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July 21, 2016

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The National Quality Strategy and The Public Sector [Slide 1]

Operator: Ladies and gentlemen, thank you for standing by. Hello and welcome to this Webinar: The National Quality Strategy and the Public Sector: Federal Agency Alignment to the Six Priorities. I would now like to turn the conference over to Heather Plochman. Please go ahead.

Housekeeping [Slide 2]

Heather Plochman: Thank you for joining today's National Quality Strategy Webinar. On your screen you'll see a few housekeeping tips for today's Webinar. You can submit any technical or content questions via the chat box to be answered during the Webinar. If you lose your Internet connection, please reconnect using the original link that ReadyTalk emailed to you; if you lose your phone connection, you can redial that phone number to rejoin as well. We've also included a number for ReadyTalk support and a link for closed captioning if you need either of those services during today's Webinar.

Agenda [Slide 3]

Heather Plochman: Today's agenda will focus on Federal agency alignment to the six National Quality Strategy priorities. First Dr. Nancy Wilson, Executive Lead for the National Quality Strategy, will give a brief overview of the Strategy and the Agency Specific Planning process. Then, Dr. Peter Briss from the Centers for Disease Control and Prevention (CDC) will discuss CDC's support for the Strategy. After that, Dr. Christine Hunter will discuss the Office of Personnel Management's (OPM's) 5-year health care quality journey. We'll finish up with the question and answer period where you'll be able to ask questions to our presenters.

The National Quality Strategy and The Agency Specific Planning Process [Slide 4]

Heather Plochman: Now, I'll turn it over to Dr. Nancy Wilson.

History of the National Quality Strategy [Slide 5]

Nancy Wilson: Thanks, Heather. What I want to do on this slide is to give a brief history of the National Quality Strategy for folks on the line who are newer to this quality improvement effort. The National Quality Strategy is a framework to improve the delivery of health care services, patient health outcomes, and population health. That was what the U.S. Department of Health and Human Services (HHS) charged us with, which is why the framework is broader than just health care—it really is health and health care. Lots of folks had input into developing this and ensuring relevant areas were covered by the Strategy. I think that it continues to resonate, now that's it's been 5 years since the Strategy began, because of its focus on better care, healthier people and communities, and affordable quality care. Next slide.

Timeline of the National Quality Strategy [Slide 6]

Nancy Wilson: Here you'll see a timeline of major events in recent years that have contributed to the strength and growth of the Strategy, in both the Federal government and the private sector. The National Quality Strategy's six priorities continue to resonate with individuals and organizations across the health and health care industries, who then adopt the Strategy, because [the priorities are] so universal: patient safety, person- and family-centered care, care coordination, reducing the leading causes of morbidity and mortality, promoting best practices for healthy living, and affordable care. So, this 2010 to 2016 timeline shows where we've been moving, and that we're well launched on our journey, but we still have a ways to go.

The National Quality Strategy: How It Works [Slide 7]

Nancy Wilson: This is an interesting slide that tells you everything you need to know about the National Quality Strategy, and how it works, in one circle graphic. What we're talking about here is how stakeholders can embrace the National Quality Strategy. You adopt the three aims, you focus on the six priorities, and you figure out what lever you can apply to your organization based on your core business functions.

CDC Support for the National Quality Strategy [Slide 8]

Nancy Wilson: Now, it's time to really see how people are embracing the National Quality Strategy and incorporating that into the work that they do. First, I'd like to tell you about Peter [Briss]. I've known him for a long time, and he's been a stalwart champion of health care quality at the CDC and with the U.S. Public Health Service for 23 years. He has diverse health care interests, including lead poisoning, vaccine preventable disease, tobacco cancer, heart disease, oral health, the list goes on. Peter is a broad thinker about the question of how do we improve health care quality—not just for specific diseases and conditions, but for the whole health care system in general. With that, I'll turn it over to Peter.

