Quality Measurement and Health Assessment Group QMHAG

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Quality Measurement and Health Assessment Group
(QMHAG)

• To work with internal and external
• partners to identify, develop, and
• implement evidence based quality
• measures and to provide quality data
• to inform and empower decision
• making by beneficiaries, purchasers,
• providers, consumers, and
• government agencies.

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MMA Mandates

• QIOs to provide quality improvement assistance to
  Part D plans and
• Distribution of comparative information to Part D
  eligible individuals regarding the quality and
  performance of Part D plans

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Part D Quality Measures Contract

• To develop an initial set of measures for the
  purposes of
• Quality improvement
• Monitor and evaluate the Part D benefit
• Based primarily on the PDE data

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Part D Quality Measures Contract

• Awarded to BearingPoint
• Assemble candidate list of Part D measures
• TEP tentatively scheduled for mid-December
• TEP will review and prioritize proposed list of
  measures

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Part D Quality Measures Contract

• Stakeholder Comments
• TEP reconvene
• Technical Specifications
• Measures Testing

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Focus of Part D Quality Measures

• Improving prescribing
• Improving disease-specific therapy
• Appropriateness of Therapy Measures- appropriate
  prescribing and drug regimen for specified
  disease states
• Cost-effective drug utilization
  management/economic impact
• Quality assurance to reduce medication errors and
  adverse drug interactions and improve medication
  use
• Controlling fraud, abuse, and waste -
  overutilization

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Short-term QM Development Goals

• Measures will be selected and developed for
• Quality improvement intervention and patient
  safety for use by the QIOs
• Evaluation and monitoring of the clinical and
  economic impact of the Part D benefit.

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Long-term QM Development Goals

• Identification of those measures that can be used
  for public reporting at the Part D plan level.
• Provide comparative information on MA-PD/PDP
  performance to Medicare beneficiaries to empower
  them in making informed decisions.
• The measures will drive quality improvement
  serving as a tool to evaluate the Part D benefit,
  Part D plan performance, and the impact of the
  QIOs technical assistance.

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Questions?

• Fatima Baysac Millar
• Fatima.millar_at_cms.hhs.gov
• 410-786-3184