The economic downturn, coupled with health care's already precarious economic state, is poised to change the way care is delivered and financed in this country. In this environment, improving health care requires raising and changing the performance expectations of the delivery system, says Janet Corrigan, PhD, president and CEO of The National Quality Forum. She says that hospital financial leaders can help by creating a systemwide, professional culture of performance measurement and reporting.
Recently, hfm interviewed Corrigan about seizing the opportunity to transform health care.
Q. The National Quality Forum (NQF) recently established the National Priorities Partnership, which is a diverse coalition that will work toward transforming health care in a time of economic crisis. How do you hope to achieve consensus on healthcare reform when so many other attempts have failed?
A. The National Priorities Partnership is bringing together the right players, at the right time, with the right plan for achieving transformational healthcare improvements. The partners represent those who receive, pay for, provide, and evaluate health care. As such, each organization recognizes it is linked to the problem, and each is taking responsibility to be part of the solution.
That begins with aligning our efforts and focusing on the right places in our vast and fragmented "system" where the biggest dividends for patients and their families can be achieved. The partners have identified six national priorities for action that can help eliminate harm, eradicate disparities in healthcare access and outcomes, reduce the burden of disease, and remove waste to ensure that resources are focused appropriately:
- Engage patients and families in managing their health and making decisions about their care.
- Improve the health of the population.
- Improve the safety and reliability of America's healthcare system.
- Ensure that patients receive well-coordinated care within and across all healthcare organizations, settings, and levels of care.
- Guarantee appropriate and compassionate care for patients with life-limiting illnesses.
- Eliminating overuse while ensuring the delivery of appropriate care.
And now is certainly the time. Our national economic crisis makes addressing health care even more urgent. With healthcare spending gobbling 16 percent of our gross domestic product and states such as New York and California in severe budgetary straits, the healthcare status quo clearly is unsustainable. A crisis of this scope and scale brings a greater sense of urgency and focus to our work.
The priorities provide a means to make America's health care more affordable and higher performing. We don't at all minimize the importance of legislative action in reforming health care-but the organizations that make up the partnership have agreed to begin working toward these goals immediately.
Q. The new administration is expected to make a serious effort to reform the nation's healthcare system. What specific issues would you like to see policymakers undertake?
A. Policymakers can achieve the most for America's patients by fundamentally raising and changing the performance expectations of the healthcare delivery system. They should start with the six priorities identified by the National Priorities Partnership. The most promising policy drivers of change include payment reform that rewards value over volume, increased measurement and reporting to improve safety and the coordination of care, and better data and research that can be readily accessed and routinely used by providers.
Q. How do you link information about quality with information about price so consumers can really judge value?
A. This is a very good question and a challenging task. I think it will be important to ensure that what we are measuring and how we are doing it are clear and focused in the right places, so meaningful comparisons can be made. We are starting to make a lot of progress in this area. HospitalCompare, NursingHomeCompare, HomeHealthCompare, and other setting-specific web sites provide a starting point for quality comparisons, but combining this information with prices for these services does not in most instances measure value. To assess value, we need to measure the quality and price of a "patient-focused episode," which for patients with chronic conditions generally extends beyond an individual healthcare setting or provider and over a long period of time (e.g., 12 months). For example, for a diabetic patient who sees a primary care provider, an endocrinologist, and a diabetician and receives hospital and home health services during a year, we would like to know the total costs of all these services and the outcomes the patient has achieved.
Producing meaningful information on value requires aggregating data from different providers and sites of care and collecting information from patients on health outcomes, so that we can get a complete picture of the patient's healthcare journey and the benefits derived.
Q. How do you hope that patients will use quality measurements in their decision making?
A. Before we can expect consumers to use quality information in decision making, it has to be more accessible and easier for consumers to understand. I think consumers are likely to use quality information, but only if we can make it mean something to them. Ideally, consumers would use publicly reported quality information to inform their decisions about any of their healthcare choices-from primary care providers to hospitals to specialists.
