The Measure of Quality Improvement: Current Opportunities and Future Direction

As the appropriate mechanisms for healthcare and Medicare reform continue to develop and gather momentum, health policy authorities and government bodies, especially the Centers for Medicare & Medicaid Services (CMS), have increased their focus on quality measures to assess and compare the extent of progress. In this session at the 2012 American’s Health Insurance Plan’s Medicare and Medicaid Conferences, 2 experts shared their insight in a presentation titled “Beyond the Stars: The Future of Quality Measurement.”

Patrick Conway, MD, MSc, chief medical officer of the CMS and director of the Center for Clinical Standards and Quality, opened the presentation by highlighting the breadth and scope of the CMS’s responsibilities as the largest purchaser of healthcare in the world, averaging $800 billion in expenditures annually, with 425 federal full-time equivalents and approximately 10,000 contractors focused on improving healthcare quality across the nation. The ultimate goal is to deliver better care and better health at lower cost.

Dr Conway emphasized that the desired approach and culture seeks input and actively listens, and that this transformation, where improvement is seen as a strategy, needs to be implemented externally and internally. Other areas of focus, he said, include the customer, process, outcomes, logistics and statistics, leadership, and the approach to continuous improvement that follows a “plan-do-study-act” model. Unfortunately, there is no “silver bullet” or magic solution to the nation’s healthcare woes. As such, incentives must be applied, successful alternatives must be provided, and intensive support must be offered to assist providers with the uphill battle of further improvement.

The transformation of healthcare at the front line consists of at least 6 components: quality measurements, aligned payment incentives, comparative effectiveness and available evidence, health information technology, quality improvement and learning networks, and the training of clinicians and multidisciplinary teams. Furthermore, to accomplish quality improvement goals quickly, interventions need to be focused, targeting the areas where they are needed most.

Currently, the CMS has over 23 quality programs and initiatives designed to facilitate the alignment and improvement of healthcare, with the framework for measurement falling into 6 domains: clinical quality of care, person- and caregiver-centered experiences and outcomes, care coordination, community and population health, efficiency and cost reductions, and safety. According to Dr Conway, the Physician Quality Reporting System (PQRS) has demonstrated the fastest growth in registry reporting and it is expected to increase the frequency of electronic health record (EHR) reporting. The goals of the PQRS are to increase the number of patient-centered outcome measures, enable the exploration of better methods to engage boards and specialty societies, and develop faster feedback loops to clinicians. In addition, the PQRS aims to further align with other quality programs: accountable care organizations improve the quality and safety of patient care while maintaining lower costs and promoting shared accountability across providers; the physician value-based payment modifier adjusts payments relative to performance on cost and quality; and meaningful use of health information technology, such as EHRs, can improve the efficiency, quality, and safety of patient care while reducing health disparities.

Following Dr Conway was Rhonda M. Medows, MD, FAAFP, executive vice president and chief medical officer of UnitedHealthcare. She stated that although quality improvement has exponentially increased since the Social Security Act was passed in 1965, changes need to be applied throughout the entire spectrum of care, and there has to be an alignment of best healthcare practices with managed care to coordinate the optimization of care delivery and quality.

Dr Conway emphasized that performance and quality improvements are transformative; however, we must first ask the right questions and act accordingly. The next phase in achieving quality improvement should include the following actionable steps: (1) coordinated quality assessment and improvement efforts that involve public and private sector initiatives; (2) a gradual transition to evidence-based outcomes measures in comparison to the current predominance of process and program measures; (3) national implementation of standardized, evidence-based measures that have been reviewed by recognized quality metric development entities; (4) development of new measures through a standardized process that has been steeped in collaborative, scientific rigor; (5) coordinated quality improvement activities that will close the current gaps in care, such as aligning patient and physician engagement goals; (6) focused measurements that will be used to improve outcomes, thereby minimizing the administrative burden for health plans, physicians, practice managers, and regulators; (7) maximized use of existing data sources and converting them to actionable information; 8) proactive integration of quality metrics into the development of healthcare technology; (9) leverage of resources, expertise, and best practices; and (10) alignment of cost efficiency measurements where appropriate and relevant.

AHIP 2012 Medicare and Medicaid Conference website

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