2024 Quality Outlook Revealed: Insights from 2023 Fall Conferences
Introduction
Attending conferences is a valuable way to take the pulse of the ever-evolving quality and value-based health care ecosystem. This past fall, leaders from the Real Chemistry Market Access team attended key quality-related events to understand trends and learn from other quality and value experts.
This blog summarizes our collective insights from the National Committee for Quality Assurance (NCQA) Health Innovation Summit, the Health Care Payment Learning & Action Network (LAN) Summit, the Pharmacy Quality Alliance (PQA) Leadership Summit, the American Heart Association (AHA) Scientific Sessions, and the Journal of Clinical Pathways (JCP) Clinical Pathways Congress + Cancer Care Business Exchange (CPC+CBEx).
We identified several themes that will continue to impact the value-based care landscape in 2024:
Progress toward accountable care has continued, but at a slower pace than anticipated
HCP-LAN reported that, in 2022, nearly a quarter of US health care payments were tied to quality and value through payment models where providers can gain or lose money based on their quality and/or financial performance. This represents progress from the early days of accountable care. However, at the fall 2023 events, we sensed frustration that the pace of accountable care adoption has fallen short of expectations. Lack of progress is particularly evident in specialty care. Fully incorporating specialty care is pivotal for expanding the scope of accountable care and for achieving true, system-wide improvements in quality and cost.
While the implementation of value-based payment programs has often yielded improvements in quality, cost reductions, or both, many programs have delivered only modest, if any, gains. While we are learning what works and what does not, we risk losing broad support for value-based programs.
The Centers for Medicare & Medicaid Services (CMS) Universal Foundation offers the latest path to measure alignment, but questions about how to address specialty topics persist
One barrier to the adoption of accountable care has been administrative burden, especially when different value-based programs have different requirements. CMS seeks to alleviate administrative burden through the Universal Foundation, a set of quality measures selected to be “used across CMS quality programs and prioritized for stratification and digitization.” This is the latest effort in an ongoing movement to align on fewer and more meaningful measures that serve as a common framework for quality across various health care settings and payment models.
Sessions at the PQA Leadership Summit discussed the Universal Foundation, but stakeholders noted that the proposed measures are not yet applicable for all care settings and types of patients. The conversations brought to light the inherent trade-offs between breadth and depth. The Universal Foundation is still too narrow to be able to support a comprehensive shift to value-based care across all specialties and therapeutic areas. Through our work at Real Chemistry, we have also identified and worked to address clinical topics and clinical areas where available measures are insufficient to capture the concepts most important to clinicians, patients, and families.
Genomic testing is redefining personalized medicine and challenging us to adapt measurement and payment frameworks accordingly
Genomics and genomic testing offer unprecedented opportunities to personalize medicine, as discussed in multiple sessions at CPC+CBEx and the AHA Scientific Sessions. This may be particularly true in oncology, where tailored treatment based on genetic profiles is rapidly becoming standard of care. However, innovations in this field are outpacing development and adoption of relevant quality measures and value-based payment frameworks (see our blogs about the Cell and Gene Therapy Access Model and the protracted timeline for developing and implementing measures).
Because emerging diagnostics and therapies often have high costs, we need data-driven mechanisms to measure their clinical and financial impacts over time. Current gaps in the availability of quality measures specific to genetic testing, genomic testing, and biomarker testing must also be addressed to fully assess the impact of these advancements, establish sustainable payment models, and help guide clinicians and payers toward the appropriate use of personalized therapies.
Measure developers and clinicians are motivated to involve patients and caregivers more deeply in measurement and improvement initiatives
A key component of promoting both personalized medicine and patient-centered care is engaging patients and families as active participants in quality measurement and improvement throughout the care continuum. Patients and families should have an integral role in defining quality of care. One presenter at the PQA Leadership Summit said, “Good care is care that improves my story. In the quality space, we need to be better story catchers.”
Conference presenters explored a range of approaches for engaging patients in improving the value of care, such as through patient-reported measures and patient advisory councils. For example, the LAN introduced its Person Perspectives Council, “which provides critical guidance on the challenges affecting individuals receiving care and caregivers in value-based care relationships.” But bringing patients to the table is just one step in fostering meaningful participation. The challenge lies less in convincing quality stakeholders of the importance of patient centricity, and more in equipping them with the skills and resources to engage patients effectively. Likewise, those seeking to engage patients should give patients the tools they need to participate meaningfully in initiatives.
