What is Quality Measurement?
Over the last fifteen years, the focus on the quality of health care has been tremendous. This has led to an upsurge in quality measurement and in the number of quality measures available. Measurement results highlight that the U.S. health care system falls short of delivering universally high quality and safety; but measurement along with financial incentives to improve care can make a difference. There are different kinds of quality measures. For example, many measures assess whether health care providers follow the right care processes or have the right care structure in place. These can provide constructive insights for health care providers. For health care purchasers and consumers, measures of clinical outcomes, patient experiences in receiving care, and patient reported outcomes measures may be the most salient. Some measures use insurance claims information, some rely on clinical data from medical records, and others require data from patients and other sources.
Why Should Employers and Other Health Care Purchasers Care About It?
For employers and other health care purchasers, it is critical to assess the value of the health care they buy and ensure their populations have adequate information to make informed health care choices. Focusing on where quality falls short also highlights where purchasers should push for improvements. First, however, purchasers must understand how to measure quality, where and how quality is failing, the role of public reporting and transparency on quality performance, and how it can be integrated with financial incentives for health care providers.
Given that there are so many measures, many employers and other health care purchasers wonder which quality measures really matter. To answer this question, CPR conducted an analysis on which clinical areas are costing employers the most, but where they are also receiving the uneven quality and paying the widest range of prices. From there, CPR identified the best quality measures in existence—focusing on outcomes measures where possible—to gauge the performance of health care providers in these areas, along with important cross cutting measures. CPR calls this list of best available measures for purchasers “the Quality Measures that Matter” (QMM). Tracking progress against these measures can help a purchaser better gauge the value of the health care they are buying.
What Are the Latest Trends in Quality Measurement?
Where does the quality measurement movement stand?
- Federal and state governments require all kinds of quality measurement for Medicare and Medicaid programs.
- Commercial health insurance plans, which used to have proprietary measures, now almost all use measures endorsed by the National Quality Forum (NQF), a consensus building organization.
- NQF has far more endorsed measures than the number that actually get used. Focusing in on a core set of measures on which to collect data will help providers focus their improvement efforts. However, it may be impossible to find a core set of quality measures that meets the needs of all stakeholders.
How Can Purchasers Utilize Quality Measures as Part of a High-Value Strategy?
- Purchasers should integrate the QMM into health plan sourcing, contracting and management so that health plans must report on the QMM—all results, not just positive ones—to both self-insured customers and to patient members.
- Purchasers can assess many of the QMM with claims data. Working independently or with a data warehouse, purchasers can measure the quality of care for their population and use results to push health plans and providers to improve.
- The QMM can also be used in direct contracting relationships between purchasers and health care providers.
- Purchasers can also push vendors that supply consumer-facing quality and price transparency tools to include any of the QMM for which they have access to data.
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