My Quality Counts
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Frequently Asked Questions

About the Quality Measures in My Quality Counts!

1. Q. What is the Western New York Quality Measurement Collaborative?

A. The Western New York Quality Measurement Collaborative (WNYQMC) was formed by the three full-service health plans – BlueCross/BlueShield of Western New York, Independent Health and Univera Healthcare – as the governance organization for the New York State Department of Health (NYSDOH) grant. A steering committee, comprised of key stakeholders of the initiative, worked together to provide overall project planning, decision-making and fiduciary responsibilities. Three project work groups were convened -- Data Governance, Physician Advisory and Operations – to foster subject-matter expertise.

Q. What measures are included in the My Quality Counts! report and who determined them?

A. The first report contains 19 ambulatory quality measures addressing diabetes, heart disease, asthma, depression, treatment of URIs in children, post-partum care, and preventive services.

All of the quality measures are based on extensive work performed by the Physician Advisory Team convened by the WNYQMC. This team is comprised of local physicians and the medical directors of the three regional health plans. Each of the measures is based on generally-accepted national guidelines for quality care endorsed by the National Quality Forum, the Institute of Medicine and/or HEDIS®.

The report also provides quality measures relating to inpatient settings, compiled from data provided through the Centers for Medicare and Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (DHHS), along with the Hospital Quality Alliance (HQA).

The My Quality Counts! report provides summary data based on 19 ambulatory metrics, including the following:

Breast Cancer Screening
Cervical Cancer Screening
Chlamydia Screening
Persistence of Beta-Blocker Treatment After a Heart Attack
Comprehensive Diabetes Care - A1C Testing
Comprehensive Diabetes Care - LDL Testing
Comprehensive Diabetes Care - DRE(Eye)
Comprehensive Diabetes Care - Urine Protein(Neph)
Appropriate Treatment for Children with URI
Appropriate Testing for Children with Pharyngitis
Colorectal Cancer Screening
Childhood Immunizations
Lead Screening in Children
Use of Appropriate Medications for People with Asthma
Antidepressant Medication Management - Acute Phase Treatment
Antidepressant Medication Management - Continuation Phase Treatment
Prenatal/Postpartum Care
Cholesterol Management for Patients with Cardiovascular Conditions
Heart Failure – Ace Inhibitor or ARB Therapy (AMA Measure)

A link to reports derived from CMS’s web site is also provided for participants seeking additional data about the in-patient measures.

As this initiative is updated over time, other ambulatory measures may be added.

3. Q. What is the benchmark or desired rate for each measure?

A. As a reference point, we have provided a regional benchmark based on the reporting of all WNYQMC Collaborative members.

4. Q. Why does the My Quality Counts! report emphasize primary care and not specialists?

A. The focus areas of the report -- which mainly address preventative services and care for people with diabetes, heart disease, and other chronic conditions – reflect the categories of care that make up a significant portion of ambulatory care services provided in the community. Primary care clinicians typically provide the care that is known to be most effective in keeping people with chronic conditions as healthy as possible; however, the data collected and reflected in this initiative includes care provided by primary care providers and by specialists.

About the Data in My Quality Counts!

5. Q. What data is included in the My Quality Counts! reports?

A. The My Quality Counts! report is based on data that reflects care provided to more than 750,000 people in the region, presenting approximately 90 percent of Western New York’s commercially insured population. The data was provided by the following organizations:

BlueCross/BlueShield of Western New York

Independent Health Association

Univera Healthcare

The My Quality Counts! report uses insurance claims data to measure certain aspects of care. The data being provided through your password-protected web portal is “de-identified,” meaning that it does not include any information that identifies individual patients, such as name and address. If you are interested in obtaining the back-up patient data that comprises an aggregated score, please sign and fax the Business Associate Agreement (BAA) available within the report portal to the P² Collaboratives project manager at (716) 541-0289. Once a fully-executed BAA is received, you will be able to review the patient data linked to each measure.

6. Q. Why are the My Quality Counts! reports based on claims data?

A. For accurate measurement and comparison across the community, large data sets are essential. Claims data is the only type of high volume data that we are aware of that is readily available in electronic format for the vast majority of health care providers. Over time, the My Quality Counts! initiative will be expanded to reflect data from other sources, such as electronic medical records, labs, and patient experience surveys. Currently, much of that information is inaccessible because it either it is trapped in paper (in the case of medical records) or the data is not currently being streamed into any centralized location (i.e., lab results).

7. Q. How can quality of care be measured using claims data?

A. Claims data reflects information submitted by providers to payers as a part of the billing process. While not all medical care shows up in billing data, it does include quite a bit of information about diagnoses and services provided. Using claims data, for example, one can measure “care processes” such as “What percentage of patients with diabetes were given or ordered and HbA1c test at least once during the measurement period?” The current reporting structure does not consider the cost or payment for that care in outcomes.

