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ADVANCING HEALTH CARE QUALITY IN 2007 AND BEYOND

ADVANCING HEALTH CARE QUALITY IN 2007 AND BEYOND. Margaret E. O’Kane President, NCQA. NCQA: A Brief Introduction. Private, independent non-profit health care quality oversight organization Measures and reports on health care quality Committed to measurement, transparency and accountability

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ADVANCING HEALTH CARE QUALITY IN 2007 AND BEYOND

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  1. ADVANCING HEALTH CARE QUALITY IN 2007 AND BEYOND Margaret E. O’Kane President, NCQA

  2. NCQA: A Brief Introduction • Private, independent non-profit health care quality oversight organization • Measures and reports on health care quality • Committed to measurement, transparency and accountability • Unites diverse groups around common goal: improving health care quality

  3. NCQA: A Brief Introduction • Quality Measurement • HEDIS, CAHPS • Accreditation, Certification, Recognition • Health Plans, Physicians and Physician Groups,Health Care Organizations (such as DM providers) • Public Reporting • State of Health Care Quality, America’s Best Health Plans, Healthchoices.org, third-party partnerships • Research • Quality measures development • Cultural disparities in health care

  4. A MEASUREMENT SUCCESS STORY: BETA-BLOCKER TREATMENT AFTER A HEART ATTACK

  5. BETA-BLOCKER TREATMENT AFTER A HEART ATTACK 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 National average: 62.6%

  6. BETA-BLOCKER TREATMENT AFTER A HEART ATTACK 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 74.1%

  7. BETA-BLOCKER TREATMENT AFTER A HEART ATTACK 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 79.7%

  8. BETA-BLOCKER TREATMENT AFTER A HEART ATTACK 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 National average: 85.0%

  9. BETA-BLOCKER TREATMENT AFTER A HEART ATTACK 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 National average: 89.4%

  10. BETA-BLOCKER TREATMENT AFTER A HEART ATTACK 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 National average: 92.5%

  11. BETA-BLOCKER TREATMENT AFTER A HEART ATTACK 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 : 93.5%

  12. BETA-BLOCKER TREATMENT AFTER A HEART ATTACK 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 : 94.3%

  13. BETA-BLOCKER TREATMENT AFTER A HEART ATTACK 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 : 96.2%

  14. BETA-BLOCKER TREATMENT AFTER A HEART ATTACK 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 : 96.6%

  15. ADVANCING QUALITYIN 2007 AND BEYOND

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

  17. PROMOTE WELLNESS • The primary function of the health care system is to cure illness • keep people healthy • We must re-emphasize primary care • The “medical home” needs to be further defined and promoted • The patient needs to be activated

  18. NURTURE THE EVIDENCE BASE • Gaps in evidence abound • Even where evidence has been developed, there are too few tools to translate knowledge into practice • Appropriateness of care needs further study – it’s tightly linked to quality IMPROVEDPRACTICE NEWEVIDENCE

  19. HOW MUCH HEALTH DO WE GET FOR THE HEALTH CARE DOLLAR? • Relative Resource Use measures calculate risk-adjusted observed cost/expected cost for critical conditions: • Cardiac conditions, diabetes, asthma, COPD, low back pain, hypertension • These conditions account for 60% of all spending • Along with related quality results, allows for plan-to-plan comparisons on value

  20. A COMPREHENSIVE DELIVERY FRAMEWORK • Whose job is it to do what? • How do we design units of measurement to encourage effective, efficient care?

  21. PAYMENT, ACCOUNTABILITY REFORM • Pay for better care, not more care • The system, as it is, rewards bad care • Cost increases are being shifted to workers—or worse, leaving some out of the system altogether

  22. THE TRINITY OF CARE: GOOD CARE DOESN’T EXIST WITHOUT ALL THREE QUALITY ACCESS AFFORDABILITY

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