How Do You Measure Quality in Health Care?

As someone who leads an integrated health care delivery system, this is a question I frequently find myself asking.

The obvious answer, of course, is to develop measurements based on treatment protocols. Of which we have plenty. It seems these days that we have a measurement and documentation requirement for just about everything. In fact, quality measurement in health care has become an industry unto itself. Hospitals and health care systems across the country pay a lot of money to have their quality of care scrutinized and, hopefully, lauded, by a number of companies that charge them for such assessments. In many cases, those assessments are valuable.

Nevertheless, I began to think about the value of measurement after exchanging some emails with my friend and college mentor, Deborah Stone. Deborah is a professor at Brandeis University’s Heller School for Social Policy and Management who’s been doing a lot of thinking lately about counting, measurement, and statistic and the ways in which numbers are used to distort and distract from reality. In a lecture she recently gave to the American Political Science Association, Deborah announced to her audience, “Numbers are figments of our imagination, fictions really, no more true than poems or drawings. In this sense, all statistics are lies.”

I’m not sure I’m willing to go as far as Deborah, who’s quite a provocative thinker, but she did make me wonder whether our current health quality measures are offering the right information and, moreover, whether everything valuable in health care can be easily measured. At some level, I suspect, things that are important are not always quantifiable. For example, even if my facilities are spotless and my clinical staff is expert at avoiding preventable infections, does that mean they’re good at explaining diagnoses to their patients? Do they know how to communicate effectively and sympathetically when delivering bad news? Do they return patient calls at night? In today’s health care climate, physicians are often required to see a specific number of patients each day. But how effective are our measurements if a physician misses that quota because she devoted extra time to a single patient who really needed the extra attention and care?

The full Forbes article can be viewed at this link.  

Transforming healthcare experiences: Exploring the impact of digital health technology on healthcare professionals and patients

The 2019 Future Health Index is based on primary research conducted across 15 countries. The research explores the experiences of healthcare professionals and individuals – which includes both current and previous patients – in their health systems through two pillars of the Quadruple Aim: improved patient experience and improved staff experience.

Evolution and developments in digital health technology, such as digital health records (DHRs), telehealth and artificial intelligence (AI), offer benefits that could lead to better health outcomes and reduced costs, paving the way toward achieving the Quadruple Aim.

This year’s research sets out to understand knowledge and appetite for using digital health technologies and how they affect experiences of healthcare. DHRs, telehealth and AI were selected due to their growing levels of adoption, as well as their potential to transform healthcare experiences.

The full 2019 Future Health Index from Philips can be downloaded below.  

Rising Health Care Charges: A Red Herring in a Value-Based Health Care World?

Certainly, the current hospital charge situation in the United States is economically inefficient in terms of the distortions among charges and costs and reimbursement as it is inequitable in its negative financial effects on specific segments of American society. However, these problems will likely diminish in importance with the continued evolution of value-based health care forces and extended health care coverage, with providers increasingly assuming the total cost-of-care financial risk.  Changing reimbursements and a focus on improving short- and long-term health care outcomes, as well as patient safety, under increased financial accountability, will frame the real value equation for health care delivery across the United States.

The full article can be downloaded below.  

On May 16, 2019, eHI released the results of our annual HIE survey. We gathered a panel of experts for a webinar to review the results and weigh in on what they mean for the industry going forward.

Webinar participants got a first look at key trends and heard in depth discussion on important questions such as:

• What's driving HIEs' work in the next two years?
• Which types of data are HIEs struggling to exchange?
• What is the expected impact of TEFCA on interoperability?
• How is value-based care influencing HIEs' decisions to adopt technology and meet payers' requests for more clinical data?
• Which services are likely to be offered in the next two years?
• What are the biggest challenges in adopting new technology?
• What is the status of HIEs in integrating clinical and claims data?

