Value Proposition, Quality Assurance and Performance Monitoring

Day 2 - Forging New Pathways to Growth and Sustainability

Working Session 1 Value Proposition, Quality Assurance and Performance Monitoring

Quality Improvement Definition: Quality improvement (QI) consists of systematic and continuous actions that lead to measurable improvement in health care services and the health status of targeted patient groups. The Institute of Medicine's (IOM) which is a recognized leader and advisor on improving the Nation's health care, defines quality in health care as a direct correlation between the level of improved health services and the desired health outcomes of individuals and populations (1)..

HRSA Quality Improvement Resource. Available Online: http://www.hrsa.gov/quality/toolbox/methodology/qualityimprovement/

What is a QI Program? A QI program involves systematic activities that are organized and implemented by an organization to monitor, assess, and improve its quality of health care. The activities are cyclical so that an organization continues to seek higher levels of performance to optimize its care for the patients it serves, while striving for continuous improvement. A QI program typically envelops all QI activities within an organization. Clinically-related QI initiatives and activities to improve an organization's operations and finance are common examples. A QI program in a health care organization often begins with leadership considering these questions:

• Why is a QI program important to an organization? • What does an organization need to know as it develops a QI program? • How does an organization start its development of a QI program? • How do QI processes work to support the success of the QI program?

HRSA Quality Improvement Resource. Available Online: http://www.hrsa.gov/quality/toolbox/methodology/qualityimprovement/

Quality Metrics Data points that are tracked and monitored as part of an overall quality assurance program model. Quantitative and qualitative measures are both important to achieve quality improvement goals. Quantitative and qualitative measurements should include both clinical and non-clinical measures.

HEDIS Measures All Medicare Advantage Plans and Health Insurance Exchange plans are required to achieve current accreditation by the National Committee for Quality Assurance (NCQA). NCQA is a private, 501 (c)(3) not-for-profit organization. NCQA is contracted by CMS to accredit Medicare Advantage plans and Health Insurance Exchange plans. In order to achieve accreditation by NCQA, health plans must undergo a rigorous assessment of all aspects of their population health systems and processes. Once a health plan satisfactorily demonstrates that they have met the NCQA standards, the health plan is awarded NCQA accreditation.

NCQA accreditation indicates that the health plan has all of the required population health and management tools to provide effective healthcare coverage for a defined population of beneficiaries. Accredited health plans must continually report on the effectiveness of their population health processes by annually reporting on defined quality measures for the population they serve. This data is submitted to NCQA and publicly reported. NCQA uses a defined data set to assess heath plan quality in a tool called the Healthcare Effectiveness Data and Information Set (HEDIS). HEDIS consists of 81 measures across five domains of care. The objective HEDIS measures provide a mechanism to track health plan performance and to complete a side-by- side comparison of health plans using these universal objective measures. HEDIS measures are a registered trademark of NCQA. Exercise: 1. Does your organization have a quality improvement program? Why or why not?

2. Does your organization track both quantitative and qualitative measures? If yes, what are some of the measures that your organization tracks?

3. What quality performance measures is your health care partners tracking or interested in tracking? How can you support your partner in tracking this information?

4. Does your organization currently track any of the HEDIS and Star measures listed above?

5. How does your organization track quality metrics?

6. How does your organization report quality?

7. What process do you use to report outcomes and produce reports on quality metrics? 8. What type of information technology system do you use to manage quality data?

9. Is your information technology HIPAA compliant? Why or why not?

10. Does your information technology meet current ONC meaningful use requirements?

11. Develop a quality improvement data capture process for at least one qualitative and one quantitative quality measure. Identify the key performance measure you will track, how you will monitor, track, and report it, and tools for capturing data.