advancing health care quality in 2007 and beyond margaret e. o’kane president, ncqa
TRANSCRIPT
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ADVANCING HEALTH CARE QUALITY IN 2007
AND BEYONDMargaret E. O’Kane
President, NCQA
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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
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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
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4 MARGARET E. O’KANE – COMMONWEALTH FUND BRIEFING
JANUARY 14, 2007
A MEASUREMENT SUCCESS STORY:
BETA-BLOCKER TREATMENT AFTER A HEART ATTACK
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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15 MARGARET E. O’KANE – COMMONWEALTH FUND BRIEFING
JANUARY 14, 2007
ADVANCING QUALITYIN 2007 AND BEYOND
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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
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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
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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
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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
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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?
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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
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22 MARGARET E. O’KANE – COMMONWEALTH FUND BRIEFING
JANUARY 14, 2007
THE TRINITY OF CARE: GOOD CARE
DOESN’T EXIST WITHOUT ALL THREEQUALITY
AFFORDABILITYACCESS