Presenters and Panelists: 

• Kayli Davis, Manager, Programs & Research, eHealth Initiative
• Chris Hobson, MD, MBA, Chief Medical Officer, Orion Health
• Joe O'Hara, MBA, Director of Clinical Innovation, Horizon Blue Cross Blue Shield of New Jersey
• Katie Sendze, MBA, Director, Client Operations and Programs, HealthInfoNet (HIE)
• Mike Sims, CFO, Delaware Health Information Network (DHIN)

Based on results from eHI’s 2019 Survey on HIE Technology Priorities, this report examines HIE perspectives on:

• Adoption of new technology
• Integrating clinical and claims data
• Types of data being exchanged
• Business drivers and priorities
• Challenges associated with the aforementioned

For almost two decades, eHealth Initiative and Foundation (eHI) has monitored the state of health information exchanges. Healthcare is experiencing rapid evolution with the emergence of new technologies and payment models. In response, both the public and private sectors are seeking ways to improve the quality and safety of care, resulting in a growing momentum to improve interoperability. Organizations like health information exchanges (HIEs) and health information networks (HINs) act as a source of valuable information and services, making the continued evaluation of their challenges, opportunities, and priorities important.

Background on Health Information Exchanges

As the name implies, HIEs provide technology and services to help their stakeholders exchange electronic health information. HIEs do not provide healthcare services. Instead, they impact the quality and cost of care, and ultimately outcomes, by sharing patient health data across organizations within a region, community, or hospital system.

Numerous trends that will drive the adoption of new technologies, the ability to exchange various data types, and the direction of HIE priorities are already evident in 2019. The healthcare industry is in the process of adopting performance-based funding models in place of more traditional reimbursement-based models. Industry is also facing an influx of value-based care initiatives; growing support for application programming interface (API) based interoperability standards, such as HL7®’s Fast Healthcare Interoperability Resources (FHIR®); complex laws for sharing non-traditional types of data; and the push for nationwide exchange of electronic health information across disparate HINs. As new payment models emerge, healthcare stakeholders are increasingly seeking out new types of data that will give a wider perspective of a patient’s health and social experiences.

An HIE’s ability to integrate data enables and supports value-based care. Stakeholders can monitor their quality and cost of care, leading to improvements in care quality and care coordination, and eventually, cost savings. However, not all HIEs have the ability to integrate the many types of data necessary to enable and support value-based care and cost-lowering activities. HIE capabilities may be limited for a variety of reasons, including technical functions, costs, competing priorities, and issues around ownership and control of the data by stakeholder organizations participating in the HIE.

Join us for a May 16, 2019 webinar reviewing the results.

HHS To Implement Pay-For-Performance Models For Primary Care Practices Serving Medicare

Two weeks ago, the Department of Human and Health Services (HHS) unveiledthe "Primary Cares Initiative," a program that aims to "reduce administrative burdens" and enable primary care physicians to earn "performance-based payments" if they deliver care to Medicare patients that meets certain targets and decreases downstream healthcare costs.

CMS has posted a request for applications for the first cohort of primary care practices. The program is intended to go into effect January 2020 and continue for five years.

It is hoped that if the Primary Cares Initiative is successful in Medicare, state Medicaid programs and commercial payers will follow suit. The ultimate purpose of the initiative, according to the Director of HHS, Alex Azar, is to move primary care from a fee-for-service to a value-based system, predicated on paying for healthcare outcomes rather than numbers of procedures.

The full Forbes article can be viewed at this link.  

US Healthcare Trends and Contradictions in 2019

Over the past several years, many healthcare trends have been identified as micro rather than macro as incremental year-to-year changes dominated the US healthcare market. Looking at 2019 and toward 2020, the shift to macro-level trends returns, reflecting market transformation during the Trump administration. For example, many 2017 and 2018 trends were a continuation of micro themes, such as benefit design offerings, care delivery initiatives, contracting, or early technologies for monitoring personal health status.

Now, structural and broader market changes are part of a bigger economic transformation that includes healthcare as a major beneficiary. As a result, in 2019 many trends are macro-focused, in addition to some continuing micro aspects, all of which are being transformed in parallel. Much of the innovation efforts to date have led to trends that move us from micro to macro perspectives on change.

The forecasted trends identified in this article focus on the macro and micro levels that may emerge or are just emerging, depending on your perspective. Furthermore, some trends may be opposing to other trends, which reflects the uncertainty along with the diversity of change in healthcare, globally and nationally.

The full article can be downloaded below.