Performance Measures to Enhance Care and Reduce Costs

Atlanta—The Patient Protection and Affordable Care Act of 2010 was designed to achieve 3 goals: better health, better care, and lower costs. The National Quality Forum (NQF) has convened the National Priorities Partnership (NPP), a multistakeholder group charged with providing annual input to the US Department of Health and Human Services (DHHS) on the development of a National Quality Strategy (NQS). In addition, the Measure Applications Partnership (MAP) was created to provide input to the Centers for Medicare & Medicaid Services on the establishment of performance measures for public reporting, identify gaps for measure development and endorsement, and encourage alignment of public and private sector performance measurement programs. At a Contemporary Issues session at the AMCP meeting titled Use of Performance Measurement to Improve Quality and Influence Payment, Tom Valuck, MD, JD, senior vice president of strategic partnerships, NQF, discussed the NQF and provided information on the MAP. Dr. Valuck began his presentation by outlining the mission of the NQF: to improve the quality of American healthcare by building consensus on national priorities and goals for performance improvement and working in partnership to achieve them; endorsing national consensus standards for measuring and publicly reporting on performance; and promoting the attainment of national goals through education and outreach programs. The NQF is a 48-partner multistakeholder partnership that includes consumers, purchasers, quality alliances, health professionals/providers, state-based associations, community collaborative and regional alliances, accreditation/certification groups, health plans, and supplier and industry groups. Dr. Valuck described the goals (better care, healthy people/healthy communities, affordable care) and strategies included in the NQS. The priorities to achieve these goals are emphasis on health and well-being; prevention and treatment of the leading causes of mortality; person- and family-centered care; patient safety; effective communications and care coordination; and affordable care. With input from the NPP, measure concepts for each of the priorities have been developed. Dr. Valuck continued the session with examples of the measure concepts, including those for (1) health and well-being (measure social support, develop a healthy behavior index, track the delivery of clinical preventive services such as immunizations); (2) prevention and treatment of cardiovascular disease (measure access to healthy foods and recreational facilities, track and reduce tobacco use, consumption of calories from fats and sugars, control blood pressure cholesterol levels); and (3) person- and family-centered care (measure patient and family involvement in care decisions, provide easy-to-understand instructions to manage chronic conditions). For patient safety, the measure concepts include creating an all-cause hospital readmission index, tracking inappropriate medication use and polypharmacy, inappropriate maternity care, and unnecessary imaging. To measure the success of effective communication and care coordination efforts, the panel suggested tracking the experience of patients during transitions of care, chronic disease control, care consistent with end-of-life wishes, care for vulnerable populations, and shared accountability for care. Finally, to measure the attainment of affordable care, the NPP concepts include a consumer affordability index, consistent insurance coverage, and tracking unwarranted variation or overuse of healthcare services and the average annual percentage growth in healthcare costs. Dr. Valuck provided detailed information about the plans for payment reform, outlining the models being developed. The models are based on moving away from a fee-for-service model toward models emphasizing financial incentives based on performance. Performance-based models reward evidence-based care, avoid inappropriate care, create increased focus on the patient, and lead to improved coordination of care, he said. Dr. Valuck then turned to a discussion of the MAP, describing the 2-tiered structure of the partnership: a coordinating committee with association and agency members representing hospitals, clinicians, dual-eligible beneficiaries, and postacute care/long-term care coupled with an ad hoc safety workgroup. The MAP is charged with coordinating strategies for performance measurements as well as providing prerulemaking input to DHHS. Criteria used by the MAP for measure selection follow: (1) measures meet NQF endorsement criteria; (2) measure set adequately addresses the NQS priorities; (3) measure set adequately addresses high-impact conditions relevant to the program’s intended populations; (4) measure set promotes alignment with specific program attributes; (5) measure set includes appropriate mix of measure types; (6) measure set enables measurement across the person-centered episode of care; (7) measure set includes considerations for healthcare disparities; and (8) measure set promotes parsimony. In conclusion, Dr. Valuck listed 4 areas for evaluation of the use of performance measures: (1) evaluate how performance measures are being used in the field; (2) investigate the factors that influence whether NQF-endorsed measures are used; (3) look at systems change that might occur as a result of using performance measures; and (4) use the results for future planning.