Even though health insurers aren’t in the exam room or surgical suite, they have a role in helping their members get quality care.
Quality improvement strategies start with measurement, so it’s vital that health care providers, insurers and other stakeholders are measuring the right things.
That was a key topic at the April 1 Quality Outcomes Summit hosted by the Blue Cross and Blue Shield Plans of Illinois, Montana, New Mexico, Oklahoma and Texas.
When members get effective and efficient care, they're better able to attain their optimal health. They also avoid unnecessary tests and treatments - translating to lower out-of-pocket costs for them and more affordable coverage for all members over time.
Dr. Michael Barr, the executive vice president of the quality measurement and research group at the National Committee for Quality Assurance (NCQA), gave the keynote address.
“When you measure what matters, change happens,” Barr said.
For example, when the NCQA started measuring how many patients received beta blockers after a heart attack, the national average among commercial PPO patients grew from about 64% to 84% over 12 years.
By measuring care quality, the Blue Cross and Blue Shield Plans are able to develop programs that help members get recommended services. The Plans also share data and create incentives to help doctors, hospitals and other facilities provide high-quality care.
“As a customer-owned organization, we are really the stewards of the health of our membership and work hard to put processes and structures in place to support them in achieving their maximum health,” said Dr. Stephanie Vomvouras, vice president and chief medical officer of quality and accreditation for the five Blues Plans. “Quality measurement is a huge part of that.”
Future of quality measurement
The hard part is making sure quality measures are aligned across the fragmented health care system.
That is, do measures allow comparisons across different insurers, doctor's offices, hospitals and other care settings? Does a measure used in one care setting have an unintended consequence in another?
“If you think about standardized measures that promote coordination and integration,” Barr said, “that’s what measurement looks like in the future.”
Better alignment also helps providers spend less time and energy reporting on different measures to various health insurers, accreditors and government programs.
“Let’s align those measures so that we’re not driving ourselves and the clinicians on the front line crazy,” Barr said.
Vomvouras agrees. “We need to make sure whatever we’re doing is not creating overly complex and challenging environments, which keep (providers) from doing what they do best,” she said.
Experts in health care quality are also studying how to measure “person-driven outcomes.”
It’s common, for example, to measure diabetes care by looking at whether a patient’s blood sugar levels are under control.
These numbers are important, but they aren’t the only metric of success for many people.
To measure person-driven outcomes, clinicians might ask patients something like, “What would you like to achieve in the next three months related to your health?”
Their answer might be as simple as walking the dog or choosing who helps them get dressed in the morning.
"They don't care about what their hemoglobin A1c is," Barr said. "They care if they can … get up and do some exercise."