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The The Transformative Transformative Effect of Quality Effect of Quality ReportingReporting
The The Transformative Transformative Effect of Quality Effect of Quality ReportingReportingMargaret E. O’KaneMargaret E. O’KaneNCQA PresidentNCQA PresidentApril 11, 2005April 11, 2005
Presentation OutlinePresentation OutlinePresentation OutlinePresentation Outline
• Who is NCQA?
• What do we want from the health
care system?
• What lessons have we learned from
the health plan experience?
• Where do we go from here?
• Private, non-profit health care quality oversight organization
• Measures and reports on health care quality
• Unites diverse groups around common goal: improving health care quality
NCQA’s Mission and VisionNCQA’s Mission and VisionNCQA’s Mission and VisionNCQA’s Mission and Vision
Mission:
To improve the quality of health care
Vision:
To transform health care through measurement, transparency and accountability
NCQA’s Review MethodologiesNCQA’s Review MethodologiesNCQA’s Review MethodologiesNCQA’s Review Methodologies
HEDIS®: A set of measures used to assess performance on key measures of clinical effectiveness
CAHPS® 3.0H: A survey used to measure members’ experiences with the care and service they receive
What is the Health Care What is the Health Care System Supposed to Do? System Supposed to Do? What is the Health Care What is the Health Care
System Supposed to Do? System Supposed to Do?
A value-based health care system
20% of peoplegenerate
80% of costs
A: Move people from right to left—
and keep them there
Healthy/Low Risk
At-Risk
HighRisk
ActiveDisease
Health care spending
Early Symptoms
Source: HealthPartners
Even After 15 Years…Even After 15 Years…Improvement ContinuesImprovement ContinuesEven After 15 Years…Even After 15 Years…
Improvement ContinuesImprovement Continues
In 2003:• 30 out of 33 clinical measures showed
improvement
• Strong gains on cardiac measures
• Average improvement is over 50% since 1996
Only 1 in 4 Americans is in an accountable
health plan
Measurement Improves QualityMeasurement Improves QualityMeasurement Improves QualityMeasurement Improves Quality
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
1996 1997 1998 1999 2000 2001 2002 2003
Mean
Beta-Blocker Treatment After a Heart Attack (Commercial, 1996-2003)
……AND ConsistencyAND Consistency……AND ConsistencyAND Consistency
Measurement Improves QualityMeasurement Improves QualityMeasurement Improves QualityMeasurement Improves Quality
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
2000 2001 2002 2003
Mean
……AND ConsistencyAND Consistency……AND ConsistencyAND Consistency
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
2000 2001 2002 2003
Mean
Controlling High Blood Pressure (Medicaid, 2000-2003)
Measurement Improves QualityMeasurement Improves QualityMeasurement Improves QualityMeasurement Improves Quality
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
2000 2001 2002 2003
Mean
……AND ConsistencyAND Consistency……AND ConsistencyAND Consistency
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
2000 2001 2002 2003
Mean
Poor HbA1C Control (Medicare, 2000-2003)
Lower is Better
What Should We Do Next?What Should We Do Next?What Should We Do Next?What Should We Do Next?
• Expand the accountability model to include all participants– HMOs and PPOs– Hospitals– Physicians– Nursing homes and home health
• Align payment systems with quality reporting and performance– P4P for plans and providers
• Incentivize the use of H-IT– Be clear about purpose
