Highmark and Allegheny Health Network: Partners in Quality Oncology Practice Initiative (QOPI) measures automation reporting.

Abstract

41 Background: ASCO’s QOPI Participation and Certification processes pose a daunting operational task for oncology practices nation-wide. The standardization and quality improvement initiatives required for Certification involve multiple constituents and often a longitudinal approach to quality and operations management. The human resources required for biannual abstraction can be burdensome given strained resources in an increasingly complex reimbursement environment. Allocating staff for retrospective medical record review requires a steep QOPI learning curve and time away from the clinic. The Allegheny Health Network and Highmark, the Nation’s tenth largest insurer, have partnered to create a monthly QOPI measures automation report which alleviates the burden of a purely human resource-based abstraction methodology. Additionally, 100% of Highmark insured, Allegheny Health Network QOPI qualifying patients are included in a monthly report to allow for near real-time clinical decision support. Methods: A multidisciplinary team was assembled with clinical and administrative representatives from Highmark and Allegheny Health Network. The team worked together in phase I of the project for over eight months to review and select specific QOPI measures that could be tracked through a custom-built, claims processing algorithm. Results: Initial data analysis included over seventy-five automated QOPI measures that would be able to be tracked and trended on a monthly basis – populated from Highmark claims data. The monthly report allows for a larger sample size with data tracking across all QOPI domains and disease sites. The multidisciplinary team has moved on to phase II of the project which will include sensitivity analyses and data refinement. Conclusions: QOPI measures automation is possible through an evolving relationship demonstrated through this unprecedented payer/provider initiative. While some of the QOPI reporting measures could be automated, human resources will still be required for annual abstraction in the on-going QOPI Certification phase. Once refined, automated measures will need to be verified to note changes in claims data and clinical documentation.