The Centers for Disease Control and Prevention (CDC) works 24/7 to address challenging health priorities [Slide 9]

Peter Briss: Thank you for that, Nancy. The Centers for Disease Control and Prevention (CDC) works 24 hours a day and 7 days a week to address many challenging health priorities at home and abroad. These include improving health security against disease threats, anti-microbial resistance, foodborne illness, health care associated infections, and many more. We work to prevent the leading cause of illness, injury, disability, and death. The top 10 leading causes of death account for 75 percent of all deaths in the U.S., and cardiovascular disease, stroke, and cancer together account for more than 50 percent of the Nation's deaths.

The Centers for Disease Control and Prevention (CDC) works 24/7 to address challenging health priorities [Slide 10]

Peter Briss: Importantly, we work to strengthen public health and health care collaboration to better align efforts to increase the value of the Nation's health investments. We partner with providers, we work to increase the use of community and clinical preventive services, and we use data to improve population health. All of these actions help reduce burden on the health care system, improve health care quality, and improve population health, and therefore, they support the National Quality Strategy.

Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease [Slide 11]

Peter Briss: So, let's delve into a few of the specifics. The National Quality Strategy talks about promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease. Why cardiovascular disease? Despite progress, this remains the leading cause of death in the United States and, in response, CDC leads the Million Hearts Initiative. This year, for example, we are working to drive development and implementation of standardized treatment protocols, action steps, and other support to improve the treatment of hypertension and tobacco use. We've displayed performance on the ABCs, which are appropriate aspirin use, blood pressure control, control of cholesterol, and smoking cessation on a clinical quality measure dashboard, representing the quality of care delivered to millions of Americans and making information about that care more accessible and transparent.

We've recognized 18 new hypertension control champions, who range from solo physicians to large health systems, for achieving high rate of hypertension control and we've disseminated their best practices to try to help others excel. Finally, we've developed and worked to deploy new performance measures related to the treatment of cholesterol and tobacco use.

Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease [Slide 12]

Peter Briss: Here, you see our additional work related to cardiovascular disease. Despite progress made, 40 million Americans still smoke, contributing to heart disease, stroke, cancer, and a host of other ailments. In response, we work to develop and deploy new quality measures related to the delivery of tobacco cessation intervention in hospitals and measurements of population-level smoking prevalence. We've also worked with the National Business Coalition on Health to help employers better evaluate health plan performance in delivering these essential interventions.

Promoting the most effective prevention and treatment practices for the leading causes of mortality [Slide 13]

Peter Briss: Cardiovascular disease isn't the only leading cause of mortality where we can do better. Cancer is the second leading cause of death in the United States, and to address this issue, CDC's National Breast and Cervical Cancer Early Detection Program ensures that low-income uninsured and underserved women receive timely breast and cervical cancer screening and diagnostic services. This year, the program has developed a new performance reporting and management system based on 11 core quality indicators related to screening, diagnostics, followup, and treatments.

CDC has also produced important provider-oriented tools and supports, including a medical education module for quality colorectal cancer screening, a gynecologic cancer curriculum, and a secure Web-based application for hospitals and providers to use already-collected cancer surveillance data to help them develop care plans for cancer survivors. Next slide.

Promoting the most effective prevention and treatment practices for the leading causes of mortality [Slide 14]

Peter Briss: Today, there are 29 million Americans who have diabetes and an additional 86 million who have pre-diabetes, whose care results in economic costs of nearly $250 billion annually. To address this issue, we've provided funding and technical assistance to State health departments to increase access to diabetes self-management education programs to improve hemoglobin A1C control and to increase the number of health system accessing and monitoring data on this control. We're also funding a 5-year program called State Public Health Actions to Prevent and Control Diabetes, Heart Disease, Obesity and Associated Risk Factors and Promote School Health, which is working in all 50 States and the District of Columbia. This program reached more than a million people this year with diabetes management self-education programs.

