Accountable Care, Quality Metrics Must Combine for Improvement | Healthcare and Technology news | Scoop.it

The healthcare industry has taken many positive steps towards improving the measurement of quality and patient outcomes, says Margaret E. O’Kane, MHA, President of the National Committee for Quality Assurance (NCQA), but true improvement comes from the marriage of metrics with innovative reform of payment and care delivery systems.  In a commentary for the American Journal of Managed Care, O’Kane states that providers, payers, and regulators must continue to promote the business case for providing the highest possible quality of care for patients.

“The accomplishments of the last quarter-century are real and significant,” O’Kane says. NCQA is celebrating its 25 year anniversary in 2015, and the healthcare quality measurement landscape looks significantly different today.  “In 1990, measuring quality was just an idea—today it is an everyday reality. Most Americans—more than 171 million—are enrolled in health plans that report NCQA’s HEDIS (Healthcare Effectiveness Data and Information Set) clinical quality measures.”

HEDIS scores are now used by Medicare, the majority of state Medicaid plans, and numerous private insurers to benchmark performance, reward improvement, and pinpoint opportunities for change.  HEDIS, along with similar patient satisfaction and outcomes measures designed to drive quality improvement, will become increasingly important as more and more industry stakeholders adopt the principles and strategies of accountable care. As HHS and private industry set ambitious goals for cost and risk sharing, benefit structures for patients and provider networks should respond appropriately.

While high-deductible plans have become the norm for patients, who are now expected to shoulder a larger proportion of costs, patients do not always invest in necessary care when they feel unable to afford the large out-of-pocket bills that will result.

“Rather than the blunt instrument of the high deductible, a better approach is Value-Based Insurance Design (VBID)—low co-pays for high value services and medications, higher for those that don’t improve heath,” O’Kane suggests. “An interesting twist is to give a financial incentive to members with chronic conditions to choose a PCMH or accountable care organization with active care management.”

Quality measurement should also be used to distinguish high-quality, high-value providers from those with poorer outcomes in order to make it easier for patients to make better choices for their health and their wallets.  In order to ensure that providers deliver high-quality care, payers should create clear financial incentives.

“This is no small set of tasks,” O’Kane acknowledges. “Over the past 25 years, consumers have become accustomed to the paradigm of choice. Providers have been rewarded for doing more and for giving more complex care. These are deeply embedded cultural norms that need to change. Now, as payers look at what is being purchased, they can act as market makers who drive volume and rewards to the delivery systems that have accepted the challenge of delivering quality, patient-centered care that is affordable.”