Does Performance Measurement define Quality Care ? What planning that goes into the delivery of true quality healthcare? What steps should one take in order to deliver quality care?

Quality of Health Care in US Adults do not receive almost half of the clinical services from which they would likely benefit 1 Other countries achieve better performance on many measures despite higher per capita health care spending in US vs. other industrialized countries 2 Spending levels vary widely among U.S. regions 3 –No evidence that more expensive regions have either better quality or improved health outcomes  From IOM, Pathways to Quality Health Care (Dec. 2006) 1.McGlynn et al, Hussey et al., 2004; Reinhardt et al., Baicker and Chandra, 2004; Fisher et al., 2003a,b

“The full potential of current [quality improvement] initiatives cannot be realized without a coherent, robust, integrated performance measurement system that is purposeful, comprehensive, efficient, and transparent.”  From IOM Pathways to Quality Health Care (Dec. 2006)

Landscape: Who Does What Measure Development National Selection and Endorsement Measure Implementation AMA-convened Physician Consortium for Performance Improvement ® (Consortium), National Committee for Quality Assurance (NCQA), JCAHO, specialty societies, others National Quality Forum™ Ambulatory Care Quality Alliance Centers for Medicare and Medicaid Services (CMS), private plans, NCQA, medical specialty boards, continuing medical education (CME), electronic health record vendors, physicians/practices, private sector regional measurement initiatives

Quality of Care Paradigm Donabedian – structure, process and outcomes Fries - 6 Ds – Death, disability, discomfort, drug toxicity, dissatisfaction and dollar cost. –HAQ, AIMS, SIP, SF-36, RAPID-5 Industrial quality –defect prevention: plan, do, measure, –Quality circle management IOM – 1996 Quality Initiative –To Err is Human –Crossing the Quality Chasm –Performance Measurement PQRI

PQRI Debate Framework: “population”, disease, physician, transparent, incentive Performance measurers –Process vs outcomes –minimum vs optimal criteria –indicator vs point-of-care guideline Reporting and payment Assessment

Who are using Consortium measures? Physicians – internal quality improvement; fulfill requests from outside stakeholders Medical Boards - Maintenance of Certification programs Medical Specialty Societies and other CME providers - CME programs Electronic Health Record Vendors – in discussion Private/Public Health Plans - recognition, pay for reporting, pay for performance programs Employers –to ensure healthcare purchased is high quality

National Committee for Quality Assurance (NCQA) Private, non-profit health care quality oversight organization Measures and reports on health care quality Quality measurement means: –Use of objective measures based on evidence –Results that are comparable across organizations –Impartial third-party evaluation and audit –Adoption of standards will promote the adoption of strategies that will improve care

NCQA Physician Recognition Programs Diabetes Physician Recognition Program (DPRP) Heart/Stroke Recognition Program (HSRP) Physician Practice Connections (PPC) NCQA Evaluates Physician Performance

Bridges to Excellence (BTE) National program A multi-stakeholder approach to creating incentives for quality –Employers, health plans, consumers, physicians and group practices Mission: Improve quality of care through rewards and incentives that –Encourage providers to deliver optimal care, and –Encourage patients to seek evidence-based care and self- manage their own conditions Focus: –Office practices, diabetes care, cardiac care –Program costs paid by participating employers Uses standards developed by the National Committee for Quality Assurance (NCQA)

Bridges to Excellence (BTE) Rewards Programs Redesign care processes to close the Quality Chasm Reduce “defects” that cost money (overuse), harm patients (ADEs) Targets all physicians and all patients Improve outcomes for patients with diabetes Reduce overuse and underuse of services Targets PCPs and Endocrinologists, and patients with diabetes Improve outcomes for patients with CVDs Reduce overuse and underuse of services Targets PCPs and Cardiologists, and patients with cardiac disease

Organizations AMA, ACP, ACR IOM, CMS AQA, NQF NCQA, IHI ICIC

Implications Liability Credentialing Business plan Contracting

Where is the lowest hanging fruit? Provide Value – reduce MSK costs and improve outcomes Reduce errors Improve function Improve satisfaction Improve pain / symptoms

Contact Information Karen Kmetik, PhD 312/