, physicians in practice today face rigorous reporting requirements from a number of quality improvement incentive programs. Between initiatives like Physician Quality Reporting System (PQRS), Meaningful Use (MU), the Healthcare Effectiveness Data and Information Set (HEDIS) and others, physicians must monitor and report several hundred performance measures to multiple sources with little to no alignment nor intersection.

The burden of complying with several hundred performance measures is compounded by the volume and variety of health information technology (HIT) vendors in the market. The lack of interoperability and standardization across vendor platforms adds significantly to the costs and effort needed to share quality data. As the health care industry moves toward electronic automation, this is a problem faced by physician practices, physician organizations and health plans alike.

The Executive Council created the Physician-Payer Quality Collaborative (PPQC) to engage government and commercial payers in an effort to focus quality improvement efforts around a core set of measures and standardize performance report and feedback with health plans. The PPQC is a physician-led activity, facilitated by MSMS and its partners on the Executive Council with technical support from Michigan Health Information Network Shared Services (MiHIN).

There are three components that form the vision of the PPQC:

Three Action Teams were created to champion these goals.  Each team includes representatives from various physician organizations and health plans across Michigan. The Action Teams are:

While hundreds of quality measures are currently used by various national quality reporting programs, the PPQC Quality Measures Action Team identified a subset on which to focus initial efforts.  All payers report HEDIS measures, many of which require supplemental clinical data.  Furthermore, payers often select HEDIS measures to include in incentive programs for providers.  The PPQC identified a “Core Set” of 27 measures that had significant overlap between all or most national and local quality reporting programs, including the State of Michigan’s State Innovation Model (SIM) initiative:

PPQC Quality Measures and Descriptions>>

MSMS will facilitate a technical pilot with the help of MiHIN for Executive Council partners to test the “report once” all payer, all patient superset concept using the agreed upon expanded BCN file format for the core measure set. The first phase of the pilot will be conducted in 2016 to ensure it can be sent electronically via the MiHIN networks and routed to the appropriate payer for their patient beneficiaries.

The second phase of the pilot will focus on the generation of Quality Reporting Document Architecture (QRDA) files, a national standard for quality measure submission included in Meaningful Use, and the standardization of “gaps in care” feedback to provide the most timely and actionable data possible.

All payers offer uniquely structured financial incentive programs which reward physician organizations for reporting and performing well on selected quality measures. The PPQC recommends an additional incentive program with partial alignment across all payers utilizing the core measures that would be evaluated on an all-patient, all-payer basis. 

This all-payer, all-patient approach differs significantly from the status-quo, in which providers report measures to a payer using only patients from that particular payer. Physician organization representatives expressed frustration on behalf of their practices to comply with different incentive programs for each contracted health plan which all require different clinical workflows. Moreover, physician organizations stated the complexity of multiple incentive programs results in prioritizing of efforts which can cause some payers to classify practices or physicians as low performers based on how their beneficiaries are prioritized.