Promoting the most effective prevention and treatment practices for the leading causes of mortality [Slide 15]

Peter Briss: Opioid misuse, abuse, and overdose are serious and emerging health care problems. This year, we published the CDC Guideline for Prescribing Opioids for Chronic Pain to provide recommendations for the prescribing of opioid pain medication for adults in primary care settings, as a way to ensure that opioids are prescribed safely and effectively.

Working with communities to promote wide use of best practices to enable healthy living [Slide 16]

Peter Briss: Another key area of work for us is that we work with communities to promote best practices to enable healthy living, because we won't make adequate progress if we're just working within the walls of the health care system. Four key risk behaviors—tobacco use, inactivity, poor nutrition, and excessive alcohol use account for 40 percent of U.S. deaths. In response, we support State and Local Public Health Actions to Prevent Obesity, Diabetes, Heart Disease, and Stroke, which is a 4-year, $70 million-per-year program that began in 2013 and operates in 17 States and four large-city health departments to address these complex issues. The National Diabetes Prevention Program also reached 33,000 participants nationally in the last year to enhance nutrition and adequate physical activity to prevent or delay the onset of type 2 diabetes.

Making care safer by reducing harm caused in the delivery of care [Slide 17]

Peter Briss: We also support the National Quality Strategy by working to make care safer. CDC works closely with many partners to improve patient safety and health care quality, including health care outbreak response, infection control, medication safety, immunization safety, and blood organ and tissue safety. This year, for example, we have worked with the White House and a number of other Federal agencies to convene a Forum on Antibiotic Stewardship to accelerate the implementation of activities under the National Action Plan to Combat Antibiotic Resistant Bacteria. We publish something called the CDC Guideline: Core Elements of Antibiotic Stewardship Programs in Nursing Homes to improve the use of antibiotics in those settings. Finally, we support over 18,000 health care facilities enrolled in the National Healthcare Safety Network and assist them with tracking and using data from their facilities to protect patients from health care associated infections.

Ensuring that each person and family is engaged as partners in their care [Slide 18]

Peter Briss: A separate area of our work to support the National Quality Strategy is ensuring that people and families are engaged as full partners in their care. CDC produces the monthly Vital Signs report, along with a host of associated clear-language materials that highlights today's most critical health care problems and guides the public health community, health care providers, and the general public to actionable patient engagement solutions. We work with varied partners including the Ad Council, the American Medical Association, and the American Diabetes Association to launch the first-ever national campaign to increase awareness of pre-diabetes as a serious health conditions.

Promoting effective communication and coordination of care [Slide 19]

Peter Briss: We also work to promote the effective and communication of care, which is another National Quality Strategy priority. Stroke is the fifth-leading cause of death in the United States. During fiscal year 2015, CDC's Paul Coverdell National Acute Stroke Program funded 11 States to work with hospital, emergency medical services personnel, and post-hospital settings to improve stroke care and outcomes by improving coordination across the continuum of pre-hospital, hospital, and post-hospital care. In these programs, adherence to evidence-based performance measures was very high, consistently above 95 percent.

Making quality care more affordable [Slide 20]

Peter Briss: In much of our work, we work to make quality health care more affordable. We partner with the Centers for Medicare & Medicaid Services (CMS) and their Center for Medicare & Medicaid Innovation (CMMI) and State Innovation Models Initiative. Working together, we provide technical assistance to grantees who are preparing population health improvement plans. We have provided data and information for an analysis conducted by the CMS Office of the Actuary to inform expansion of Medicare coverage for the National Diabetes Prevention Program. We're also contributing to efforts that assure inclusion of the National Diabetes Prevention Program is a covered benefit for State and public employees in 10 States, which is more than a million total covered lives.

Going Forward [Slide 21]

Peter Briss: Going forward, CDC will continue to work to improve clinical care that occurs in health care settings, while linking that work to community resources that improve population health.

