Mark McClellan, M.D., PhD, Director, Engelberg Center for Health Care Reform, Carolyn Clancy, M.D., Director, AHRQ, speaking at a Capitol Hill briefing, emphasized the need for valid, timely, and consistent information on the quality and cost of healthcare to be made available. The Engelberg Center for Health Care Reform at Brookings, along with support from the Robert Wood Johnson Foundation hosted the July 30th briefing to underline how more complete and collaborative information would help to achieve high value healthcare.
Michael Painter, JD, M.D., Senior Program Officer, Robert Wood Johnson Foundation pointed out that in order to achieve a high value quality healthcare system, forces have to be aligned in the community, key stakeholders have to work together not only statewide, but also regionally and locally, plus the public has to be engaged.
According to Dr. McClellan, effective health IT in terms of electronic records not only plays an important role in improving quality and care coordination between patients and providers, but it is also important for payers because by using the data, they are able to evaluate care and be in a better position to provide support through incentives.
Dr. Clancy noted that the AHRQ’s “2008 National Healthcare Quality Report” sees the immediate need for a virtual infrastructure to measure and report on quality and costs. The infrastructure would collect information systematically, analyze, and then summarize the data for information on safety problems and better evidence on effectiveness.
A paper produced by the Quality Alliance Steering Committee (QASC) describes the road to high-value health care and how to develop the infrastructure needed for meaningful quality measurement and reporting. Formed in 2006, the QASC is a collaborative effort of physicians, nurses, hospitals, health insurers, consumers, employers and other purchasers, government, and sector specific quality alliances.
QASC is involved in a range of activities locally, regionally, and nationally and has statewide pilot projects underway in Florida and Colorado. These pilot projects are collecting data from multiple health plans and will compute the results for 17 NQF-endorsed measures. The data includes composite measures for ambulatory care, preventive care medication management, and measures for diabetes, heart disease, lower back pain, arthritis, and depression.
The pilot projects are working with health plans in the two states, with CMS, and with America’s Health Insurance Plans Foundation. Other pilot efforts are going to collect and combine clinical data to include lab results and registry information from specialty societies and other entities including claims data. Also, as part of the “High-Value Health Care Project”, multiple efforts are currently underway to address the best practices for collecting data on race, ethnicity, and language that needs to be standardized and supported by patients and consumers.
In addition, there are other efforts underway in several parts of the country to measure and improve performance to determine the most effective way to promote consistent and comparable quality measures across regions. At this time, QASC is creating a network of regional measurement sites to identify effective, efficient, and widely applicable measurement practices that will be replicated and implemented across the nation.
QASC’s goal for 2010 is to launch 7-10 pilots to produce additional performance measurement results that will rely on selected clinical data elements. These new pilots will address how to measure healthcare disparities and how to efficiently collect information on care experience and resource use.
As for 2011, the goals are to launch 7-10 new pilots to produce further performance measurement results from not only clinical data but also from HIT systems. For 2012, new projects as needed will be launched to produce clinically sophisticated performance measurement results.
Several panelists at the briefing contributed their thoughts on the topic. Panelist John Tooker, Executive Vice President and Chief Executive Officer, American College of Physicians discussed how complex it is to effectively manage chronic diseases. He pointed out that a great deal of information is needed for each patient and this means that each physician is required to interact with many physicians to treat the patients needing chronic care management. Physicians are required to deal with not only complicated but also with enormous amounts of information. As a result, how the data is presented and used can greatly affect quality and the cost of healthcare.
Steve Findlay, MPH, Health Care Analyst and Managing Editor of “Consumer Reports Best Buy Drugs,” looking at the problem from the consumer’s viewpoint, can see how overwhelmed consumers are with choices and information. As he sees it, in order to obtain good quality care, not only providers but also consumers are greatly in need of outcomes and measurement information.
Jim Chase MHA, President of Minnesota Community Measurement a non-profit collaborative, supports greater transparency. The group includes medical groups, clinics, physicians, hospitals, health plans, employers, consumer representatives and quality improvement organizations. According to Chase, one of the most promising results is that in the five years that the organization has been measuring which medical groups are providing optimal care for their patients with diabetes, the number of people receiving the best possible care has almost tripled.