b'Hospice Enrollment InitiativeMOQC has been collecting performance data on QOPI End of LifeNewApproachNewPartnerships!Measure 47, hospice enrollment, palliative care referral/services orBeginning in Fall 2018, MOQC medical oncology practices documented discussion for many rounds. The overall performance ofpartnered with hospices from across Michigan with the goal of the collaborative has not shown an improvement in hospice enrollmentincreasing enrollment to hospice care. Several projects were or documented discussion (EOL Measure 47a), when compared toidentified for implementation in each region under this initiative. QOPI. See data below, for most recent Round 1, 2019 data.The projects will be part of a statewide toolkit that will be accessible to all of our practices on our website moqc.org. The QOPI Measure EOL47a tools that will be available for any practice to use include: 100% 100% pamphlets for starting conversations about hospice care with 94%88% 89% patients and caregivers83%75% 77% 79% 79% 80% 81%71% 74% an infographic comparing palliative care and hospice80%60% 60% 60% 62% 63% 63% 66% 67% 68% 68%Proportion 60% 44% 44% 45% 46% 50% 50% 50% 50% 51% 58% 59% information sheets 40% 43% letter templates to facilitate communication between hospices 34% 38%32%24% 26% and MOQC medical oncology practices20% access to education about hospice for clinicians. 0% 0% Practices are encouraged to use any of these resources to start 39 7 48 108 5 26 6 91 106 80 59 18 22 102 107 68 13 MOQC 73 96 71 29 100 49 50 66 27 101 85 2 25 21 20 109 64 81 19 104 4652 QOPI discussions with patients and caregivers about end of life earlier in Practice and Comparative Groups the disease process. Sharing accurate information and addressing Since 2015, MOQC has not demonstrated improvement in thisgoals of care can help dispel misperceptions about hospice. area of care. The American Society for Clinical Oncology (ASCO)This initiative represents a unique collaboration between medical guidelines support the initiation of discussions about end-of-lifeoncology and hospice providers. MOQC is also collaborating with care preferences early in the course of cancer, and readdressinghospice physicians and radiation oncology physicians to develop an the topic based on clinical events or patient preferences. Theagreement for the use of palliative radiation therapy in hospice. There benefits of hospice to cancer patients includes:is variation in the availability and frequency of palliative radiation Improved survivaloffered by hospices and radiation oncologists, and there is significant Reduction of high-risk or high-burden interventions such opportunity to improve care in this area. We hope that this initiative will as futile chemotherapylead to more effective and efficient care, and truly make a difference for cancer patients and their caregivers in the state of Michigan.Reduction of high-intensity healthcare utilization and costsHowLongwillthisTake?Improvement in health related quality of lifeMOQC anticipates that this is a multi-year, multi-project initiative. BarrierstoImprovements There are layers of intersecting factors that impact practices Due to lackofknowledge and misperceptions, hospice is notand hospices ability to enroll cancer patients. We introduced used early enough for cancer patients to optimize the benefitsthis project in Fall of 2018 and our goal is to demonstrate an of hospice. Misperceptions about hospice and stigma aboutimprovement at both the region and State level that is sustainable death are pervasive. Many people associate the word hospiceover the next three to five years. We will be reporting on hospice with death and giving up on care, as opposed to an alternativeenrollment at every regional and biannual meeting. approach to care. Patients believe that if they enroll in hospiceHowWillWeKnowifWeImprove?they will no longer be able to receive pain medication andThree end of life measures in the current MOQC Med Onc track antibiotics for symptom management. Providercharacteristicsdeal with hospice enrollment.are among the strongest predictors of whether or not a patient receives hospice care. Most physicians receive little skills trainingTwo of the three measures are tied to annual BCBSM-MOQC value-about communication at end of life. In addition, prognosticationbased reimbursement (VBR).of when death will occur is inherently difficult and this degreeBCBSM-MOQC of uncertainty becomes a reason not to refer. Oncologists mayValue Based QOPIReimbursement Measurebecome reluctant to refer their patients because of unclearQOPI Measure Name MeasureNumberresponsibilities between themselves and hopsices in developingHospice enrollmentYesEOL 42and directing patients plans of care. Sometimes, medical oncology practices are not aware that patients have beenHospice enrollment & enrollmentwithin 7 days of death (lowerisbetter)NoEOL 45enrolled in hospice, or even that their patients have died in hospice.Hospice enrollment ordocumented discussionYesEOL 47a6'