Questions and Comments? [Slide 22]

Peter Briss: Thank you very much; my contact information is listed here.

Healthier Employees, Healthier Americans [Slide 23]

Heather Plochman: Our next speaker is Dr. Christine Hunter, Chief Medical Officer at the Office of Personnel Management (OPM).

Christine Hunter: Thank you so much and welcome to all of the attendees—I was so impressed with the diverse list of people listening in and hope that we can offer you something this afternoon that will be a takeaway you can apply in your own organizations. I was asked to talk to you this afternoon about OPM's 5-year quality journey. We joined the Interagency Working Group on Quality shortly after the National Quality Strategy was published in late 2011. Like any major employer, OPM is the human resources office for the Federal government—essentially, we are the HR office for the largest employer in America.

And like any major employer and even hospitals and health systems, perhaps you might imagine yourself for a moment in the role of an employer with a large staff with diverse needs. We all want to take care of people who are sick; we want to keep others healthy, especially our active employees; we want to control cost at the benefit margin and in general; and we want to set a positive example. So, OPM embraced the National Quality Strategy and our membership on the Interagency Working Group on Quality and began to think of it as our opportunity not only to improve the health of those that we serve directly—our employees, their families, our retirees, and their families—but to set a good example that others could follow, and in general to improve the health of the pool that we recruit from.

Healthier Americans Strategic Goal [Slide 24]

Christine Hunter: The first thing we did—and I think this is common in all organizations trying to make a framework change—is to say that a good strategic framework needs to incorporate both immediate and long term goals and be able to respond to emerging needs. We were given an opportunity to rewrite our agency's strategic goals, and because any good strategy has to have leadership buy-in, this opportunity to rewrite our agency strategic goals was key to all the progress that followed.

Specific provisions aren't critically important to you, but of course our core business is that we're the human resources shop, we contract for benefits, and so we need to have the benefits that people need and will use, and they need to be smoothly operational. But we also added strategy, and wanted to improve preventive services delivery. Five years ago people were just beginning to talk about what's upstream of the episode of care. We also wanted to reach out to develop partnerships in support of population health efforts, some of which Dr. Briss mentioned, like Million Hearts. We also partnered with folks as diverse as the Medical Group Management Association, the National Prevention Council, and accreditors like the National Committee for Quality Assurance and URAC, the National Business Coalition on Health, and America's Health Insurance Plans, as well as colleagues at the Department of Defense, the Veterans Administration (VA), and HHS.

We felt we needed to enhance outreach in health literacy as well, because people can't take advantage of things that they don't understand. And our primary tools for executing all of our quality improvement work are the Federal Employee Health Benefits Program (FEHB) and the insurance benefits that we offer, and I'll explain those in just a minute. We also have our Work Life Program, through which OPM sets the rules for many other Federal agencies on things like telework, time off, lactation support in the workplace, tobacco-free-workplace rules, and those sorts of things.

Federal Employees Health Benefits Program [Slide 25]

Christine Hunter: So, what is FEHB? This is America's largest employer-sponsored group health insurance program. We have 8.2 million Federal employees, retirees, and family members covered with our program. We give broad choices: members choose from plans currently offered in their area. Nationally, we're contracting with 97 health insurance carriers to offer 250 plan options. We operate in every zip code in America and many overseas. Our members need to have a choice of health care that meets their time in life and is responsive to the medical circumstances of themselves and their family. We set some boundaries to our plans, what plans must cover, and in general you'll see those in the gray box: everything from preventive care to emergencies, traditional hospital care, mental health, and newer services like lactation support and tobacco-cessation counseling and wellness.

