Building a health care system that is high-quality, equitable, affordable, and patient-centered cannot happen without effective performance measurement. But getting measurement right can be tricky and often involves a host of factors, not least tying payment to performance.
These were some key takeaways from a presentation by Dana Gelb Safran, ScD, the President and CEO of the National Quality Forum (NQF), at United Hospital Fund’s Quality Leaders Forum meeting on October 16. A renowned executive and expert on performance measurement, health policy, and quality improvement, Dr. Safran is now overseeing NQF’s portfolio of health care quality measures and its advancement of innovation in value-based care and health equity.
“I'm here because I have a deep belief that performance measures are absolutely central to our being able to get the health care system that we want, both in terms of the costs of the care, the quality, the outcomes, the equity, and patient centeredness. All of it, I believe, hinges on our ability to measure how we're doing and identify where we need to improve,” Dr. Safran told attendees at the virtual event.
She added that the field of quality measurement is “pretty nascent.” “If it were a human, it would be in its late adolescence or early adulthood.”
Dr. Safran noted that, in the late 1990s, the President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry determined that an entity was needed to “be the steward of our nation’s quality measures." That is how in 1999 the NQF was born, with United Hospital Fund playing a central role in its creation.
Measures can be used to improve the quality of care in four main ways, according to Dr. Safran:
- Sharing performance data with providers and health plans
- Attaching dollars to performance in performance-based payment arrangements
- Tying reputations to performance by reporting performance data publicly
- Creating performance-based networks that give consumers incentives to use certain providers over others
Dr. Safran discussed “process measures” vs. “outcome measures” and emphasized the importance of value-based payment. “I do believe that changing the way we pay for care is what's going to help us get to affordable and equitable and high-quality care that is improving our population's health—not just delivering services,” she said. “Value-based care is about saying: ‘Here are the outcomes. You're the clinicians. You decide what the right process is to get there, and it will be different for every patient.’ That's how you get to truly patient-centered care.”
In a previous role at Blue Cross Blue Shield of Massachusetts (BCBSMA), Dr. Safran helped pioneer what’s known as the alternative quality contract (AQC), one of the first payment reform programs that linked outcomes and quality measures to payment. “Our goal was to have a voluntary payment model that would do two things: improve the quality and outcomes of care for our population, while at the same time slowing the rate of growth in medical spending.”
The AQC yielded striking results, showing notable improvements for adult chronic care, adult health outcomes, and pediatric care—and paving the way for broader payment reforms across the country. “It was the first time that we're aware of that any payer asked providers to be accountable—not just for what happened inside their four walls, but what happened after patients left the practice.”
Several years after the AQC’s launch, notes Dr. Safran, frustration mounted over the lack of outcome-focused measures. As a result, the Blue Cross provider network explored patient-reported outcome measures in six different areas, including behavioral health as well as knee and hip pain.
Says Dr. Safran: “I do believe that patient-reported measures changed the clinical dialogue, because now clinicians have in front of them information about how patients are feeling and how they're functioning and how that's changing over time—that changes the clinical dialogue in ways that are very meaningful to patients.”
In late 2022, the National Quality Forum launched a major initiative called “Aligned Innovation,” which involves a coalition of payers, purchasers, and providers working to advance measures that are more patient-centered, outcome-focused, and will “fill the highest-priority measure gaps” says Dr. Safran. Their initial priorities have focused on behavioral health and maternal health outcomes and include health equity assessment methods.
The Quality Leaders Forum is a group of emerging and established health quality leaders committed to improving the delivery of high-quality care in the greater New York area. Members include alumni from the UHF/GNYHA Clinical Quality Fellowship Program and honorees from UHF’s Tribute to Excellence in Health Care. Members are invited to network and discuss current issues in health care quality with nationally recognized quality leaders and to pursue opportunities for sharing best practices.
Past Forum summaries can be found here.
UHF is grateful to Elaine and David Gould, whose generosity supports the Quality Leaders Forum.