Continuous Improvement and the Expansion of Quality ... - NCQA

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T H E S TAT E o f H E A l T H C A R E Q U A l I T y 2 0 1 1 • E x E C U T I V E S U M M A R y HEdIs: responding to Evidence and to Purchaser needs Early quality measures were developed specifically for HMos, and focused on use of recommended services. Today, measures are reported by other types of health plans, as well as some fee-for-service (ffS) programs like Medicaid. Public payers (Medicare, Medicaid and the federal Employees Health benefit [fEHb] program) and private payers (including those in the Evalu8 tool) use HEDIS measures. Screening Rate 80 70 60 50 40 30 20 10 0 2001 fIgurE 2. EyE ExaMs for dIabEtICs–MEdICarE 2002 2003 2004 2005 2006 HMO PPO NCQA now specifies HEDIS measures for individual clinician and clinician groups, using both conventional data sources and electronic health records (EHR). HEDIS—the most widely used measures for ambulatory care—includes measures of outcome; measures of overuse and resource use; and measures of care coordination. outcome measures—NCQA measures of outcome include “intermediate outcome measures” that reflect test results, as well as patient experience. They capture cholesterol control, blood pressure control and blood sugar (HbA1c) control in diabetics. Patient experience of care—measured through the Consumer Assessment of Healthcare Providers and Systems (CAHPS ® )—is another important measure of outcome. 2007 2008 2009 2010 11
top 10 and bottom 10 states “location, location, location” is not only the mantra of the real estate industry—it’s relevant to health care, too. Past editions of the State of Health Care Quality Report showed that quality varies by Census bureau region. This year’s analysis of top 10 and bottom 10 states is more specific: it shows that some states are outliers within their own regions. Cohort calculations of top 10, bottom 10 and middle 32 states include Puerto Rico and Washington, D.C. The calculations are based on mean rates of four measures: Comprehensive Diabetes Care (nine indicators), Controlling High Blood Pressure (one indicator), Persistence of Beta-Blocker Treatment After a Heart Attack and Cholesterol Management for Patients With Cardiovascular Conditions (two indicators). No state went from the top cohort to the bottom cohort (or vice versa) from 2009 to 2010. d 12 N AT I o N A l C o M M I T T E E f o R Q U A l I T y A S S U R A N C E Top 10 cohort Middle 32 cohort bottom 10 cohort d d d d d d d d d d Rose to 2010 cohort from 2009 fell to 2010 cohort from 2009 d d d ! d d d
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C H R o N I C D I S E A S E M A N A
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M E A S U R E S T A R G E T E D A T
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C o N S U M E R A N D P A T I E N T
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128 N AT I o N A l C o M M I T T E
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130 APPENDIx 1: HEDIS EffECTIVENESS
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134 APPENDIx 2: HEDIS EffECTIVENESS
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142 APPENDIx 4b: ACCREDITED VS. NoN
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148 APPENDIx 6A: ACCREDITED VS. NoN
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150 APPENDIx 6b: ACCREDITED VS. NoN
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152 APPENDIx 7A: PUblICly REPoRTING
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158 APPENDIx 8: PUblICly REPoRTING
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172 MEASURE N AT I o N A l C o M M
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174 APPENDIx 14b: VARIATIoN IN PlAN
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180 APPENDIx 16A: VARIATIoN IN PlAN
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182 APPENDIx 16b: VARIATIoN IN PlAN
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184 REfERENCES N AT I o N A l C o M
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ACkNoWlEDGMENTS Health Plans The 20
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Continuous Improvement and the Expansion of Quality ... - NCQA

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