2023 CMS Quality Conference Addresses Health Disparities

The PHE is over. It’s time to refocus attention on quality care.

The theme for the Centers for Medicare & Medicaid Services (CMS) Quality Conference, held virtually May 1-3 this year, was Building Resilient Communities: Having an Equitable Foundation for Quality Healthcare. Each day of conference was packed with informative and inspiring sessions led by high-level public officials and other industry stakeholders invested in the mission of advancing value-based care.

“This is a powerful vision for the future of health and healthcare in the country,” said Jean Moody-Williams, RN, MPP, deputy center director, Center for Clinical Standards and Quality, CMS, in her welcome address. With the public health emergency (PHE) for COVID-19 coming to an end this month, she said, “we are ready to embrace the future.”

To do this, we need to recover from the effects of the PHE, such as provider burnout, and build back our workforce, Moody said. “Let’s work together to make bigger strides in patient safety and access to care,” she continued, “and renew our focus on where healthcare trends are leading us.”

The breakout sessions that followed each day’s opening talks throughout the 2023 CMS Quality Conference were categorized by initiative:

• New innovation and technology

• Engaging partners and communities

• Patient safety

• Expanded access to quality and affordable behavioral and physical healthcare

• Advancing health equity

• High reliability and quality improvement

• Collecting and using quality data

• Healthcare system resiliency

Here are just some of the valuable takeaways from the 2023 CMS Quality Conference.

New Innovation and Technology

Under this track, attendees could learn about CMS’ activities for achieving digital quality measurement, leveraging data standards, and exploring quality measure redesign.

In the session “Bring the People to the Data,” attendees learned more about Center for Clinical Standards and Quality’s (CCSQ’s) vision of “bringing users to the data.” To avoid data duplication, security, and transparency issues, CCSQ looks to enhance current architecture and processes that provide users a “one-stop-shop” to data and analytics tools.

In the session “Promoting Evidence-Informed Policy Analyzing Changes in Burden from CMS Rulemaking,” LT John Watts, U.S. Public Health Service Analyst for CMS’ Office of Burden Reduction & Health Informatics, clarified that CMS defines impact of burden on the healthcare system in a holistic way, extending beyond dollars and hours saved and including patient health outcomes and health equity. CMS now assesses burden by measuring dozens of CMS rules to understand their impact on patients, providers, and stakeholders. Data such as travel to appointments, long wait times, ineffective interventions, and language differences, for example, now factor into the scope of burden. The Impact Analysis Workgroup (IAW) was created to discuss aligning methodology with advancing equity and driving innovations, provider and patient surveys, comments on CMS rules, price changes, staff turnover, and CMS outreach events.

Engaging Partners and Communities

This track featured sessions that discussed how to encourage the buy-in needed from businesses and communities to achieve alignment, growth, and equity throughout the healthcare system.

In the session “Strengthening Community-Base Services and Coordinated Care in Medicaid,” the Center for Medicaid and CHIP Services (CMCS) and a representative from Pennsylvania Health and Human Services (PA HHS) discussed current efforts related to quality measurement, measure development, publicly reporting on home and community-based services and quality activities to promote equity. The CMCS and PA HHS representatives discussed data stratification, gaps in measures, involving stakeholders in designing measures, and more.

In the presentation “CCSQ Support Central: An Elevated Customer Experience,” CMS representatives spoke about how the CCSQ Support Central portal can provide better program and technical support to the healthcare community as it strives to meet reporting requirements. CCSQ has expanded its features over the past year. Now, for example, users can schedule a callback with a customer service agent at a preferred date and time; use the new live chat and resource line (C.A.R.L.); and track a submitted ticket using SMS verification.

In the last round of sessions on the second day of conference, Rena McClain from CMS’ Office of Burden Reduction and Health Informatics (OBRHI) presented insights into results from the “Provider Experience Survey on Telehealth and the Collection of Social Determinants of Health Data.” The primary focus of the survey, conducted Aug. 19-Sept. 30, 2022, was to examine the experience and perceptions of providers serving underserved communities, including rural areas, high-poverty areas, and ethnic communities. While 1,187 providers responded, McClain believes that a larger probability-based survey is also needed.

The data from the survey showed that 54 percent of providers screen for patients’ social needs and risks, and that those providers used the data collected to identify potential barriers to good health outcomes and refer patients to other resources. Mental health and financial strain were consistently the top unmet social needs. In high-poverty areas, patients were more likely to list lack of comfort using technology, lack of internet access, and lack of access to a smartphone or other internet-connected device as a barrier to utilizing telehealth. In these areas, more than 60 percent of patients use audio-only telehealth. Other areas identified for improvement included a need for providers to use standardized screening processes and tools, continued education for providers on standardizing demographic and social needs data, and increasing digital health literacy for patients.

