What is the Value of a Quality Measure?
by Christina Onolaja, MHA
Quality measures are a key aspect of primary care, not just because value-based care requires satisfaction to receive incentive payments, but because they can impact patient wellness. At a base level, it is common sense to evaluate an individual for early signs of diseases that could evolve into a more serious issue such as cancer or heart disease.
Unfortunately, not all insurance payors have the same idea of what quality measures should be tracked or even what the target values should be. For example, one payor may say hypertension is defined as having a blood pressure of greater than 130/80 while another may say 140/90. Uncontrolled diabetes may be defined as an A1C greater than 8 for one payor and greater than 9 for another. A lack of consistency in these expectations causes confusion for primary care practices and can result in unmet quality measures.
Becker’s Hospital Review recently published an article discussing a CMS proposal to create universal quality measures across all payors. This effort would cover quality measures in the categories of wellness and prevention, chronic conditions, behavioral health, seamless care coordination, person-centered care and equity for adults and wellness and prevention, chronic conditions, behavioral health and person-centered care for children. The goal of this proposal is to improve patient outcomes due to having a single set of criteria for which quality measures should be tracked.
Until this change is made, primary care practices still have an obligation to their patients to track key measures and address concerns. Data is an important part of this process and understanding where the practice and providers are in their quality journey. Most EHRs have the ability to identify which quality programs the organization is a part of as well as which quality measures need to be tracked. If the organization is part of an Accountable Care Organization (ACO), there may be additional tools and platforms where this data can be evaluated. Regardless of which tool is used to track the data, it is important to do so in an ongoing basis so the organization is not playing catch up at the end of the year to avoid losing quality payments.
While it is a great idea to share quality measure satisfaction progress regularly with providers, workflows should be in place for staff to perform outreach to patients with gaps or unmet measures and schedule appointments or issue referrals for tested needed to satisfy the measures. Providers do not often schedule their own appointments which means the entire team must be engaged in meeting the measures for true success. As discussed in the article Increase Quality Measure Satisfaction through Nurse-led Annual Wellness Visits, implementing a Nurse Care Coordinator who is tuned into necessary quality measures and conducting outreach can make a significant difference in closing gaps.
Additionally, third party technology can simplify this process by putting the data the practice needs easily at their fingertips. Practice leadership should also ensure the correct programs are activated in the EHR so the correct measures are being tracked. Finally, data should be evaluated on a monthly basis to determine where adjustments need to be made, with a focus on educating providers, staff, and patients about their individual role in quality measure satisfaction.
More articles written by Christina:
COLLABORATIVE COMMUNICATION AS THE FOUNDATION FOR QUALITY HEALTHCARE
