1. The Transformative Effect of Quality Reporting Margaret E. O’Kane NCQA President April 11, 2005

2. Presentation Outline Who is NCQA? What do we want from the health care system? What lessons have we learned from the health plan experience? Where do we go from here?

3. Private, non-profit health care quality oversight organization Measures and reports on health care quality Unites diverse groups around common goal: improving health care quality

4. NCQA’s Mission and Vision Mission: To improve the quality of health care Vision: To transform health care through measurement, transparency and accountability

5. NCQA’s Review Methodologies HEDIS ® : A set of measures used to assess performance on key measures of clinical effectiveness CAHPS ® 3.0H: A survey used to measure members’ experiences with the care and service they receive

6. What is the Health Care System Supposed to Do? A value-based health care system 20% of people generate 80% of costs A: Move people from right to left— and keep them there Healthy/ Low Risk At- Risk High Risk Active Disease Health care spending Early Symptoms Source: HealthPartners

7. Even After 15 Years… Improvement Continues In 2003: 30 out of 33 clinical measures showed improvement Strong gains on cardiac measures Average improvement is over 50% since 1996 Only 1 in 4 Americans is in an accountable health plan

8. Measurement Improves Quality Beta-Blocker Treatment After a Heart Attack (Commercial, 1996-2003) …AND Consistency

9. Measurement Improves Quality …AND Consistency Controlling High Blood Pressure (Medicaid, 2000-2003)

10. Measurement Improves Quality …AND Consistency Poor HbA1C Control (Medicare, 2000-2003) Lower is Better

11. What Should We Do Next? Expand the accountability model to include all participants –HMOs and PPOs –Hospitals –Physicians –Nursing homes and home health Align payment systems with quality reporting and performance –P4P for plans and providers Incentivize the use of H-IT –Be clear about purpose