Other sessions discussed oral health, kidney transplantation, the End Stage Renal Disease Treatment Choices Learning Collaborative (ETCLC), MIPS Value Pathways (MVPs), care management for Alzheimer’s patients, care delivery related to behavioral health and chronic pain and minority populations, eliminating disparities among minority populations, and maternal health.

Patient Safety

To say that the COVID-19 PHE put enormous stress on the healthcare system that caused safety problems for both patients and staff is an understatement.

Officials from the Beneficiary and Family Centered Care National Coordinating Oversight and Review Center (BFCC NCORC) began the discussion on patient safety by asking, “Are we reaching the goal in preventing patient safety events in hospitals? The BFCC NCORC uses national data to identify opportunities for quality improvement and increased patient safety, and collaborates with CMS and other partners to support the rights and services for people with Medicare.

The organization conducted a review between May 2022 through January 2023 of nearly 3,000 charts for hospital discharge dates after Sept. 30, 2020. They found that 54 percent of patients experienced at least one type of patient safety event (PSE). However, they also found that only 2 percent of these PSEs were “definitely preventable.” Still, further patient safety research is needed. The BFCC NCORC plans to continue identifying opportunities for targeted intervention and education for preventing PSEs and hospital acquired conditions (HACs).

Other sessions under this track looked at patient safety efforts and how to use data and innovative approaches to improve patient safety in nursing homes.

As intriguing as these sessions were, none could compare to the enthralling presentation, “Healing with Intention,” given by Rana Awdish, MS, MD, FACP, FCCP, from Henry Ford Health. Her account of her near-death experience as both a physician and a patient was eye-opening to the dangers of not seeing the patient beyond the data. Thankfully, after considerable time and effort, she has recovered. Relating her experience to the COVID-19 PHE, Awdish said, “I believe we are in a similar point now where we’ve been through something that has revealed all the flaws in our system, and we have an opportunity to rebuild in a different way.”

Expanded Access to Quality and Affordable Behavioral and Physical Healthcare

In “Opportunities for Better Integrated Physical and Mental Health Care,” Elisabeth Kato, MD, MRP, medical officer at the Agency for Healthcare Research and Quality (AHRQ) talked about another area of concern. In 2020, nearly 57 million Americans, or one in five adults, experienced mental illness and 17 million additionally had a co-occurring substance use disorder (SUD). “However, less than half of these individuals received proper treatment,” she said.

Best practices in mental health and substance use disorders services and supports were discussed by a panel of medical professionals from the Department of Health and Human Services (HHS) and the Department of Veterans Affairs (VA).

There was also much discussion around telehealth, including mental telehealth, which opened a host of opportunities during the pandemic. The panel warned that we should all take care not to make assumptions, however: Telehealth can be a huge barrier for some patients and caregivers. They may not have a safe, private space for their telehealth visits; broadband may not be available in rural areas; and those suffering homelessness are even more lacking in resources. Telehealth offers many advantages, but it must be assessed for all segments of the population, and individually considered by providers.

Other sessions looked at the collaboration between the Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention, and CMS; how value-based care can narrow the gap between quality, disparities, and culture; health-related social needs; and opportunities for advancing chronic pain care.

Advancing Health Equity

Sessions categorized under this track discussed various quality reporting systems such as the End-stage Renal Disease (ESRD) Quality Reporting System, and efforts to improve data and advance health equity standards among both specialty communities and across hospital settings.

In the session “Making it Work: Practical Solutions to Health Equity for Hospitals,” Cynosure Health provided an overview of a CMS final rule requiring hospitals to screen patients for social determinants of health (SDOH). Attendees learned of hospital-tested resources and tips, including how to build trust with patients to promote understanding and engagement; steps for building action plans to support community well-being; and how to interpret data in support of existing quality and safety reporting efforts. Insights also were shared from hospital champions from across the various stages of the implementation of a SDOH screening process.

Other sessions focused on the use of data dashboards and interactive tools to identify and address health disparities; developing partnerships for culturally and linguistically appropriate services (CLAS); and harm reduction in “Indian Country.”

High Reliability and Quality Improvement

This track featured a culmination of topics related to quality improvement — from the HEARTS in America program for hypertension, to the front lines of the Beneficiary and Family Centered Care Quality Improvement Organization, to strategies for protecting Medicare beneficiaries and the Medicare Trust Fund.