8. Q. Are there limitations when using claims data for performance reporting?

A. Yes. While claims submissions are the only high volume data source that we are currently aware of that is readily available in electronic format for all health care providers, we realize that using claims data is not perfect.

9. Q. How old is the claims data used in this report?

A. The data used in this report reflects care provided during calendar year 2008, with comparative data from the 2005-2007 timeframe. The first quarter 2009 data will be distributed to providers in late 2009 or early 2010.

10. Q. What is the minimal sample size?

A. The minimum sample size for any single measure in the My Quality Counts! report is 30 patients. If your practice does not sustain enough patients for the measure to be calculated (<30), an *(asterisk) will appear next to the measure.

11. Q. Why is the data being provided at physician level and not at practice/clinic level?

A. Granularity of data is optimal in this situation. Patient attribution at physician level provides for a more accurate process to verify data. It also promotes responsibility and accountability at the physician level.

12. Q. Does the data put into place a hybrid adjustment factor to resolve the differences between administrative claims data and actual clinical activity?

A. Yes.

13. Q. Who has access to the aggregated reports posted onto the web?

A. In addition to the project manager for the P² Collaborative, who is providing back-end services to publish the data, and ViPS, the data aggregator, each participating health plan will receive the aggregated data scores for all three plans in report format.

14. Q. Who can have access to the supporting patient-level reports?

A. In addition to the project manager for the P² Collaborative, who is providing back-end services to publish the data, and ViPS, the data aggregator, each participating health plan will only receive supporting, patient-level reports about patients who are members of its health plan.

15. Q. What if patients don’t comply with a physician’s recommended treatment?

A. We acknowledge that certain patients are less likely to follow through with recommended care. My Quality Counts! is intended to inform everyone about aspects of care that are vitally important to getting and staying as healthy as possible. In addition to producing this report, efforts are underway regionally to engage people to do their part to improve personal health and comply with their doctors’ advice.

16. Q. After reviewing my patient-level data, I note some corrections that I would like to make. Whom should I contact?

A. We are working on creating an on-line corrections portal that will be operable by the end of 2010. Until that time, you should contact the appropriate health plan as you would any claims correction.

17. Q. Why add another report? Will the other quality/P4P reports provided by plans go away?

A. A business case is presently being compiled to address the sustainability of this collaborative project in order to eliminate duplication of efforts to prepare quality/P4P reports among the participating plans.

18. Q. What about the inclusion of data from fee-for-service Medicaid plans?

A. Efforts are currently underway with State Medicaid fee-for-service and a Medicaid Managed Care plan to become a member of this collaborative in future reports to physicians.

19. Q. How will interpretation of the data be used to change the way I practice?

A. Based on the aggregate report that you are provided, you will decide if and how your practice will need to change.

20. Q. Will it be possible for the physicians to validate the information in the aggregated report?

A. No. The initial funding was not adequate to develop a verification portal or process for physician data correction. However, a sustainability plan is being developed that will include processes for data verification and correction, and it is the intent of the three collaborating health plans to develop an actionable portal in the future.

21. Q. Can reports be run for groups as a whole?

A. WNYQMC is interested in determining the level of interest that groups have in receiving group-specific reports. As a pilot, WNYQMC will be working to develop a methodology to be able to "roll up" individual physicians into group practice reports. Currently, WNYQMC is publishing reports at the physician level.

22. Q. Can I opt out of this program?

A. There is really no opt in or opt out. Information will come from the plans based on their administrative data and sent to the data aggregator for the development of a physician specific report using data from all the plans. Whether you, as a provider, wish to access it is voluntary.

23. Q. Will my data be publicized?

A. No, there is no public reporting requirement during the two years of the NYSDOH demonstration grant (2007-2009). However, the P² Collaborative is committed to public reporting as a requirement of its Aligning Forces for Quality grant from the Robert Wood Johnson Foundation. The goal for public reporting is to develop a consumer portal in the first quarter of 2010.

24. Q. What are some tips on succeeding with performance measures?

A. Knowledge of the measures and coding will assist with success. The measures are based on national standards and best practices and employing treatment standards will result in greater compliance. While this pilot set of 19 measures addresses only a handful of conditions, by working on these measures your practice can gain experience in using measures to gauge how closely you are able to consistently follow evidence-based guidelines.
* Designate an office “Quality Manager” -- someone to be responsible for performance measurement.
* Bill for all services provided.
* Code accurately and completely.
1. Review encounter forms to be sure that codes used will count
2. Verify with your billing company that correct codes are billed
* Request current “actionable” reports from plans and review baseline WNYQMC report.

1. To improve coding and billing practice
2. To identify practice patterns not consistent with measured standards
3. To identify patients who need to be called in for care
* Reinvest bonus money for future success

* Strengthen skills and resources related to data management.

* Consider implementation of a registry or an electronic health record with a registry function.

* Contact the P² Collaborative of Western New York, Inc. to determine what quality improvement services are available at (716) 725-4562.

Have questions? Contact My Quality Counts! at (716) 541-0289.