Promoting Effective Communication [Slide 26]

Christine Hunter: As I said on the last slide, if people don't know how to use their benefits and they don't known what was or wasn't in them, then we can never achieve the population of healthier employees and families that we're striving for. We don't get the community outreach, the penetration, or the sticking power. So, we have embraced a number of newer communication strategies to try to help employees and families become partners in their health, and on this last slide you see one of our employees, Amber Hudson, who will be conducting a Twitter chat just before our Open Enrollment season each year to let people know a little bit more about the choices and benefits they have, and why they might want to shop around for better rates, for different wellness benefits, or for time-of-life benefits like acupuncture, chiropractic, and fertility. All of our plans have free preventive care. We added self-plus-one enrollment options, to accommodate today's modern families, and we immediately embraced same-sex spouses as soon as the rules about that changed. At present, we have a plan comparison tool that's undergoing some modernization and drug pricing tools. Employees, families, and retirees are always worried about whether they can comply with the health regimens, whether there are physicians with advice for them, or whether or not drug costs will determine someone's ability to adhere to a particular prescription.

Preventing Leading Causes of Mortality [Slide 27]

Christine Hunter: We started off in the traditional space. I think every employer, every health system, and every community is concerned about taking care of people at the top of the pyramid. People in that little red triangle that have complex medical health needs, may require a lot of care coordination, and who may require care that's going to be expensive and complex. We said, to make an impact on that, beyond things like patient-centered medical homes and to coordinate care, we need to prevent leading causes of morbidity and mortality.

We rapidly joined CDC's Million Hearts initiative, and did a number of things to try to reduce the rates of cardiovascular disease and stroke among the Federal employee population. A particularly successful effort was our tobacco cessation campaign; we were early adopters of free tobacco cessation benefits. Benefits part of all of our plans offer tobacco cessation counseling, multiple attempts per year, and over-the-counter as well as prescription drugs as a completely free benefit. No cost sharing, no co-pay, and you can get it at least twice a year. We recognize that it may take people as many as five attempts to quit successfully.

Each year we do a survey of about 40,000 employees to look at the prevalence of tobacco use. I'm pleased to share with you that our survey this year shows that only 10.6 percent of Federal employees are currently using tobacco, and that number continues to decline each time we do the survey. We're proud of that. We cannot prove that employees are using our benefits exclusively, but in fact it doesn't really matter to us if they're using a quit line, if they're using peer support, etc. The idea is that we made them aware that they have a free benefit, that we endorse quitting, and we'd like to help them; and that they go out and embrace whatever resources are most suited to their intention to quit.

We have covered preventive services since 2012 at 100 percent coverage, so there's no cost sharing out in front of the deductible, no co-pay, and, like Dr. Briss mentioned, some of the key efforts in there involve things like diabetes prevention and cancer screening. Moving a little bit more deeply into Million Hearts, we realized that if people quit tobacco and got preventive care, we still have to address modifiable risk factors, including blood pressure control, that result if uncontrolled in people who are at much higher risk for heart attack or stroke. I'll share a little bit about the measure set we use for all health plans. Within our measure set, we put the hypertension control measure at the top, and we rate all health plans and link their profit according to the extent to which they're able to assist their members in controlling blood pressure. We've been looking at a variety of things recently, including medication adherence and cardiac rehab.

Enabling Healthy Living [Slide 28]

Christine Hunter: Physical health is only one dimension of total health and well-being. Enabling healthy living, we felt, begins with mental, physical, spiritual well-being all being in balance and that we needed to focus on mental health as a key component of well-being. When the National Quality Strategy was implemented back in 2012, and certainly since then, there's an ongoing stigma to people being upfront with mental health concerns and diagnoses. People often will postpone getting help until they are in crisis, and so our first step was to promote our employee assistance programs, which reach out to people at the lowest level and address concerns that they may have about themselves, a coworker, or family member. We also work with the Substance Abuse and Mental Health Services Administration (SAMHSA) to promote the National Suicide Prevention lifeline to all employees. We join our colleagues in the VA to say if you save a life that's not one of our lives, it doesn't matter, it is still a saved life. We feel like suicide prevention is absolutely critical, and the more people are aware of crisis action hotlines and ways to get help quickly that it is a benefit to our society in general.

