12) Health Care Quality & Linking Quality to Payment

Question 1

Who does quality of health care matter to and what does this entail?

Answer 1

• Providers → Pt-centered, Professional, On-time EBP
• Payers → High quality care should be efficient
• Pt’s
• Employers → Healthy and happy workforce

Question 2

How is value of health care measured?

Answer 2

Outcomes

Question 3

What is cost reduction without consideration of outcomes?

Answer 3

Dangerous and Self-Defeating

Question 4

What is the current state of alternative ways to decr cost?

Answer 4

• Payment cuts
• Moving away from fee-for-service

Question 5

Why do providers need strategies for moving away from cost reduction models?

Answer 5

• Providers w/better outcomes will grow market share
• Improved efficiency in providing excellent care will lead to more opportunities for contracts
• Providers demonstrating incr value will be most competitive

Question 6

Value Formula

Answer 6

Quality/Cost

Question 7

Quality

Answer 7

Clinical outcomes and pt’s experience

Question 8

Costs

Answer 8

Monetary costs + Harm to pt’s and the system (aka waste)

Question 9

According to the 2003 study in the NEJM, what proportion of respondees didn’t get the care that was recommended?

Answer 9

Half

Question 10

According to the 2001 “Crossing the Quality Chasm” Report, what dimensions of the US health care system were fxning at a lower level than they should?

Answer 10

• Safety
• Timely
• Effectiveness
• Efficiency → Avoids waste
• Equitability → Provides care that doesn’t vary in quality bc of pt’s personal characteristics such as gender, ethnicity, SES, etc
• Pt-Centered

Question 11

What are the quality problems w/the US health care system?

Answer 11

• The system is fragmented
• Lack of coordinated care
• Payment is quality neutral; As long as providers follow the rules, they’ll get paid

Question 12

What things contribute to the evolution of quality improvement efforts?

Answer 12

• Recognition that quality is not directly linked to dollars spent
• Variability
• Emphasis on Public Reporting → Hospital and Provider Ratings
• Relationship to Disparities
• Evolution of Measurement Science → Outcomes collection
• Health IT → More ways to share info
• Comparative Effectiveness Research

Question 13

What is the Berwick Triple Aim

Answer 13

The idea that a high-fxning health system:

• Will improve individual experience of care → Users should have a positive experience
• Improve public health
• Decr per capita cost of care

Question 14

What are barriers to Berwick’s Triple Aim?

Answer 14

• Supply-driven Demand → Pt’s want to try new tx’s
• New tech often has limited impact on outcomes
• Physician-centric Model → 1:1 model w/MD’s at center is not good
• Little/No Foreign Competition to Spur Domestic Change → No drive to make our care better; US has the most fragmentation
• Too little appreciation of system knowledge among clinicians and organizations → Gets deferred to insurance companies and administrators bc providers don’t understand the intricacies of data collection

Question 15

What makes the triple aim the quadruple aim?

Answer 15

Improving the Work-life of HCP’s → Demands on HCP’s are taking too much of a toll

Question 16

True or False: Part of the ACA required the secretary of the Dept of Health and Human Services to create a National Strategy for Quality Improvement to guide the effort

Answer 16

True

Question 17

National Quality Strategy

Answer 17

Nationwide effort to provide direction for improving the quality of health and healthcare in the US

• Guided by the Triple Aim

Question 18

What is the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)?

Answer 18

Repealed sustainable growth rate formula for Medicare payment to establish a new framework to reward physicians for value/quality over volume

Question 19

Payment Adjustment

Answer 19

Adjustment of payment based on quality reporting (MIPS)