Part 2: How Quality Measures Support Effective Consumer-Patient Involvement

This is Part 2 of a 2-part series on Involving Consumers in Healthcare Quality

Part 1 identifies the types of healthcare consumers best positioned to drive change and discusses how organizations can identify, involve, and train these potential change leaders. In this paper I focus on the interplay between quality and cost measures and involving consumers in improving healthcare quality. Consumers could be a powerful force in reshaping healthcare if we can figure out how to use quality and cost measures to support and harness their potential to catalyze change.

MEASURING THE VALUE, SUPPORTING CHANGE

The role of measurement in supporting change can’t be overstated. The common saying goes, “What gets measured gets done.” In the past, healthcare has not reflected this truism, because the value of services provided has not been rigorously measured. Services provided for similar medical conditions have varied widely within Maine and across the country, along with outcomes and costs. This is starting to change, as payers and policy makers have started to demand more accountability for benefits, costs, and results of care.

Consumers and consumer organizations can support the momentum for change, for expecting healthcare services to provide value – value that can be measured and reported. While it may be hard for an individual patient-consumer to make a big impact, influence increases when individual efforts are linked and supported by consumer advocacy groups. These groups are growing in numbers of participants and effectiveness. Their collective voice depends on the strength of quality evidence – what data tells us about benefits, costs, and results of care along with stories that ‘put a face’ to the data and make it real and compelling.

QUALITY MEASURES AND CONSUMER INFLUENCE

In order for quality data to help drive change, 3 conditions must exist:

  • Reliable measures of healthcare quality must be developed and available for use. Multiple, highly regarded national groups have developed and are continuing to develop reliable quality indicators derived from evidence-based guidelines. These groups include the National Quality Forum, The Leapfrog Group, Centers for Medicare and Medicaid Services, and others. While not perfect, quality indicators reflect evidence-based best practices for managing common diseases and conditions, preventing medical mistakes, and reducing unnecessary tests and procedures. The indicators serve to differentiate high performing systems from others performing less well.

Consumers have a voice in developing quality and safety guidelines and indicators through certain specific groups, such as the Robert Wood Johnson Foundation-funded Consumer-Purchaser Alliance. In addition, they participate on the board and workgroups of the National Quality Forum and other bodies.

  • Quality measures must be continually evaluated and improved. Measuring healthcare value is in its infancy. While some current indicators are known to reflect safety and quality of care (such as hospital infection rates, blood pressure management in primary care, etc.), others do not yet have unequivocal evidence of value (“gold standard” evidence). This doesn’t mean that current indicators have no value, but rather, that they are a work in progress. Many capable researchers and policy makers have developed currently available indicators based on the best data now available. As measurement of outcomes increases and improves, so will quality indicators.

  • Quality measures must be actively used to catalyze improvement in healthcare value. Here’s where “the rubber meets the road.” The Centers for Medicare and Medicaid Services (CMS) is actively engaged in shifting from paying from volume to paying for value – value reflected by quality indicators. In the not too distant future, providers will not be reimbursed on the number of procedures or services performed, but on the health of their Medicare patients. Medicare Accountable Care Organizations are currently experimenting with this model and some are doing well, sharing in financial rewards for achieving quality indicator targets.

Consumers and consumer advocacy groups must play a major role in having quality and cost indicators used, or pushback from established and powerful interests will negate their effectiveness in driving change. As noted above, our current metrics are not perfect, but they are based in the evidence we currently have about what produces safe, quality care. Consumers on boards, committees, work groups, in policy positions etc. need to insist on being data-driven, on reviewing and using current quality indicators and encouraging the development of improved measures.

WILL IMPROVED MEASUREMENT RESULT IN FASTER CHANGE?

In healthcare, the forces of resistance are certainly as powerful or perhaps even more powerful than the forces for change. Many groups, internal and external, have vested interests in keeping things as they are. But we can’t. We can’t afford medical mistakes. We can’t afford poor quality. And we can’t afford the financial burden imposed on us all.