More recently, we have moved toward addressing the opioid epidemic. Not only in publishing what we think are responsible prescription controls that generally align to the CDC guidelines that Dr. Briss told you about earlier, but improving access to care. We found many of our plans either didn't fully embrace the medications that can be used to address opioid addiction—perhaps they didn't have qualified prescribers in their network, perhaps they weren't doing anything to reach out to the community and say can we help more doctors get training for this, perhaps reversal agents weren't on the lowest tier in the formulary. We have worked diligently in the last year to try to improve access to medication-assisted therapy, to a variety of settings of care, and to reversal agents like Narcan.

Our latest effort has been work with the White House in enforcing parity in mental health benefits, which says that mental health benefits should be offered equally with physical and other health benefits. Again, we want benefits that people should know about and know how to use, and we believe that we ought to assist them in making that transition so that this becomes part of the general vocabulary.

Enhancing Affordability [Slide 29]

Christine Hunter: All of these efforts have to take place in a setting of constant communication, where we contact health plans, who contact many of you who are on the phone, with health systems, providers, and group practices. We needed to align ourselves with systems of measurement that were common in the health care world, but one of our concerns when we looked at a variety of measures in use in other contexts was the number of measures available and the so-called measures fog that everyone ranging from providers in exam rooms to hospital and health plan executives can quickly become overwhelmed with. In choosing measures, there are principles that they be relevant to our population specifically, that they be actionable at the health plan level, and that they'll be harmonious. We have 19 measures with an external benchmark. We found that by comparing ourselves to other government agencies or only comparing within our FEHB portfolio, we might be giving gold stars to people who are really only a C+ in comparison to the best of the best, so we use an actionable external benchmark for our measure set.

We began collecting data well before 2010, and started scoring plans in the run-up for this for 2012 and began posting them publicly right around that time. Of course, we enforced our accreditation standards, and we are now in the first year where each health plan's profit is directly linked to their performance on those 19 measures. This creates dramatic alignment, putting our money where our mouth is. We have our strategic plan, our clear set of priorities, and we're aligning our payment systems with that. We're also mindful that this kind of thing can drive unintended consequences, and we're always watching for that, but we're anxious to purchase value-based care and to learn from others who are doing so.  

Making Care Safer [Slide 30]

Christine Hunter: One must always be mindful that doing all those things on the front end doesn't help us if care delivered is not safe. Back in 2012, we begin our efforts with the partnership for patients in ensuring timely prenatal care and reducing early elective deliveries through “Hard Stop” policies. You might think that people who have health benefits have no barriers to accessing timely prenatal care in all of the communities in which they live and work, but it turns out that's not the case. We have partnered with March of Dimes in their “Go Before You Show” campaign because women weren't as acutely aware of the importance of going into the doctor early in a pregnancy. We think that early elective deliveries can be less common than they are now, and we joined with many others on a maternity action team: the American College of Obstetrics and Gynecology, the Childbirth Connection, CMS, HHS, and the March of Dimes to help promote Hard Stop policies. So I hope all of those of you who are on from hospitals have those policies in place. We ask our plans to preferentially contract with hospitals that have Hard Stop policies in place. So, if you tried to admit a woman for labor induction without a medical indication before 39 weeks, the patient would be transferred to the head of maternal-fetal medicine, who would then have a conversation about the medical implications for that procedure rather than convenience implications. I'm proud to say many States have achieved the goal of getting below 5 percent early elective deliveries, and congratulations if you are among them. We're also engaged in preventing all-cause readmissions. CMS focuses on cardiovascular disease and pneumonia among others, but we are interested in all-cause readmissions, and particularly mental health. We have a number of programs in place to affect that without patient bounce-back.  

