2019 Quality Measurement: What’s In and What’s Out

After decades of measuring and reporting health care quality without transformative change in outcomes, industry and government are realizing the fundamental problem is in the infrastructure of our system.

Quality measurement and improvement has evolved over the years from early work centered on evidence-based practice to more recently with the turn of the century, a rapid influx of value-based programs. Today, quality reporting for providers and organizations is burdensome and excessively complex. Even in organizations that have administrative support and resources, quality reporting is convoluted as inconsistencies exist within every aspect. The benefits of electronic documentation and interoperability cannot be realized in this confusing, pieced-together system.
Leveraging these learnings requires construction of a large-scale framework. Takeaways from this year’s Digital Quality Summit make it feel as if we are on the path of constructing a measurement system for a better tomorrow. With a room full of diverse quality measurement experts, it is evident that these are the concepts of our past:

Adopt what is there. Rather than sub optimizing what is there (aka. billing codes), there is need to engineer new standards and mechanisms for the intentional purpose of measuring quality.

Lagging reporting. Reporting quality is expressed in longer-term clinical outcomes, yet providers need data early in the process to make meaningful improvements.

Manual extraction. Medical record review, whether for program requirements or an improvement project, will progressively become a thing of the past with the transition to electronic extraction.

Misalignment of the parts. The lack of a clear connection between the parts (systems, concepts, data elements, code and value sets), on top of extraneous information (irrelevant codes) causes unnecessary complexity, and a fragmented, confusing state.

These past learnings will help create a valid measurement system upon which regulatory, financial and operational structures can be built. Reflections of this year’s summit indicate these are the trending topics of our future:

Building in value. Measuring what matters from the patient perspective of quality, experience and cost. NCQA’s newly published whitepaper on Rheumatoid Arthritis is a great example of the progress being made on measuring patient-centered definitions of clinical outcomes.

Developing flexible infrastructure. Constructing a foundation that will provide expressive representation yet be nimble to our ever-changing system. HL7’s Clinical Quality Language aligned with the Quality Data Model has the capability to create more powerful logic that can modularize and harmonize measurement across programs.

Digitalization. One-way data sharing out of the clinicians’ workflow and awareness has yet to drive the type of improvement that is needed. Today, there are 38 Electronic Clinical Quality Measures that are being used to put data in the hands of clinicians in an effective and efficient way to drive improvement.

Despite making strides in moving to electronic documentation of clinical care to support coordination, we still cannot get the data for this core purpose, let alone for quality measurement. Now understanding where we have been and where we are going, you can take these steps to support your clinicians’ quality performance:

1. Identify the different quality initiatives your organization is participating in (MIPS, PCMH, ACO, etc.) and reduce the reporting burden by focusing on measures that align with multiple initiatives.
2. Use existing data definitions and workflows (+ documentation processes) to build measures and validate them.
3. Post results to engage the care team and develop specific interventions to change outcomes.
4. As you make improvements, build processes to sustain the outcomes.
5. Repeat the steps above to create a high reliability organization.

Not any one of us holds the answer to solving the problems we have with quality measurement. With aligned purpose, the right people, processes and technology, history-making strides can be made. The methods by which we measure health care quality will continue to evolve as experience is gained with transforming our system. KPI Ninja holds a unique position with having deep experience with interoperability and quality measurement. We are a data source agnostic, big data driven analytics platform with more than 20 applications designed to support every type of healthcare customer. With this degree of comprehensiveness, we are well-suited to continue working closely in this evolution to meet your population health and value-based payment goals.

All together or not at all. Lisa Anderson, eCQM Project Director at the Joint Commission, and I celebrating collaboration.

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