Health equity considerations should be embedded across all dimensions of health care, but stakeholders worry about losing momentum
Health equity remains a hot topic in health care quality, underscoring the ongoing ethical and business imperative to address inequities in health care access, utilization, and outcomes. Speakers emphasized the need to integrate health equity into every aspect of health care, rather than treating it as a siloed concern.
To sustain momentum, health care organizations must ensure that the teams and initiatives they devote to health equity are resourced, sustained, empowered, and woven into overarching organizational goals and decisions for expanding access and improving quality and outcomes. This is especially critical given increasingly hostile policies that undermine equity efforts. As noted at the LAN Summit, engaging and collaborating with community-based organizations is a powerful tactic for bringing equity into accountable care models.
Several sessions at the NCQA Health Innovation Summit noted the potential for quality measurement and value-based payment to advance equity, but also acknowledged significant technical barriers, as discussed in the next section. Our Real Chemistry Market Access and Global Inclusion and Health Equity teams have been collaborating with several organizations to implement our Rooted Health Equity Measurement Framework to support organizations in holding themselves accountable for advancing equity across their initiatives.
Advancements in digital measurement have occurred despite interoperability and data collection barriers
Data interoperability is another area where progress has moved more slowly than expected, despite being a conference topic for decades. Conference speakers acknowledged progress with the adoption of Fast Healthcare Interoperability Resources (FHIR) and other technologies, but they also described pervasive interoperability challenges and digital infrastructure barriers that prevent providers from unlocking efficiencies, making informed clinical decisions, and optimizing care pathways.
The move toward digital quality measures (DQMs) and electronic clinical quality measures (eCQMs) has been prioritized by measure developers and implementers such as CMS, PQA, and NCQA because these measures promise to integrate more seamlessly with clinical workflows, standardize data collection, improve accuracy, and reduce measurement burden. Presenters described CMS’ investment in the digital quality ecosystem through creation of standards for data formats, application programming interfaces, and measure calculation tools.
As with all measures, the utility of DQMs and eCQMs is dependent on the quality of the underlying data. For example, measuring inequities requires stratifying data by characteristics such as race/ethnicity and sexual orientation and gender identity. But implementing structures and processes for collecting accurate data has been haphazard and plagued by challenges to privacy and safety. However, as speakers from Real Chemistry and the LGBT (Lesbian, Gay, Bisexual, and Transgender) Cancer Network noted, implementation barriers should not prevent quality measurement efforts: “inactivity supports continued discrimination.”
Artificial intelligence (AI) is opening new frontiers in health care quality
Conference presenters highlighted the potentially transformative use of generative artificial intelligence (AI) in health care and discussed how AI can be used to improve health care processes and enhance patient outcomes by promoting efficiency, accuracy, and personalization. For example, AI has been used successfully to detect valvular heart disease, capture data in prior authorization, and target patients for more effective care management interventions. However, our ability to measure the effectiveness of AI-powered tools is still in its infancy.
Integrating AI into health care and quality evaluation is complex. We must consider data privacy, algorithmic transparency, and the equitable delivery of AI-powered health care, among other challenges. Conference sessions emphasized the need for thoughtful integration to ensure AI enhances quality and equity, and that it supports human decision-making rather than complicating or undermining it.
At Real Chemistry, our team is exploring AI applications for a variety of health care challenges. In fact, in producing this blog, we harnessed our proprietary AI tool to distill themes and synthesize content from a dynamic discussion among the market access leaders who attended these conferences.
Looking ahead to 2024
Despite the slow pace to date, we believe that progress toward adoption of value-based programs will continue in 2024. Strides in digital measurement and alignment across programs may reduce burden on providers to participate, but measures of quality specialty care will still be needed and will be slow to roll out. However, organizations such as the LAN will continue to work on tactics to advance specialist participation in value-based programs.
In 2024, we also expect to hear more about the role of AI in quality measurement itself and whether AI tools can help create meaningful measures beyond what we have seen from recent big data movements. This might include measures utilizing novel data sources, like wearables and social media data, or measures derived from machine learning across diverse datasets.
Stakeholders will continue working to create measures and value-based programs that promote personalized medicine, patient-centered outcomes, cost reduction, and health equity. As health care professionals incorporate patient perspectives into quality measurement, improvement, and equity efforts, the patients, families, and community organizations participating in these efforts may seek more authentic partnership and reciprocity. We also expect conversations around equity to increasingly emphasize the business imperative across all sectors, from cost savings via improved access to preventive services to expanded access to needed medications among historically marginalized communities.
