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The Role of Quality Measurement in Healthcare — Transcript

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0:00hello everyone and welcome to the role
0:03of quality measurement in healthcare in
0:06this presentation we will cover the
0:07state of Healthcare in the United States
0:09and then we're going to take a journey
0:11through the history of healthcare
0:12quality to build a foundation for your
0:14future learnings thanks so much for
0:16joining us
0:18my name is Amanda Ryan and I am the
0:21director of education at Pharmacy
0:23quality Alliance and I will be your
0:25speaker for this presentation
0:29the learning objectives for the
0:31presentation are listed for you here on
0:33the slide but I'll go through them with
0:34you briefly as well now at the end of
0:37the presentation you'll be able to
0:39review some healthcare economics concept
0:41Concepts that we will be covering and
0:43you'll be able to relate those to
0:44healthcare quality you'll also be able
0:47to describe the current state of the
0:49United States healthcare system and how
0:51the ACA or the Affordable Care Act
0:53shaped and still does in fact shape that
0:55system you'll be able to explain how the
0:58current system of U.S Healthcare focuses
1:00on quality and will do that by learning
1:03about the National Quality strategy and
1:05then finally you'll be able to identify
1:07the role that quality measures play in
1:09delivery of Health Care in the United
1:11States
1:14and with that let's begin by discussing
1:16the state of United States Healthcare
1:21this slide shows Healthcare spending as
1:24a percentage of GDP over the last 40
1:27years or so so from 1980 to 2019 and
1:31that's the most recent data that we have
1:32available if you look over there on the
1:35left at 1980 you can see that compared
1:38to a handful of other high income
1:40Nations the United States spent a
1:42similar amount of money on Health Care
1:44however over the last 40 years you can
1:47see a pretty significant change all the
1:50countries have increased the amount that
1:52they're spending on health care but the
1:53United States has increased that amount
1:55by quite a bit more than the other
1:56countries you can see here so bottom
1:59line here is we are spending a lot of
2:01money on Health Care
2:04and then since we spend so much money on
2:06Health Care in the United States you
2:08would think that should result in higher
2:10quality Care
2:11however in likely what is not a surprise
2:14to you that is not the case in fact when
2:17we compare Health Care System
2:18performance to other high-income nations
2:21we can see that once again the United
2:23States is an outlier this time in the
2:25opposite direction
2:27the United States performance Falls well
2:30below the average of other countries and
2:32also far below the other two countries
2:34that are closest to it in this graphic
2:36which are Switzerland and Canada
2:39the performance scores here are really
2:40pretty comprehensive and they cover
2:42multiple domains of Healthcare System
2:44performance and they include things like
2:46access to care the care process
2:49administrative efficiency equity and
2:52Health Care outcomes
2:54so this is where we are we're spending a
2:56lot for not much of a return on that
2:59investment there is a significant
3:01disparity between the amount that we
3:03spend on health care and the quality of
3:05that care in the United States
3:08so let's think about how to address
3:10these issues we need to do that by
3:13focusing on increasing the quality of
3:15care while reducing the overall cost of
3:17care so the two concepts we just covered
3:19this can be done by moving from high
3:22volume care to high value care so on the
3:25graphic on the slide you can see that
3:27cost is depicted on the y-axis and
3:30quality is depicted on the x-axis high
3:33volume care is what has been
3:34traditionally delivered in the United
3:36States and it is generally higher cost
3:38and lower quality well if you move over
3:41there to the right you can see high
3:43value care which is where we are
3:45currently transitioning and that
3:47generally is is delivered at lower cost
3:49but higher quality so we are looking at
3:52a transition here from high value high
3:54volume to high volume
3:56now we're going to go on a quality
3:58Journey where we're going to discuss the
4:00history of healthcare quality and
4:02provide more context about how we're
4:04moving from high volume to the high
4:06value care that we talked about a few
4:08moments ago
4:09this will lead us at the end to the
4:12value equation which will be helpful for
4:14you to use as you learn and understand
4:16more about Healthcare quality
4:20we are going to begin our journey back
4:22in 1999 so as you can see we've been
4:25talking about Healthcare quality for
4:27quite some time now and in 1999 The
4:30Institute of medicine released the first
4:32of two seminal reports on Health Care
4:34Quality
4:35the first report was entitled to Ayers
4:38human building a safer Health System
4:40this report highlighted that medical
4:43errors are a common and serious problem
4:45in health care in fact it showed that
4:48between forty four thousand and ninety
4:51eight thousand Americans die every year
4:53in hospitals due to preventable medical
4:55errors
4:57the report also emphasizes that medical
4:59errors are not simply the result of
5:01individual shortcomings and this is
5:03something that's very important to
5:05remember as we talk about Healthcare
5:06quality but these errors are actually a
5:09result of systematic systematic issues
5:11within the Health Care system and to
5:14address this we need a comprehensive and
