Marilyn Tavenner Explains Methods of Implementing, Coordinating Quality Measures

The key in developing core sets of quality measures is looking at coordination of care, cost of care, and quality of care, as methods that all work simultaneously together, explained Marilyn Tavenner, president and CEO of America’s Health Insurance Plans. However, she added that creating a small amount of measures centered upon core conditions and directly tied to outcomes is far more beneficial than creating a hundred new measures.

Transcript (slightly modified):

CMS and AHIP recently worked together to identify core sets of quality measures. What was the importance of doing so?

Well when you talk about delivery system reform, part of what you’re trying to do is get around coordination of care, cost of care, and quality of care. And we think all 3 can move simultaneously. But if you don’t have common agreement on what are the important quality measures, then it’s very confusing for the provider, whether it’s a hospital, a physician or plans, and it’s confusing to know how to measure across different payers.

So it shouldn’t matter whether you’re an employer sponsored insurance or the exchange or Medicaid or Medicare Advantage. We just want common measures that are easily understandable by those people who are providing the care.

What is next for this effort?

Next is obviously making sure we communicate all those measures and that they’re implemented in contracts, particularly in new contracts and modified in existing contracts, so we make sure it’s being implemented across the system. Once that’s accomplished, which will certainly take several months, then we will move to selectively add additional measures, such as pediatrics. We didn’t tackle pediatrics in the first round of measures, but obviously there are a lot of children out there and they need quality measures as well.

So, we will slowly, deliberately and with a lot of stakeholder input, add additional measures. But the goal is not to have a hundred measures. The goal is to have fewer measures that are tied directly to outcomes.

How do you maintain a balance between added new measures, but keeping these sets to just a small number of core measures?

I think you do that by looking at what are the top 10 conditions, or the top 20 conditions, that you’re trying to address and you focus on those. And, you don’t let every person keep adding measures. I think that’s what’s happened over the last several years. Well intentioned. I have to say I was a part of that process but they really, the measures have gotten too numerous to count. They’re not all outcome oriented and providers don’t know, "do I chase this set of measures? Or that set of measures?" And so what we’re trying to do is have one group that applies to all payers and applies to all providers.

Ambitious goal, I admit.