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 Conclusion The Dartmouth Group has shown that cost and quality do not have to be a trade-off, but how do we get to affordable, quality health care? We must focus on buying value in health care, but the politics are challenging. our current marketplace is fractured; providers have different approaches for working with each sector. Patients are confused and vulnerable, and appeals to their fears have succeeded. It is challenging in this environment to implement strong, synchronized strategies to improve coordination and delivery of care. Health plans can be drivers of improvements to cost and quality in health care markets. As “market makers,” they should pursue strategies to activate and engage members. leading-edge health plans devote significant resources to keeping their members healthy. Health plans need to construct “value choices” at the provider level so patients do not overpay and are not over-treated or victims of medical errors. NCQA’s objective in seeking a value agenda is to advance the triple aim—improving the individual’s experience of care and the population’s health, and reducing the overall cost of care. Ultimately, consumers hold the power to reshape insurance markets. The concept of a new insurance marketplace, facilitated by Exchanges, flows from the premise that consumers will be motivated to compare health plans. Measures based on CAHPS and HEDIS are a logical place to start. EndnotEs 1. Draper, D.A., R.E. Hurley, C.S. lesser, b.C. Strunk. 202. The Changing face of Managed Care. Health Affairs, Jan-feb;21(1):11–23. 2. Enthoven, A. 1993. The History and Principles of Managed Competition. Health Affairs, Vol 12, Supplement 1, 24–48. 23
24 HEDIS MEASURES of CARE about HEdIs The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by most HMos and PPos plans to measure performance on important dimensions of care and service. by providing objective, clinical performance data measures against a detailed set of measurement criteria, HEDIS helps purchasers and consumers compare health plans’ performance. HEDIS measures address a broad range of important health issues: • Antibiotic use • Asthma • breast, cervical and colorectal cancers • Care for older adults • Childhood immunizations • Cholesterol management HEDIS includes the Consumer Assessment of Healthcare Providers and Systems (CAHPS) 4.0 Survey. The CAHPS survey measures members’ experiences with their health care in areas such as claims processing and getting needed care quickly, and asks them to rate their health plan on a scale of 0–10. HEDIS 2011 data collected for this report generally reflect services delivered during calendar year 2010. To ensure validity of HEDIS results, certified analysts rigorously audit all data, using a process NCQA designed. See the appendices for more details about national averages and performance trends. Hos Measures 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 • Diabetes • High blood pressure • Medication management • Mental illness • Smoking • Prenatal and postpartum care Medicare Health outcomes Survey (HoS) measures evaluate the physical and mental health of seniors enrolled in Medicare and are the first patient-based self-report of health status as a measure of quality of care in elderly populations. Including HoS in HEDIS measurement creates a broader scope of measures to evaluate the quality of care provided by health plans for the Medicare population. Included in this report are four HoS measures:
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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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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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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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