A new system of measuring healthcare quality is needed

Monday, October 31, 2016
It is, therefor, time to measure the quality of healthcare from the vantage point of those needing healthcare, Dr. Bruce A. Chernof, MD and President & CEO, The SCAN Foundation, writes in a blog on the Huffington Post.

Our health care system is purpose-built to cater to performance needs from regulators and healtcare purchasers,for their  oversight, and expectations.  As such, this has fostered the proliferation of all sorts of clinical quality measures by multiple organizations. The current state of quality measurement serves these audiences reasonably well. But there is a twofold problem with evaluating quality using these tools, Chernof finds.

Too much variation

First as a physician, Chernof still sees too much variation in the technical quality of American health care. Secondly, clinical measures alone ignore how value is perceived through the eyes of those who actually use the delivery system.

‘When we look at the highest users of health care — those with serious medical problems and functional limitations — we now have oodles of technical measures for each condition on their problem list, and yet really no understanding of whether we are contributing to a person’s quality of life.’ This means that systems of measurements need to change drastically, to cater to the needs of the users of healthcare. If healthcare stakeholders are to achieve the dramatic improvements anticipated through new payment and service delivery models, the mushrooming of purely clinical measures must be thinned out to make room for a new generation of metrics that consider outcomes from the person’s perspective, says Chernof.

Important resources

Fortunately, recently three important new resources were made available to help frame and advance measures that will ensure new systems of measurements.

1.    The National Committee for Quality Assurance (NCQA) released two accreditation products to assess organizations responsible for coordinating long-term services and supports. Theses products should help community-based organizations, health plans, and others acknowledge and prepare for the needs of Medicare-Medicaid beneficiaries and may eventually become core requirements for any provider serving vulnerable populations. Thirty organizations were chosen as early adopters that now actively trial these products.

2.    The National Quality Forum (NQF) released case studies of how specific communities are using data and measurement tools to improve quality. They demonstrate lessons learned to guide the development of quality measures from the person’s perspective, as well as areas for further examination.

3.    The SCAN Foundation recently released a set of four Essential Attributes that may help define quality measurement through the eyes of people receiving care. With assistance from the Alliance for Health Reform and Health Management Associates, these Essential Attributes were developed through leadership from major national quality, health care delivery, and advocacy organizations, as well as federal government leaders, including the Centers for Medicare & Medicaid Services. In summary, the Essential Attributes focus on these principles:

  • The person’s full range of needs — medical and non-medical — as well as the needs of caregivers, are identified and respected.
  • This full range of needs are incorporated into a care plan that is tailored, safe, and timely.
  • The person can easily navigate the delivery system to get services they need, and avoid those they do not need or want.People and their caregivers provide feedback and are an ongoing part of quality improvement for the delivery systems they touch.

Next generation quality measurements

Taken together, these four attributes should shape the next generation of quality measures, Chernof believes. They wil provide a coherent, person-centered path forward. ‘The time has come to balance technical health care quality with tangible human-focused outcomes so that we can delivery on the promise of the “Triple Aim“ and provide meaningful value for all.’