Current healthcare reform efforts under consideration in Congress—ranging from payment reforms (such as episode payments and accountable care organizations) to efforts to promote implementation of health information technology—have at least one thing in common, according to Mark McClellan, MD, director of the Engelberg Center for Health Care Reform at the Brookings Institution in Washington, DC.
"We can't do any of them without reliable, meaningful, and consistent measures of quality being available," McClellan said recently at a "Getting to a High-Value Health System" meeting in Washington. That means now is the time to "get systems in place to support better decisions for patients by their clinicians involved in their care, and by everyone who is working at the personal level to improve care."
The High-Value Health Care concept is a project of the Quality Alliance Steering Committee, made up of the Engelberg Center, the Robert Wood Johnson Foundation, the American Board of Medical Specialties, and America's Health Insurance Plans. The idea is that little attention has been directed to the questions: What reform is needed to ensure that needed quality measures are implemented quickly and efficiently, and how can the measures be used to improve healthcare?
Getting to better quality healthcare will take some time, According to Carolyn Clancy, MD, head of the Agency for Healthcare Research and Quality, quality is moving in the "right" direction. She said at the current rate, "it will take 18.73 years to close the gap between best possible and actual care," she said at the meeting. "So we've got a long way to go."
To move toward a healthcare system that better measures and reports on quality and costs consistently across the country, the steering committee has introduced a three-year plan to advance this idea. Among the goals are:
- Meeting the need for a "virtual infrastructure" for quality and cost measures
- Creating a seamless data collection and reporting infrastructure
- Advancing a model for electronic base data sharing to improve care
- Developing a national infrastructure
McClellan emphasized that the focus was not just on quality reporting. "It really should be a consistent outgrowth of all the other steps we're taking over the next few years to improve care," he said. For example, health information technology payment incentives to providers can be "a powerful force" to produce quality measures.
The Office of the National Coordinator for HIT, working with AHRQ, has emphasized that the "meaningful use of health IT" relates to improving healthcare. "It's not just focusing on certification of systems, but actually getting information using those systems [to] document where the gaps are," he said.
Those HIT systems can help providers and patients improve their care," McClellan added. "At the same time, that can be a basis for quality measures that show that the HIT system …is actually having an impact."