ICYMI: The State of Health Care Quality Promising, With More Work

ICYMI. That’s text speak for “in case you missed it.” It’s very possible you did miss the live unveiling Webex for NCQA’s 25th anniversary edition of the State of Health Care Quality Report. The response and registrations outpaced expectations.

For those who missed it, catch the entire presentation here. Download the full report here.

If you want the quick summary and a few thoughts provided by NCQA’s president Margaret E. O’Kane, here goes.

Ms. O’Kane unveiled the report by highlighting the positive impact of the Medicare Stars measures and rating system comprised of a number of HEDIS measures as well as some others.

CMS created the Medicare Stars system to incentivize and highlight quality improvement. The number of high performing 4 and 5 Star plans rose from 40 to 45 percent from 2014 to 2015, proof that linking payment with performance is powerful motivation. The percentage of enrollees in these highly rated Medicare Advantage plans rose from 60 to 70. That also indicates consumers consult quality ratings and reward high performers with their business. More incentives for the plans and their providers leads to quality improvement.

“Medicare has very strategically driven a quality agenda,” O’Kane explained. “If you are a high performing plan, you get paid more and put more of that money back into benefits like hearing aids and glasses. It is a consistency of message using behavioral economics. It is making a difference.

There are other signs that O’Kane’s mantra “What gets measured gets improved” holds true. Among the 136 measures in this year’s report, we find that over three to five years:

  • 46 measures (34 percent) had consistent performance gains.
  • Only 12 measures (9 percent) had consistent and statistically significant declines.

Among the highlights is progress on measures dealing with the obesity epidemic nationwide. It’s clear actually tracking patients’ body mass index (BMI) helps. There is strong improvement in the number of clinicians who now monitor BMI in adults. The number of clinicians monitoring BMI in children has significantly improved too. In addition, more health care providers also provide children advice on nutrition and exercise.

The measure for Behavioral Health care do not paint as positive a picture. We’ll call it mixed. There is a significant one-year improvement in Antidepressant Medication Management—Effective Acute Phase Treatment. But two measures that look into follow-up care for patients recently hospitalized for behavioral issues found disappointing declines in performance. There are also declines in performance for the number of clinicians who initiate treatment for alcohol or other drug dependence.

And in an area recently in the news, measures that look at whether clinicians are monitoring people diagnosed with schizophrenia or bipolar disorder and whether those patients are staying on their meds show little or no change.

We won’t close on that negative note, though. Progress looms in the form of The Medicare Access & CHIP Reauthorization Act (MACRA), the legislation that revises Medicare’s fee-for-service payment system for physicians and other clinicians, to reward value instead of volume. Those payment incentives discussed above are “going viral” spreading to plans and providers outside that initial Medicare Advantage universe. Expect to hear more on that throughout the coming year. NCQA recently published a white paper on moving forward with MACRA. Read it here.

So, to sum up this year’s State of Health Care Quality report. Measuring works. It drives improvement. So do incentives that reward quality improvement. Measures in the report once again reflect that narrative. Still, behavioral care particularly needs increased attention from plans and providers.

As predictable as the annual release of this report, there is this final call to action. We have more work to do. In case you missed it.

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