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Framing Value in Cancer Care

Leveraging the Quality Payment Program to achieve Minnesota’s cancer plan goals

Cancer Plan Minnesota 2025 was released in January 2017 by the Minnesota Cancer Alliance. The plan is a framework for action—with 19 measurable objectives and 92 strategies—that invites everyone to get involved in reducing the burden of cancer and promoting health equity. It challenges organizations and individuals in every sector and every region of the state to step up, work together and make a difference for all Minnesotans. As an active member of the Minnesota Cancer Alliance, Stratis Health looks for ways to support implementation of the cancer plan.

One way was to develop a crosswalk of the cancer plan’s goals to the quality measures in the Medicare Quality Payment Program (QPP). Stratis Health is actively supporting Minnesota clinicians and health care organizations to understand QPP and achieve exceptional performance in their Merit-based Incentive Payment System (MIPS) Composite Performance Scores.

Clinicians eligible for QPP must start collecting performance data in 2017. Those in the MIPS track—the majority of eligible clinicians participating in QPP—need to identify which of the 271 quality measures they plan to report on.

Quality Payment Program - quality measures

The alignment between the cancer plan and the QPP quality measures is strong. QPP MIPS has 46 cancer-related quality measures.

QPP Cancer PlanOf these, 36 are categorized as process measures. They primarily fall under two National Quality Strategy (NQS) domains, with 21 under Effective Clinical Care, such as percentage of women 50-74 years of age who had a mammogram to screen for breast cancer, and 11 under Communication and Care Coordination, such as percentage of patients undergoing a screening mammogram whose information is entered into a reminder system with a target due date for the next mammogram.

“When a guidance document like the Minnesota Cancer Plan comes up, we’ll typically review it to see if it aligns well with our current strategic direction and the asks from payers, CMS, and the state,” said Timothy Hernandez, family physician and medical director for quality and clinical practice at Entira Family Clinics.

Entira has partnered for four years with Health East in a Medicare Shared Savings Program (MSSP) accountable care organization (ACO). Because the ACO does not yet take on downside risk, Entira eligible clinicians fall under the MIPS track. When looking at how to approach the menu of options for the QPP measures Hernandez said, “The key is to hone in on those you are currently doing and maybe need some minor adjustments. We are hopeful that we can ride our wave of high quality long enough until we can figure it out.”

Some organizations are finding that their electronic health record (EHR) systems are not configured to capture data for their preferred cancer-related QPP measures. Because of the advanced age of its population, one Minnesota primary care practice shared that it was considering selecting the Age Appropriate Screening Colonoscopy measure (percentage of patients greater than 85 years of age who received a screening colonoscopy from January 1 to December 31), for which lower numbers are better as an indication of efficient use of resources based on evidence-based care practices. Unfortunately, its EHR vendor was not able to build the measure into its system for use this year as one of its QPP quality measures.

“Each time CMS changes the measures in any significant way, there’s a tremendous amount of work to be done in recalibrating your systems to support them,” noted Hernandez.

Because QPP builds on previous quality programs, measures from the former Physician Quality Reporting System and Medicare EHR Incentive Program may already be built into an EHR system. Clinicians may be able to leverage existing workflows, decision-support tools, templates, and standardized reports to ease the transition into MIPS. One vendor clearly laid out the 24 QPP measures its system will support in 2017. Three of those measures are for cancer screenings and two are for preventive care.

MN Community Measurement has submitted an application to become a Qualified Clinical Data Registry (QCDR). Once approved, clinicians can use MNCM as a registry submission method to report on approximately 10 measures, one of which is Q113 Colorectal Cancer Screening.

“In working with clinicians to understand QPP, 2017 really is a transitional year for most of them,” said Candy Hanson, Stratis Health program manager supporting clinician participation in QPP. “For many, the program is making them take a bigger step toward using their population data and to understand the future of payment based on quality and cost effectiveness.”

Consumer view on value in cancer care

Many patients expect health care organizations to already be meeting quality standards. When asked what value in cancer care means to them, members of the Stratis Health Community Outreach Committee said:

  • Whole person, person-centered/directed care
  • Prevention
  • Early detection
  • Education
  • Quality of life
  • Ability to connect with your doctor or oncologist
  • Support from the whole care team
  • Advocacy of treatments
  • Meaningful research

Many of these answers align with the QPP Advancing Care Information or Improvement Activities categories, like “Patient-Specific Education” and “Engagement of patients, family, and caregivers in developing a plan of care.”

We invite you to review Minnesota’s new cancer plan to see how it aligns with your strategies and ability to succeed in the Quality Payment Program.