Initial Plan Released to Meet Affordable Care Act Requirements

A new strategic plan developed by the secretary of the Department of Health and Human Services (DHHS) has been released to address how the Affordable Care Act’s mission of increasing high-quality and affordable healthcare will be accomplished in the United States. The National Strategy for Quality Improvement in Health Care outlines specific priorities and broad aims designed to improve healthcare outcomes and meet patient and community needs. Although the National Quality Strategy will be revised annually to help meet the goals outlined in the Affordable Care Act, the DHHS report released in 2011 describes the initial strategy and the plan for implementation. According to the authors of the report, the strategy will serve as a guide for those who deliver and pay for healthcare in the United States and should promote a healthcare delivery model that reduces administrative burdens and relies on collaboration. The National Strategy for Quality Improvement in Health Care was developed after collecting input from federal and state agencies, local communities, clinicians, patients, businesses and employers, payers, and provider organizations. The goal of the strategy is to facilitate measurable improvement in healthcare outcomes, while improving the overall health of the country. To lead healthcare improvement efforts, the strategy identifies 3 broad, national aims. The first aim is to provide better care by focusing on patient-centered approaches that are reliable, safe, and accessible. Next, the plan hopes to promote healthy people and healthy communities through proven interventions designed to address social, behavioral, and environmental factors impacting overall health. Finally, the last national aim is to provide more affordable care by finding ways to reduce the cost of healthcare for individuals, families, employers, and the government. In addition to the national aims, the strategy also identifies 6 priorities that the authors believe have the potential to rapidly improve healthcare outcomes. The priorities were developed with the input of key stakeholders and include the following: (1) making care safer, (2) ensuring person- and family-centered care, (3) promoting effective communication and coordination of care, (4) promoting the most effective prevention and treatment for the leading causes of mortality, (5) working with communities to promote best practices for healthy living, and (6) making quality care more affordable. In terms of preventing the leading causes of mortality, the strategy plans to begin with cardiovascular disease, a chronic illness that is responsible for 1 of every 3 deaths in the United States. The impact of cardiovascular disease can be reduced through interventions aimed at encouraging aspirin use, controlling blood pressure, reducing cholesterol, and quitting smoking. In addition to simply identifying the key priorities, the National Quality Strategy also lists specific examples of initiatives currently in place to address each priority. For example, one program in place to make care safer is the Michigan Keystone Intensive Care Unit Project. Under the program, Johns Hopkins University, Baltimore, Maryland, and the Michigan Health and Hospital Association have joined together to implement recommendations from the Centers for Disease Control and Prevention to reduce central line bloodstream infections in patients in 100 intensive care units in Michigan. Three months after implementation of the recommendations, the rate of these infections was reduced by two thirds. Whereas each local area will find its particular way to meet all 6 of the priorities, all communities will also need to find ways to work collaboratively with clinicians, patients, provider organizations, and other stakeholders to find solutions. According to the authors of the report, the long-term goal is for all patients to receive “the right care, at the right time, in the right setting, every time.” While the individual approach to healthcare will differ across the country, the DHHS has also developed 10 principles to assist stakeholders in developing initiatives that meet the aims and priorities outlined in the national strategy. Some of these principles include payment incentives for programs encouraging better health or collaboration among healthcare teams, publically reporting information to both consumers and payers, measuring healthcare outcomes using consistent and nationally endorsed measures, and adopting more health information technology programs to reduce costs and improve quality. Before the National Strategy for Quality Improvement in Health Care was developed, there was limited coordination or alignment between stakeholders or states to determine a common direction for the future of healthcare in the United States. With the help of the national strategy, which will be updated each year based on new research and stakeholder input, communities and healthcare providers will be able to share ideas and work together to find the best ways to deliver healthcare that is both affordable and of the highest quality. The strategy will also be used to guide DHHS agencies as they develop new programs and initiatives. Under the Affordable Care Act, the national strategy was directed to include specific plans, goals, benchmarks, and standardized quality metrics; however, for the first year, quantitative aspects have been excluded from the strategy. According to the authors of the report, this was done purposely to allow collaboration between stakeholders. Throughout 2011, additional input will be collected from those at the state level and in the private sector to develop specific benchmarks and quality metrics. The strategic plan is expected to evolve as more information is gathered and the healthcare needs in the country change; the DHHS will continue to provide annual updates to the public and Congress.