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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