5:16systematic approach to improve patient
5:18safety
5:20the second report which was released in
5:222001 is called crossing the quality
5:24Chasm this report highlights that safety
5:27issues are not just confined to
5:29hospitals as you would expect and that
5:32Americans are not receiving the care
5:33that they should be
5:35it also identifies and recommends
5:37improvements in six dimensions of
5:39Healthcare in the United States and
5:41those include patient safety care
5:44Effectiveness patient-centeredness
5:46timeliness hair efficiency and equity
5:49and much like to air as human this
5:52report emphasizes that the Health Care
5:54System must be transformed in order to
5:56deliver high quality safe and effective
5:59care to patients
6:02continuing now on our journey in 2006
6:06John Whittington and Tom Nolan from The
6:08Institute for healthcare Improvement
6:10developed what is called the triple aim
6:13the triple aim allows us to clarify that
6:16systematic approach that we just talked
6:18about that's required to improve Health
6:20Care Quality it contains as the name
6:23suggests three aims which are the
6:25experience of care population health and
6:28per capita cost so once again you do see
6:31both elements of quality and cost within
6:33the triple aim
6:34while crossing the quality Chasm did
6:37focus on the individual experience of
6:39receiving Health Care the triple aim
6:41actually went beyond this the individual
6:44experience of care as you can see there
6:46on the bottom left is one part of the
6:48triple aim but also included is
6:51population health and that addresses
6:53reasons individuals seek care in the
6:55first place and things that happen
6:57outside of healthcare including social
6:59determinants of health and then of
7:02course as we said the third part of the
7:03triple aim is per capita cost
7:06improving the U.S health care System Inc
7:09requires a simultaneous focus on all
7:11three of these aims and focus on all of
7:14these simultaneously does reinforce each
7:17of the others we need all three aims to
7:19get where we're going and in addition to
7:22that it's important to recognize that no
7:24one entity can be entirely responsible
7:26for the Triple aim and also by extension
7:29no one entity can possibly be
7:31responsible for Health Care Quality
7:33so this is a call for all of us to work
7:36together in pursuit of high quality
7:38Health Care
7:41after the triple aim was designed some
7:43thought leaders advocated for adding a
7:46fourth aim to address healthcare
7:47provider burnout or Health Equity
7:50and then following that in 2022 ihi CEO
7:55cater mate and colleagues advocated for
7:57What's called the quintuple aim which
8:00includes both Workforce well-being and
8:02advancing Health Equity
8:04they believe that achieving high quality
8:06care for all cannot be realized without
8:08these additional aims the quintuple aim
8:11represents a more holistic approach and
8:14also a more comprehensive approach to
8:16healthcare quality and also provides a
8:18framework for thinking about how to
8:20improve the quality of care while also
8:22addressing broader social determinants
8:24of health and well-being of healthcare
8:26providers
8:29now back to our Healthcare journey and
8:32we're going to go to 2010 when we're
8:34going to and now we're going to talk
8:35about the patient protection and
8:37Affordable Care Act which is also known
8:39as the ACA or Obamacare in 2010 the ACA
8:43became law
8:44the ACA did create significant changes
8:47to the U.S Health Care system in a
8:48number of ways and while we will not be
8:51able to cover all the provisions of the
8:52ACA here we will cover a few of them now
8:55as part of the ACA Medicaid was expanded
8:58which increased the number of low-income
9:00individuals who are eligible for the
9:03program
9:04the ACA also created a health insurance
9:06Marketplace which allows people to shop
9:09for insurance online
9:11subsidies were also provided to assist
9:13in the affordability of insurance
9:14coverage
9:15the ACA also included a number of
9:18insurance reforms these included
9:20requirements to offer Insurance
9:22regardless of pre-existing conditions
9:24and coverage for certain types of care
9:26including preventative care
9:28the ACA also contained mandates for
9:31individuals to have health insurance
9:33coverage and also mandates for many
9:35employers to offer health insurance
9:40Medicaid expansion raised the
9:42eligibility floor to 138 percent of the
9:46federal poverty level however the
9:48expansion of Medicaid was effectively
9:50optional for States and not all states
9:53chose to expand Medicaid
9:55here you can see a map that shows which
9:57states opted to expand Medicaid and this
9:59is current as of November 2022 the navy
10:02blue states have chosen to expand
10:04Medicaid and the orange states have not
10:06expanded it South Dakota is the one
10:09state you can see here in light blue and
10:11they are scheduled to implement their
10:13expansion on July 1st 2023.
10:18the health insurance Marketplace
10:20provided a new option for people to shop
10:22for health insurance individuals can
10:25choose the amount of coverage that they
10:27need and likewise if not buy insurance
10:29that they don't need and they can also
10:31comparison shop among different plans
10:33additional financial assistance was also
10:36introduced to help with affordability of
10:38health insurance
10:41multiple Insurance reforms were included
10:44in the ACA some expanded access to
10:47insurance and they included those
10:49individual and employer mandates that I
10:51referenced earlier as well as Provisions
10:53allowing young adults to stay on their
10:55parents Insurance until they are 26.
