More gains in quality, but always room for improvement

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Every year, the National Committee for Quality Assurance releases an annual State of Health Care Quality report. While our most recent report shows disappointing progress in key areas, it serves as an excellent blueprint to track where our healthcare system is making progress and identifies where it still needs work.

The most recent report offers some good news. More Americans than ever are benefiting from the accountability that measurement and transparency bring to healthcare. The number of people enrolled in health plans that publicly report Healthcare Effectiveness Data and Information Set (HEDIS) quality results has doubled to more than 171 million in only 11 years.

In many areas, quality measurement and performance have grown in lockstep. Almost half the clinical areas HEDIS evaluated in 2013 saw sustained and significant quality gains over long periods. And many other measures showed incremental improvement.

But then there is also the other side of the findings. Almost 10% of quality measures showed persistent and significant declines in quality from 2008 to 2013. With costs as high as they are and with performance clearly not where it needs to be, the takeaway is clear: We must improve.

In an unprecedented shift from the fee-for-service model, HHS announced this year that it has set quantifiable goals in moving toward pay-for-performance, the model heralded by the healthcare quality movement. By 2018, HHS plans to deliver 50% of Medicare benefits through alternative models such as accountable care organizations.

We strongly support and applaud this movement. ACOs work by capturing quality (or performance) metrics, incentivizing improvement (giving docs more money for doing well, as opposed to doing more) and making healthcare patientcentric. Together with the Five-Star Quality Rating System used by Medicare Advantage plans, we are slowly moving toward realizing the triple aim for all: better health, better care, lower costs.

A version of this essay appeared in April on Modern Healthcare.

Margaret E. O'Kane
Margaret E. O’Kane is the founding and current president of NCQA. Modern Healthcare magazine has named O’Kane one of the “100 Most Influential People in Healthcare” nine times, most recently in 2014, and one of the “Top 25 Women in Healthcare” three times.

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