Collecting and Using Quality Data

Under this track, sessions focused on current and future initiatives for collecting quality data and using it effectively to meet program goals set by CMS’ Framework for Health Equity 2022–2032. Quality measures and interoperability were at the forefront of these discussions.

In the session “Leveraging Standardized Functional Status and Cognitive Data to Inform Care Coordinated Across the Ecosystem,” panel members from CMS, the Office of the National Coordinator for Health Information Technology, and civilian stakeholders reviewed efforts to promote interoperable exchange of standardized clinical data, such as that made available in the CMS’ Data Element Library (DEL). Likewise, the United States Core Data for Interoperability Plus (USCDI+) is a new initiative to support the identification or establishment of domain or program-specific data sets that will operate as extensions to the existing USCDI.

Other sessions under this track discussed the Quality Innovation Network-Quality Improvement Organization’s Real-Time Medical Systems Quality Improvement Collaborative; efforts to enhance data interoperability and standardization of electronic clinical quality measures (eCQMs) and digital quality measures (dQMs); and efforts to improve oral health and overall health outcomes.

Healthcare System Resiliency

Resilience is the dynamic and demonstrable outcome of an individual, family, or community’s ability to cope with uncertainty, access needed resources, and adjust or bounce back in an often-hazardous environment.

In the session “Resiliency, Resourcefulness, and Recovery: Healthcare System and Disaster Management in Geographically Isolated Communities,” a moderated discussion focused on the resiliency and resourcefulness across entities (e.g., federal, state, local, tribal, and territorial) who have had to prepare for, mitigate, and overcome challenges related to natural disasters (e.g., earthquakes, fires, disease outbreaks) and human-made disasters (e.g., oil spills, lead poisoning, climate change).

Listen to This

Rounding out the breakout sessions, there were many listening sessions allowing open dialog between presenters who tried to answer tough questions such as:

• What are the priorities of the HHS?

• How does the government restore trust in science?

• How do we advance health equity across all CMS programs?

• What are the implications and opportunities for healthcare quality?

• How is CMS implementing its National Quality Strategy to promote quality healthcare?

In the listening session “Promoting Quality Health Care: Implementation of the CMS National Quality Strategy,” Drs. Michelle Schreiber, Doug Jacobs, Susannah Bernheim, and Aditi Mallick spoke about CMS’ National Quality Strategy (NQS), a set of goals aimed at promoting quality healthcare outcomes, safety, equity, and accessibility for all patients, which launched in 2022.

The Universal Foundation was created to align quality measures across CMS to reduce the burden on providers and improve standardization of measurements in a way that is broadly applicable, digitally reported, and capable of being stratified to identify and track disparities.

Next steps are to develop measure sets per population, adjust existing measures, add measures across the care journey, and continue to test newly created measures.

Another panel discussed “Quality Care: Integrating Physical and Mental Health.” They explained why integrating physical and mental health services and supports matters in the current environment, pointing to issues like rising substance use disorders, an uptick in mental health conditions, and a lack of postpartum coverage in all states. Behavioral health is currently treated separately from primary health for the most part, even though many patients with a behavioral health condition also have a comorbid condition(s). By building our healthcare systems to address what really matters to people, we will build systems that improve health outcomes and also reduce costs, the panel agreed. CMS is also looking at utilizing healthcare’s unlicensed workforce to take some of the burden off primary and specialty providers in addition to matching more exactly the intensity of intervention with the acuity of the individual patient to improve patient care while reducing costs.

JoVonn Givens, Task Order Director from Alliant Health Solutions, finished day three of CMS’ 2023 Quality Conference with her presentation on “Building a Resilient Workforce that Enhances Patient Care.” Givens outlined the importance of leaders fostering a healthy, happy staff that enhances the patient experience. Through behavioral science examples, Givens illustrated how psychological, social, cognitive, and emotional factors inform the actions employees take and the decisions they make. By considering the way humans make decisions and react to both problems and praise, leaders can empower those they lead and help spread joy, according to Givens.

Givens suggests asking staff what matters to them and using tools like the Resilience Rounding Tool as a communication aid. She suggests providing links to self-care videos to combat issues like compassion fatigue in nursing home workers and resources like the Center of Excellence for Behavioral Health in Nursing Facilities, which focuses on increasing knowledge, competency, and confidence in nursing facility staff to care for residents with behavioral health conditions.

Facing Our Future

The CMS’ 2023 Quality Conference was three days of thought-provoking insight into the present state of our healthcare system and where improvements are needed. As valuable as quality data is for science, quality care can only be achieved when every individual is seen, heard, and valued.

Source:
https://www.aapc.com/blog/88010-2023-cms-quality-conference-addresses-health-disparities/