10:58other reforms increase consumer
11:00protections by reducing denials based on
11:03pre-existing conditions as well as
11:06prohibitions against certain
11:07unreasonable premium increases and
11:10canceling of insurance coverage
11:13in addition to the provisions that we've
11:15already covered the ACA also had a
11:17significant focus on quality
11:19for example the National Quality
11:21strategy or nqs was created under the
11:24ACA
11:25it was a strategy to guide not only
11:27local but also State and National
11:29efforts to improve quality of care
11:32the nqs focuses on six priorities that
11:36address Americans most common health
11:38care concerns you can see those six
11:40priorities here we'll talk about just a
11:42sampling of them now if you start over
11:44there on the left you can see in the
11:46First Column refers to making care safer
11:48by reducing harm caused by the delivery
11:51of care so this sounds very much like
11:53those two iom reports that we referenced
11:56from early in the 2000s and 1999. in the
12:00middle you can see a strategy around
12:03promoting effective coordination and
12:05communication of care that's something
12:07we've been working on for quite some
12:08time and we continue to face challenges
12:11in that area especially as new digital
12:14Communications are introduced and we
12:16have new ways to communicate with one
12:17another in various forms and then
12:20finally over there on the right you can
12:22see a dollar sign so once again we are
12:25thinking of high value care and when we
12:27do that we have different elements of
12:29quality that play into it but cost is
12:31also part of the Asian
12:33so now that we've been talking about
12:35various elements of quality you may be
12:37asking yourself about how we track
12:39meaningful change on the priorities that
12:42we just discussed and other elements of
12:44quality well the way that we do that is
12:46actually through measurement you're
12:48going to learn a lot more about
12:49measurement in upcoming sections of this
12:52course but for now I'd like to tell you
12:54about two measure resources from the
12:56centers for Medicare and Medicaid
12:58services or CMS
13:00the first is Meaningful measures 2.0
13:03which was launched in 2022 and it builds
13:07on the original meaningful measures
13:08initiative from 2017. meaningful
13:11measures 2.0 includes a set of goals
13:14which are intended to facilitate and
13:16move towards value-based care and it
13:18targets issues that are probably going
13:20to sound very familiar to you and those
13:22include patient-centered care safety
13:25chronic condition seamless care
13:27coordination Equity affordability and
13:31efficiency wellness and prevention and
13:33Behavioral Health so we're seeing a lot
13:35of themes here between the nqs the
13:38triple aim and the quintuple aim carried
13:40through into the meaningful measures 2.0
13:42initiative
13:43the initiative also does emphasize the
13:46importance of the patient in caregiver
13:48voice across CMS programs
13:50the second resource and that you can see
13:52a screenshot here on the slide of is the
13:55measures management system blueprint
13:57this provides an overview of quality
13:59measure development implementation and
14:02maintenance and each section includes
14:04information about important steps that
14:06are associated with a given stage in the
14:09measure life cycle this measure life
14:11cycle actually aligns very closely with
14:13ours here at pqa which you will learn
14:15learn about in more detail soon
14:20okay we are almost to the end of our
14:23quality journey and for now I'd like to
14:25take a moment and introduce you to a
14:27sampling of organizations that play a
14:29role in healthcare quality
14:31you can see organizations here such as
14:33the Joint Commission which is
14:35responsible for Hospital accreditation
14:37and patient safety also there are some
14:40measure development developers including
14:42ncqa which is responsible for the
14:45creation and maintenance of hedis
14:46measures as well of course uh pqa which
14:49is focused on medication use quality the
14:52LeapFrog group is another group here
14:54that is on the slide and they are a
14:56non-profit who reports Hospital quality
14:58and safety data
15:00as we wrap up our journey you can use
15:02the framework that you see here on this
15:04slide to help you think about how all
15:06the different pieces are fitting
15:08together
15:09at the base of this framework our
15:10performance measures which help us to
15:13assess opportunities to improve quality
15:15of care
15:16off to the left you can see clinical
15:18practice which is both influenced by
15:21performance measures and also itself can
15:23influence performance measures
15:26that's at the next level performance
15:28measures are rolled into measurement
15:29programs and then finally measurement
15:32programs allow us to assess the overall
15:34quality of care that an entity provides
15:38all right we are now at the end of our
15:40quality Journey which is leading us to
15:42the value equation as we are closing the
15:45door on volume-based care we are opening
15:48it to value-based outcomes and the
15:50essence of value is captured by the
15:53value equation which is value equals
15:56quality over cost
15:57as we discussed earlier the goal is to
16:00provide high quality care that both
16:03increases for high value care that both
16:05increases quality and while decreasing
16:07cost and as some of the early graphs in
16:10this presentation showed you we have
16:11ample opportunities to do both of these
16:14things in the United States
16:15we have accomplished a lot in the last
16:1820 plus years but there is still much
16:20work to be done I hope you enjoyed
16:22learning about the state of Healthcare
16:24in the United States and that our
16:25journey through the history of
16:27healthcare quality has built a solid
16:28foundation for your future learnings
16:30thank you for joining me for the role of
16:32quality measurement in healthcare

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