We're also proud to say that we are working with CDC on encouraging antibiotic stewardship, and would welcome anyone's suggestions as to how health plans and employers can get involved in that very, very important movement.

2016 and Beyond [Slide 31]

Christine Hunter: So, continuing the journey, we are very attentive to laws and regulations on the Medicare Access and CHIP Reauthorization Act (MACRA) and the Merit-Based Incentive Payment System (MIPS), which are the new Medicare payment formulas and delivery system reform efforts being championed by CMMI.

We're also looking at supporting a variety of other initiatives, including accountable care organizations that we think may enhance our ability collectively to get to quality health outcomes. We are constantly curating our measure set because when our plans achieve success on one measure we want to reward them, but we want to immediately substitute another so that there is growth and continuous improvement.

All of this would not work if people don't have access to care, so one of the areas we're looking at reinforcing is our access to mental health care, which I already explained. I knew expansion of autism services served a particularly vulnerable group of children, and expanding applications of telehealth across the board, from urgent care that's acute but not serious, all the way up to the modulation of chronic conditions through telehealth interventions and tele-mental health, are all other ways that we are working to increase access to care. This is especially helpful in the mental health space, ensuring that folks get timely followup after hospitalization.

Questions? [Slide 32]

Christine Hunter: I thank you for your attention this afternoon. You can see on the slide that you are welcome to contact my associate Sheila Pinter should you have questions or comments for OPM. Thank you, Nancy.   

Discussion/Question and Answer [Slide 33]

Nancy Wilson: Thank you both for explaining what's happening behind the scenes in the Federal government in terms of health and health care quality improvement. I'm going to turn it over to Heather, who will open it up for questions.

Discussion/Question and Answer [Slide 34]

Heather Plochman: Thanks, Nancy. I'm going to start asking a couple of questions coming in through the chat box. This question is for Peter. Do you encourage cooperation between medical and police authorities in reducing opioid misuse?

Peter Briss: Yes, most big health problems are going require multiple-sectoral approaches to really make progress.  You're unlikely to fully address them working in just health care or any other sector. So, as I said in my main text, linking health care settings to community settings is really important. Now having said that, when you're talking about opioid misuse, I'm not personally convinced that it's primarily a criminal justice problem. I'd say that there is a lot of stuff that a variety of sectors are going to be able to do that will help.   

Heather Plochman: Thank you. The next question is for Dr. Hunter. What constitutes a high-quality consumer-friendly insurance product? Does it include incentives to avoid low-value or even harmful care?

Christine Hunter: A high-quality consumer-friendly insurance product does include incentives, but our incentives are primarily for the health plans that we contract with. We have a minor program of incentives for employees, but we are a little bit more restricted as public-sector employees. I mean, in the private sector, employers can offer generous incentives for particular behavior. For example, we cannot change the premium based on someone's tobacco use status—we're not legislatively permitted to do that.

In general, when we are talking about high-quality, we're talking about a member who picks one of our plans, who knows that we are surveilling how that plan produces health outcomes in conjunction with the physicians and health systems that they offer, and that we will curate the set of benefits to meet the needs of our employee population to the greatest extent and will put those things out in front of cost sharing of the deductible that we feel are critically important.

Heather Plochman: Thank you. The next question is for Dr. Briss. Are there specific programs you discussed that health plans are participating in, focused on the Medicaid population?

Peter Briss: One great example in Medicaid has been funding the whole spectrum of tobacco cessation therapies and widely publicizing the availability of those strategies. This is along the line of the work that Dr. Hunter described that OPM is doing. We know from Massachusetts, for example, that making these things available to Medicaid recipients and publicizing it broadly can result in big impacts on tobacco use, which is still the leading cause of death in the State.

Heather Plochman: Great. Our next question is for Dr. Hunter. One of the items that you mentioned was smoking cessation. Do you believe that new approaches and initiatives are needed in the future to encourage smoking cessation?

