ADVANCING HEALTH CARE QUALITY IN 2007

AND BEYONDMargaret E. O’Kane

President, NCQA

2 MARGARET E. O’KANE – COMMONWEALTH FUND BRIEFING

JANUARY 14, 2007

• Private, independent non-profit health care quality oversight organization

• Measures and reports on health care quality

• Committed to measurement, transparency and accountability

• Unites diverse groups around common goal: improving health care quality

NCQA: A Brief Introduction

3 MARGARET E. O’KANE – COMMONWEALTH FUND BRIEFING

JANUARY 14, 2007

• Quality Measurement– HEDIS, CAHPS

• Accreditation, Certification, Recognition– Health Plans, Physicians and Physician Groups,

Health Care Organizations (such as DM providers)

• Public Reporting– State of Health Care Quality, America’s Best

Health Plans, Healthchoices.org, third-party partnerships

• Research– Quality measures development– Cultural disparities in health care

NCQA: A Brief Introduction

4 MARGARET E. O’KANE – COMMONWEALTH FUND BRIEFING

JANUARY 14, 2007

A MEASUREMENT SUCCESS STORY:

BETA-BLOCKER TREATMENT AFTER A HEART ATTACK

5 MARGARET E. O’KANE – COMMONWEALTH FUND BRIEFING

JANUARY 14, 2007

National average:62.6%

BETA-BLOCKER TREATMENT AFTER A HEART ATTACK

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

6 MARGARET E. O’KANE – COMMONWEALTH FUND BRIEFING

JANUARY 14, 2007

74.1%

BETA-BLOCKER TREATMENT AFTER A HEART ATTACK

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

7 MARGARET E. O’KANE – COMMONWEALTH FUND BRIEFING

JANUARY 14, 2007

79.7%

BETA-BLOCKER TREATMENT AFTER A HEART ATTACK

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

8 MARGARET E. O’KANE – COMMONWEALTH FUND BRIEFING

JANUARY 14, 2007

National average:85.0%

BETA-BLOCKER TREATMENT AFTER A HEART ATTACK

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

9 MARGARET E. O’KANE – COMMONWEALTH FUND BRIEFING

JANUARY 14, 2007

National average:89.4%

BETA-BLOCKER TREATMENT AFTER A HEART ATTACK

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

10 MARGARET E. O’KANE – COMMONWEALTH FUND BRIEFING

JANUARY 14, 2007

National average:92.5%

BETA-BLOCKER TREATMENT AFTER A HEART ATTACK

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

11 MARGARET E. O’KANE – COMMONWEALTH FUND BRIEFING

JANUARY 14, 2007

:93.5%

BETA-BLOCKER TREATMENT AFTER A HEART ATTACK

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

12 MARGARET E. O’KANE – COMMONWEALTH FUND BRIEFING

JANUARY 14, 2007

:94.3%

BETA-BLOCKER TREATMENT AFTER A HEART ATTACK

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

13 MARGARET E. O’KANE – COMMONWEALTH FUND BRIEFING

JANUARY 14, 2007

:96.2%

BETA-BLOCKER TREATMENT AFTER A HEART ATTACK

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

14 MARGARET E. O’KANE – COMMONWEALTH FUND BRIEFING

JANUARY 14, 2007

:96.6%

BETA-BLOCKER TREATMENT AFTER A HEART ATTACK

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

15 MARGARET E. O’KANE – COMMONWEALTH FUND BRIEFING

JANUARY 14, 2007

ADVANCING QUALITYIN 2007 AND BEYOND

16 MARGARET E. O’KANE – COMMONWEALTH FUND BRIEFING

JANUARY 14, 2007

THE IMPACT OF IMPROVEMENT: What is the 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

17 MARGARET E. O’KANE – COMMONWEALTH FUND BRIEFING

JANUARY 14, 2007

PROMOTE WELLNESS

• The primary function of the health care system is to cure illness

• keep people healthy

• We must re-emphasize primary care• The “medical home” needs to be further defined and promoted• The patient needs to be activated

18 MARGARET E. O’KANE – COMMONWEALTH FUND BRIEFING

JANUARY 14, 2007

NURTURE THE EVIDENCE BASE

• Gaps in evidence abound• Even where evidence has been

developed, there are too few tools to translate knowledge into practice

• Appropriateness of care needs further study – it’s tightly linked to qualityNEWEVIDENCE

IMPROVEDPRACTICE

19 MARGARET E. O’KANE – COMMONWEALTH FUND BRIEFING

JANUARY 14, 2007

HOW MUCH HEALTH DO WE GET FOR THE HEALTH CARE DOLLAR?

• Relative Resource Use measures calculate risk-adjusted observed cost/expected cost for critical conditions:– Cardiac conditions, diabetes, asthma,

COPD, low back pain, hypertension– These conditions account for 60% of all spending

• Along with related quality results, allows for plan-to-plan comparisons on value

20 MARGARET E. O’KANE – COMMONWEALTH FUND BRIEFING

JANUARY 14, 2007

A COMPREHENSIVE DELIVERY FRAMEWORK

• Whose job is it to do what?

• How do we design units of measurement to encourage effective, efficient care?

21 MARGARET E. O’KANE – COMMONWEALTH FUND BRIEFING

JANUARY 14, 2007

PAYMENT, ACCOUNTABILITY REFORM

• Pay for better care, not more care

• The system, as it is, rewards bad care

• Cost increases are being shifted to workers—or worse, leaving some out of the system altogether

22 MARGARET E. O’KANE – COMMONWEALTH FUND BRIEFING

JANUARY 14, 2007

THE TRINITY OF CARE: GOOD CARE

DOESN’T EXIST WITHOUT ALL THREEQUALITY

AFFORDABILITYACCESS