# Presentation: 290633

## Materials Developed in Consultation With:

- Carolyn Clancy, M.D., Agency for Healthcare Research and Quality, HHS
- Karen Bell, M.D., Office of the National Coordinator for Health Information Technology, HHS
- Helen Burstin, M.D., M.P.H., Agency for Healthcare Research and Quality, HHS
- Margaret O’Kane, M.H.S., National Committee for Quality Assurance
- Richard Sorian, National Committee for Quality Assurance

- This briefing has been developed under the auspices of **Health Systems Research, Inc.** under a contract with the Office of the National Coordinator for Health IT, HHS

- November 29, 2005

## Scope and Boundaries of the Issue: Overview

- Increasing demands from purchasers that providers demonstrate quality delivered
- Clear evidence that public reporting of performance leads to improvements
- Recent efforts to harmonize efforts promising: reduced burden, increased focus on improving care
- Physicians now actively engaged
- Substantial and unrealized opportunity to provide useful information to consumers

## Scope and Boundaries of the Issue: Data and Monitoring

- Imperfect data, multiple sources of measures
- Measures development is a dynamic, evolutionary process, but improvements are being made
- Limited collaboration between quality assessment and health IT communities
- Recognition by all stakeholders of urgent need for alignment of disparate monitoring initiatives
- National Quality Forum endorsement now seen as vital prerequisite

## Environmental Scan 

- Quality reporting robust, yet lacking in several key areas
- Many issues surround accountability for care
- Pay-for-Performance (P4P) creating “positive tension” for improvement and accountability for care
- Needs of patients with multiple conditions and providers fueling need for more patient-centered care

## Environmental Scan (cont.)

- NCQA as model: accredits managed care organizations, including for Medicare and Medicaid
- New alliances for prioritizing implementation of endorsed measures
- Need for the development and greater use of measures on disparities in care

## Key Collaborations

- Quality coalition between NCQA, GE, Verizon, Ford, Humana, P&G, UPS, BCBS of KY, OH and IL, IHA of California, and Tufts, United and Aetna health plans
- Diabetes and Cardiac Care Link Programs reward top performing physicians
- Physician Office Link Program rewards physicians for investing in IT and creating  chronic care improvement programs

## Key Stakeholders and the Benefits They Accrue from Advancements in this Area: CMS

- Alignment of quality efforts  improved quality, value for taxpayers
- Promotes patient-centered care
- Improvements in care for people <65 can yield substantial benefits for Medicare (e.g., diabetes; hypertension)
- Assure that covered services are consistent with current science

## Key Stakeholders and the Benefits They Accrue from Advancements in this Area: Private Payers

- Success of private sector initiatives limited by market share: common measures and standards reduce administrative burden
- Robust, timely information on quality can inform contracting decisions
- Consumer-directed approaches require information on quality and value.

## Key Stakeholders and the Benefits They Accrue from Advancements in this Area: Providers

- Coordinated efforts in measurement and monitoring should serve multiple purposes: CME; maintenance of certification
- Predictability in requirements allows investments in infrastructure and systems
- Shift focus from ‘which report today?’ [OR reformatting the same information for different entities] to care improvement.

## Key Stakeholders and the Benefits They Accrue from Advancements in this Area: Consumers

- Transparency can enhance choice of hospital, plan, physician – and ultimately treatments.
- Personal health records can serve as vehicle for customizing information based on individual preferences and health care needs.
- Enables more active role in personal care.

## Major Barriers 

- Lack of harmony between existing standards, formats, and requirements for quality monitoring and reporting (e.g., variability in what is coded and how)
- Inconsistent and uneven demand by purchasers for information
- Shift of covered lives from accountable (i.e., HMOs) to less tightly organized arrangements (e.g., PPOs, CDHPs, HSAs)

## Major Barriers (cont.)

- Infrastructure for collecting and reporting quality measures is fragmented (NCQA; JCAHO; CMS QNet) or not yet established (physician performance).
- Functionality of easy export of quality data to accreditors, public health entities, others not clearly defined

## Potential Implementation and Acceleration Opportunities 

- Interoperability will expand capacity to measure important aspects of care, including critical quality improvement and care management tasks
- Emerging national consensus for set of quality measures to be used by all payers and all providers

## Potential Implementation and Acceleration Opportunities

**EHRs should be able to move us towards**
**population health and management:**
- Identify all patients taking a particular medication
- Identify patients in need of screenings
- Identify patients by chronic condition who are in need of a test or visit,
- Flag all outstanding laboratory tests and flag abnormal results needing follow-up
- Produce standardized quality measures

## Potential Implementation and Acceleration Opportunities 

- AHRQ, CMS, VHA, DoD to work with NCVHS to develop **minimum data set** of appropriately formatted data elements and fields needed to produce a set of agreed upon quality measures
**Relevance to The Community**
- Minimum data set to be tested with AQA pilots
- Key components for certification and feedback to vendors