Unfortunately, we've not seen enough reports about quality information that are truly consumer-focused. The healthcare system is well meaning, but too often we have our own language and we assume the rest of the world shares it. We need to connect to where patients and their families are, instead of expecting them to translate our complicated language and data. For instance, if we expect quality information to influence consumer decisions, we must define what quality is and why it matters. Just as consumers are accustomed to reading nutrition labels in making shopping decisions for their families' nutrition, we must provide user-friendly data and information about health quality. To help get there, NQF has endorsed guidelines for developing consumer-focused reports about quality that can help guide those who develop performance reports(www.qualityforum.org/news/releases/102708-endorsed-measures-pr.asp).
Q. As stated in an NQF Issue Brief, Providing Consumers with Useful Information About Healthcare Prices, some policymakers believe that price transparency is an important tool for reining in healthcare costs. What sorts of payment mechanisms seem most promising in terms of fostering high-quality care?
A. Aligning payment around "episodes of care"-particularly for chronic conditions-is an area that offers promise. This kind of payment structure considers the patients' needs even after they leave the hospital or doctor's office and rewards greater coordination of care.
For example, Geisinger's ProvenCare program charges insurance companies a flat fee for a coronary bypass procedure, which includes the cost of 90 days of follow-up care. This fundamental change in payment has saved money, and produced healthier patients with shorter hospital stays, fewer readmissions to the intensive care unit, and more discharges directly to homes.
Q. What should hospital senior financial executives be doing to ensure the highest patient safety and quality of care at their organizations?
A. Hospital leadership can create a systemwide, professional culture of performance measurement and reporting. If all caregivers are relentless about monitoring and publicly reporting results achieved for patients and studying those data carefully to identify areas to improve and learn, quality and patient safety will improve exponentially. The Institute for Healthcare Improvement-whose president and CEO, Donald Berwick, MD, co-chairs the National Priorities Partnership-has catalogued countless examples of this commitment of caregivers on its web site (www.ihi.org). NQF provides a quality award each year recognizing innovative health systems that have improved quality and patient safety. These award winners offer some instructive advice in improving quality and safety (www.qualityforum.org/awards/award-winners.asp).
Janet Corrigan, PhD, is president and CEO of The National Quality Forum, a private, not-for-profit standard-setting organization established in 1999. The NQF mission includes setting national priorities and goals for performance improvement, endorsing national consensus standards for measuring and publicly reporting on performance, and promoting the attainment of national goals through education and outreach activities. From 1998 to 2005, Corrigan was senior board director at the Institute of Medicine (IOM). She provided leadership for IOM's Quality Chasm Series, which produced 10 reports during her tenure, including To Err Is Human: Building a Safer Health System and Crossing the Quality Chasm: A New Health System for the 21st Century. Before joining IOM in 1998, Corrigan was executive director of the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry.
Corrigan received her doctorate in health services research and master of industrial engineering degrees from the University of Michigan, and master's degrees in business administration and community health from the University of Rochester. She is the recipient of numerous awards and recognitions, including Modern Healthcare's "100 Most Powerful People in Healthcare" (2008) and "Top 25 Women in Healthcare" (2007), the IOM Cecil Award for Distinguished Service (2002), the American College of Medical Informatics Fellow (2006), the American College of Medical Quality Founders' Award (2007), the Health Research and Educational Trust Award (2007), and the American Society of Health System Pharmacists' Award of Honor (2008). She serves on numerous boards and committees, including the Quality Alliance Steering Committee, the Hospital Quality Alliance, the National Center for Healthcare Leadership, the Kaiser Permanente Institute for Health Policy Advisory Board, the American Health Information Community (AHIC) Successor, Inc., Board of Directors, the eHealth Initiative Leadership Council, and the Robert Wood Johnson Foundation's Aligning Forces for Healthcare Quality (AF4Q) National Advisory Committee.
Publication Date: Sunday, February 01, 2009