Christine Hunter: Thanks for that question. We have been pleased with our progress, but 10.6 percent is not zero percent. And when we survey members, we find out that nearly all think actively about quitting, but many don't know that they have facilitated opportunities to do so. Our focus has been on encouraging employees to use the resources that we do give them, and our family members and retirees that are a little bit harder for us to reach directly. We want to bring those strategies home and to make them accessible right where people do their everyday shopping. We want to be sure that things like the corner drugstore chain's tobacco cessation program is fully covered by the FEHB plan, so it's close and accessible. I think the questioner may be asking about things like e-cigarettes as a gateway to stopping or starting; we're reading that literature with interest, but we haven't taken any specific position on that with respect to cessation.

Peter Briss: I'll add to that answer. We know a lot about what works in smoking prevention and smoking cessation; the whole spectrum of evidence-based therapies, as I've said already, approaches including pricing, strategies, and smoke-free area strategies and hard-hitting mass media, all of those things work. The 50th Anniversary Surgeon General's Report, published in 2014, talked about a range of other additional emerging tobacco cessation strategies and tobacco prevention strategies that might help us get to the end of the epidemic faster, including reducing the amount of nicotine in cigarettes.

Heather Plochman: Thank you for that answer, Peter. Our next question is for Dr. Hunter.  Where can I find a list of the 19 quality measures OPM is using?

Christine Hunter: You can find it at OPM.gov, our Web site. If the questioner would like to email Sheila Pinter, her contact information is listed on my last slide; we'll send you a direct link to the measures. All of our communications with our health plans are public, in the public domain, and listed on the Healthcare and Insurance section of OPM's Web site. That particular communication carries a tag of 2015-10 if you'd like to look for the particular document.

Heather Plochman: We have another question for Dr. Hunter. You mentioned the concept of external benchmarking. What characteristics were looked for in terms of deciding which entities were selected for comparison, beyond just organizations providing similar services?

Christine Hunter: I'll take that question—it's a great question, and the answer is that we require the nationwide commercial benchmark. We felt that health care was and is somewhat originally driven by the adoption of particular protocols, and the availability of services. So, while States' benchmarks are of interest to us, our focus has remained making sure that Federal employees, to the greatest extent possible, get care that rivals the best available in the commercial sector in the United States.

We don't currently have any measures in the set that are restricted to members over 65, but we're contemplating some. We would consider a Medicare benchmark, and we will take the measures they benchmark from any measures steward that can make them available in an audited manner. We won't just take a benchmark reported in an email; we have to see that the benchmark is as auditable as our collection of the measures. Thank you.

Recent National Quality Strategy Updates [Slide 35]

Heather Plochman: Great. Thank you Dr. Hunter. And before we close, we wanted to give a couple of recent National Quality Strategy updates. The 2015 National Healthcare Quality and Disparities Report and 5th Anniversary Update on the National Quality Strategy was recently published. We've included the link here, and this report featured key data updates and progress made at the 5-year anniversary of the NQS.

Recent National Quality Strategy Updates cont'd. [Slide 36]

Heather Plochman: In recognition of the Strategy's 5-year anniversary, the National Quality Strategy released a toolkit for stakeholders to use. It includes promotional materials, graphics, Web content, and more, that you all can use and tailor to your specific needs to share your successes and progress throughout 2016. So we've included the link to that here as well.

Thank you for attending today's presentation! [Slide 37]

Heather Plochman: Thank you all so much for attending today's presentation. The presentation archive will be on the Working for Quality Web site in the coming weeks. We've also included the links to the 2016 Agency Specific Plans here, and there are additional plans up there beyond CDC and OPM for you to take a look at. Agencies participate in this Agency Specific Plan process each year, and come to the table with new programs and initiatives each year aligned with the National Quality Strategy. Thank you, and we'll conclude the Webinar.

Nancy Wilson, Peter Briss, Christine Hunter: Thank you all for attending today's event.