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Consumers stand to benefit from new consensus about what constitutes quality health

Feb 27 2016
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Core quality measures for doctors and hospitals will lead to better care and more healthy days.

No doctor, no matter how dedicated or smart, can keep track of every patient in their practice without a good system in place. A good system needs to track and measure health activities, like whether patients are getting the right tests or taking prescribed medications, and health status, like whether a diabetic patient’s condition is under control. Then it can alert the doctor when you are behind on a needed screening or treatment, or test results show your medical condition is no longer under control. Yet until now, there was no common set of measures that everyone agreed to use.

Things are about to change thanks to an unprecedented agreement about how quality care is defined, delivered and paid for.

Government regulators and insurance companies often have had their own sets of measures that they used to evaluate the quality of care in practices and hospitals. This meant that as a patient, your doctors were juggling many different demands, and couldn’t rely on one set of measures that would help them track and care for all of their patients. Doctors could try to meet different measures depending on who was paying the patient’s bill, or simply choose one set of measures, or avoid putting any systems in place at all. None of these approaches was the best answer for you, the patient.

With core measures, consumers will know everyone involved in their care is working and tracking toward the same goals.

Things are about to change thanks to an unprecedented agreement about how quality care is defined, delivered and paid for. This agreement reflects almost two years of hard work between doctors, insurers, the federal government, large employers, and consumer groups to develop a common core set of quality measures. These core quality measures will be written into contracts between insurers and health care systems. They’ll be built into electronic medical record systems, and used by medical practices to help identify people who need care. They’ll even help determine how much doctors and hospitals are paid.

Most important, however, the common core measures will help patients get better quality care and better value for their health care dollar, said Andrew Baskin, M.D., a medical director at Aetna who has played an active role in the Core Quality Measures Collaborative workgroup.

“When doctors can focus on a single set of measures for certain conditions, regardless of who is paying for that patient’s care, they will be able to put systems in place to help them give patients optimal care,” he said.

A new, better way to measure quality

Over the next few years, the core quality measures will replace uncoordinated, confusing and sometimes low value measures that were independently set by everyone from professional medical associations to insurers to the Centers for Medicare and Medicaid Services (CMS), and nonprofit groups focused on quality, Baskin said.

“Trying to track and report so many separate measures is an administrative burden to practices, and complying takes more resources than most have.”

For example, today doctors with diabetic patients in their practices can be asked to report many different measures related to diabetes to different insurers. The different insurers may not use the same measures, and when they do use the same measure, such as hemoglobin A1C levels, they might not agree on the level that patients should reach or exactly how to do the measurement. “Trying to track and report so many separate measures is an administrative burden to practices, and complying takes more resources than most have,” Baskin explained.

As the payments for more and more doctors and hospitals are impacted by their patients’ outcomes, a common set of core measures will be increasingly important. Companies that build electronic medical record systems for doctors and hospitals now can use the one set of core measures, rather than making everything customizable depending on who is paying. Health care providers can get information from those systems and reach out to patients who need to come in for a test, immunization or screening, or whose test results indicate their conditions are not under control.

First core quality measures

Having core standards will also make it easier for consumers to compare quality among providers, Baskin said. When everyone is tracking the same measures the same way, it will be easier for insurers and independent groups to offer consumers consistent comparisons of quality, along with cost.

“We’ve already agreed to seven sets of core quality measures, and over the next few years will be adopting more,” Baskin said. “We’ll keep revisiting them too, to make sure we always have measures that are supported by research and proven outcomes, and agreed upon by experts in each field. That way, consumers will know everyone involved in their care is working and tracking toward the same goals — from their doctor and hospital, to the nurse teaching them to deal with their condition, to their insurance companies and the quality rating app on their phone.”

Health and Human Services has set a goal to have 30 percent of Medicare payments in alternative payment models that focus on high quality and cost effective care by the end of 2016 and 50 percent by the end of 2018. Aetna’s goal is 75 percent by 2020.