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Getting on the Same Page for Quality Health Care

The effort strikes at the heart of a key question in health care: How do we measure where we are, where we wish to go and how well we are progressing towards achieving higher quality while also managing costs?
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The concept of "value" is at the core of one of the most important movements in the health care industry today. From broad reforms designed to shift our payment system to reward value rather than volume, to new tools to help consumers shop for the most bang for their buck, it seems as though everyone -- including this writer, in this blog -- is talking about value.

As I mentioned in an earlier post, a very simple equation can be used to conceptualize and define value -- it's the ratio of the quality of care relative to the costs of delivering that care. Sounds straightforward enough, doesn't it? Cost is relatively easy to measure. But spoiler alert! Defining specific metrics to measure quality, or even what is included in a quality measure, is an extraordinarily complex endeavor that requires coordination by many stakeholders and tons of data.

Here is the good news: Things are about to get quite a bit simpler. The Core Quality Measures Collaborative is an unprecedented effort that brings together major provider organizations, employers, consumers and a group of payers, including the Centers for Medicare and Medicaid Services, that collectively provide coverage for over 70 percent of insured Americans. On Feb. 16, the collaborative released seven core sets of clinical quality metrics that those participating in the collaborative have agreed to use for measuring several key areas of medical care.

The effort strikes at the heart of a key question in health care: How do we measure where we are, where we wish to go and how well we are progressing towards achieving higher quality while also managing costs?

Quality is a crucial facet of health care value because without it, the dynamics of the industry could devolve into a race to the bottom on costs. Focusing on quality and cost together will help shape the health care system into one that delivers high-quality care to the broadest population possible, at an affordable price for the consumer, while also providing individuals with information relevant to them as they make their own health care decisions.

We at Health Care Service Corporation have for years incorporated quality measurement in our relationships with contracting doctors and hospitals. Like us, nearly every stakeholder in the health care ecosystem wants to see to it that patients or members receive quality care.

But it turns out that in pursuit of that lofty goal, we in the health care industry find ourselves with another problem: Each of us has our own set of metrics that may measure similar aspects of quality in different ways. It would be like the Chicago Blackhawks and New York Rangers assigning different point values for goals.

In medicine, keeping up with all of the metrics for just two or three payers and multiple accrediting bodies is enough to drive even the most mild-mannered physician -- to use a medical term -- bonkers. On top of that, using different measures makes it impossible to compare results between systems and payers or combine information in a way that could give consumers a better idea of health care value.

It is in response to this that the Core Quality Measures Collaborative came together around three specific key aims.

Recognize high-value, high-impact, evidence-based measures that promote better patient health outcomes and provide useful information for improvement, decision-making and payment.

Reduce the burden of measurement and volume of measures by eliminating low-value metrics, redundancies and inconsistencies in measure specifications and quality measure reporting requirements across payers.

Refine, align and harmonize measures across payers to achieve congruence in the measures being used for payment and other accountability purposes.

The result of this process to recognize, reduce and refine is seven core measure sets -- for Accountable Care Organizations (ACO)/Patient Centered Medical Homes (PCMH)/Primary Care; Cardiology; Gastroenterology; HIV/Hepatitis C; Oncology; Orthopedics; and Obstetrics and Gynecology -- that have been agreed upon by payers and providers participating in the collaborative as the most important and relevant metrics to use to measure quality.

The development of a common set of metrics should be celebrated by all health care stakeholders as a huge step in the right direction to create a high-value health system.

It's good news for doctors, because it will mean lightening their burden for collection and reporting of data, freeing them to focus on quality improvement and patient care. Common measures will allow employers and other groups to be more discerning purchasers of health care for their employees and members. And for payers and agencies who are trying to reform our health care system, it removes a key barrier to the widespread adoption of value-based care by standardizing the ruler by which progress is measured.

Lastly, it's good for consumers. To this point, the value has largely been discussed in abstract terms at the highest levels of government and private players in the health care industry. More even than cost of care, quality and how to discern quality variations between different providers brings the discussion to the individual in a tangible and meaningful way. After all, consumers of health care -- and that is all of us at some point in our lives -- are the ones who must live with the outcomes of the care we receive. We can never know for certain whether a given course of care will yield the best outcomes, but with the right information, we can make informed decisions that lead to the greatest likelihood of success.

As a health insurer, HCSC supports quality measurement in word and in action, as we work to improve our members' health care experience and outcomes, while keeping their costs as low as possible. Beyond our four walls, we will continue to work with others from across the health care space to refine the ways quality is measured, and in so doing shape the health care system into one that delivers value.