Conclusion
The 2023 fall conferences we attended served as a useful platform for exploring future directions of quality measurement and value-based care. As paradigms shift and new treatments and technologies broaden the horizons of medicine, the need to define, measure, and incentivize the delivery of health care value remains critical. Engaging diverse patients and families in creating these value definitions and prioritizing evidence-based initiatives that reduce health care inequities can support improvements in care and outcomes in 2024 and beyond.
Discussion question: What do you see as the leading trends in health care quality for 2024?
About the Quality Outlook Commentary Series
Breakthrough treatments in cancer care, including precision therapies tailored to specific patient factors, are driving rapid changes in the definitions of oncology quality and value. Efforts to implement value-based care models in oncology must meet the demands of evolving science, new best care practices, and shifting patient priorities. Quality measures must be up-to-date and relevant. Payment models must recognize the challenges and costs of managing complex patient populations with diverse needs. In this JCP blog series, Quality Outlook, Real Chemistry will explore key issues in oncology quality and value through posts focused on measurement, value-based payment, and quality improvement.
Theresa Schmidt
Theresa Schmidt, MA, has nearly two decades of experience in health care policy, quality, and health information technology. As a Vice President, Value Based Care at Real Chemistry, she leverages her expertise in non-acute care, analytics, quality measures and quality improvement, value-based payment, and research to help clients and partners achieve their business goals. Theresa has a diverse health care background and has held prior positions at the National Partnership for Hospice Innovation, Healthsperien, Avalere Health, and eHealth Data Solutions. She serves on the board of the Advancing Excellence in Long Term Care Collaborative.
Danny Bellet
Danny Bellet, MBA, is the AI Strategy and Product Innovation Lead at Real Chemistry, where he consults across the organization to apply artificial intelligence to drive innovation and growth. He champions the strategic infusion and adoption of AI tools into Real Chemistry workflows while leading development of AI-driven products that anticipate and meet market demands. In his prior role as Group Director, he leveraged diverse data sources to deliver data-driven insights and performance marketing solutions to pharmaceutical and biotech clients. With a rich background in analytics, including positions at Wunderman Thompson Health, Institute for the Study of Business Markets, and AccuWeather, Danny brings a wealth of experience in transforming data into actionable insights. His commitment to harnessing AI as a catalyst for the next phase of digital transformation positions Real Chemistry and its clients for success in the evolving health care technology landscape.
Donna Dugan
Donna Dugan, PhD, MS, leads the Organized Customer Strategy practice of Real Chemistry’s Market Access function bringing 23 years of insight and subject matter expertise, particularly on quality measurement, health policy, and health services research. Through her work on our Market Access team, Donna leads remits with manufacturers that focus on how to achieve success within the value-based marketplace, including through understanding behavior drivers for organized customers such as health systems, integrated delivery networks (IDNs), and payers. She also leads strategic advising work with an association of health plans and individual health plan clients. Before joining Discern/Real Chemistry, Donna was an independent consultant, working on quality measurement and health-policy-related projects for organizations such as the National Committee for Quality Assurance (NCQA), the National Quality Forum (NQF), and the Pharmacy Quality Alliance (PQA). Donna also served as Director of Performance Measurement at NCQA, where she led the unit that developed and implemented Healthcare Effectiveness Data and Information Set (HEDIS®) measures.
Dave Sloan
Dave Sloan, PhD, is a Director, Organized Customer Strategy on the Market Access team at Real Chemistry, with expertise in health care organizational strategy and quality of care. For over 10 years, he has worked with health plans and life sciences companies to develop measurement and communication strategies. Dave has a PhD in neuroscience from the University of Virginia and was a research fellow in the office of David McKinley (R-WV). He applies his scientific training to helping clients succeed in the health policy environment.
Erik Muther
Erik Muther, a Senior Vice President at Real Chemistry, is a thought leader and subject matter expert in value-based care and healthcare performance measurement. Erik leads strategy and implementation projects related to primary care transformation, real-world evidence generation, provider engagement, quality measurement and multi-stakeholder collaboration with clients in the health and life sciences industry.
Tom Valuck
Tom Valuck, MD, JD, is a Partner at Real Chemistry. He is a thought leader on health care system transformation and helps lead the firm’s focus on achieving better health and health care outcomes at a lower cost. Tom’s work at Real Chemistry includes facilitating the exploration of next-generation measurement and accountability models for health care delivery systems. He also helps clients develop strategies to achieve success within the value-based marketplace.
