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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?
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Quality of Health Care in US• Adults do not receive almost half of the clinical
services from which they would likely benefit1 • Other countries achieve better performance on
many measures despite higher per capita health care spending in US vs. other industrialized countries2
• Spending levels vary widely among U.S. regions3
– 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, 20032. Hussey et al., 2004; Reinhardt et al., 20043. Baicker and Chandra, 2004; Fisher et al., 2003a,b
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“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)
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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
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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
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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
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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
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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
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NCQA NCQA Physician Recognition ProgramsPhysician Recognition Programs
• Diabetes Physician Recognition Program (DPRP)• Heart/Stroke Recognition Program (HSRP)• Physician Practice Connections (PPC)
NCQA Evaluates Physician Performance
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Bridges to Excellence (BTE)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)
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Bridges to Excellence (BTE) Bridges to Excellence (BTE)
Rewards ProgramsRewards 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
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Organizations
• AMA, ACP, ACR
• IOM, CMS
• AQA, NQF
• NCQA, IHI
• ICIC
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Implications
• Liability
• Credentialing
• Business plan
• Contracting
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Where is the lowest hanging fruit?
• Provide Value – reduce MSK costs and improve outcomes
• Reduce errors• Improve function• Improve satisfaction• Improve pain / symptoms
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Contact Information
www.physicianconsortium.org
Karen Kmetik, PhD
312/464-4221