HCQ PTHE HEALTH CARE QUALITY IMPROVEMENT PARTNERSHIPTHE HEALTH CARE QUALITY IMPROVEMENT PARTNERSHIP

11

The Business Case for The Business Case for Quality: Quality: A CMS PerspectiveA CMS Perspective

at the Institute for Quality in Laboratory Medicine, April 29, 2005

HCQ PTHE HEALTH CARE QUALITY IMPROVEMENT PARTNERSHIPTHE HEALTH CARE QUALITY IMPROVEMENT PARTNERSHIP

22

VisionVision

The right care for every patient every time

HCQ PTHE HEALTH CARE QUALITY IMPROVEMENT PARTNERSHIPTHE HEALTH CARE QUALITY IMPROVEMENT PARTNERSHIP

33

What is the right care?What is the right care?

• Safe• Effective• Efficient• Patient-centered• Timely• Equitable

-- Crossing the Quality Chasm The Institute of Medicine

0

50

100

150

200

0% 100%LEVEL OF PERFORMANCE

NU

MBE

R O

F O

BSER

VATI

ON

S

1998-1999

2000-2001

2024-2025(Projection)

Pursuing Perfection in MedicareHospital and Office Care (all states, 24 measures)

2 0 2 4

HCQ PTHE HEALTH CARE QUALITY IMPROVEMENT PARTNERSHIPTHE HEALTH CARE QUALITY IMPROVEMENT PARTNERSHIP

66

ScopeScope

• This vision is transformational, not incremental

• To serve Medicare and Medicaid we must transform the entire healthcare system.

• Transforming the system requires, in turn, transforming CMS, which is often a part of the problem as well as a part of the solution.

HCQ PTHE HEALTH CARE QUALITY IMPROVEMENT PARTNERSHIPTHE HEALTH CARE QUALITY IMPROVEMENT PARTNERSHIP

77

Transformational strategiesTransformational strategies

• Work through partnerships• Publish quality measurements• Pay-for-performance/quality• Promote health information technology• Create and use evidence about

effectiveness

HCQ PTHE HEALTH CARE QUALITY IMPROVEMENT PARTNERSHIPTHE HEALTH CARE QUALITY IMPROVEMENT PARTNERSHIP

88

Work through partnershipsWork through partnerships

Includes coordination • within CMS• across Federal agencies• between governmental and

nongovernmental partners.

HCQ PTHE HEALTH CARE QUALITY IMPROVEMENT PARTNERSHIPTHE HEALTH CARE QUALITY IMPROVEMENT PARTNERSHIP

99

Publish quality measurementsPublish quality measurements

• Audiences are both professionals, providers, and purchasers and the beneficiary audience.

• We must drive out secrecy

HCQ PTHE HEALTH CARE QUALITY IMPROVEMENT PARTNERSHIPTHE HEALTH CARE QUALITY IMPROVEMENT PARTNERSHIP

1010

Pay-for-performance/qualityPay-for-performance/quality

Includes paying for

• prevention • disease management• patient-centered care.

HCQ PTHE HEALTH CARE QUALITY IMPROVEMENT PARTNERSHIPTHE HEALTH CARE QUALITY IMPROVEMENT PARTNERSHIP

1111

Promote health information Promote health information technologytechnology

Includes • standards development and

promotion• systems development • encouraging implementation• payment for HIT results

HCQ PTHE HEALTH CARE QUALITY IMPROVEMENT PARTNERSHIPTHE HEALTH CARE QUALITY IMPROVEMENT PARTNERSHIP

1212

Create and use evidence about Create and use evidence about effectivenesseffectiveness

CMS becomes part of post-marketing surveillance

When effectiveness is not absolutely clear, coverage may be conditional on registering data

At the same time coverage decisions become faster

PATI-ENT

SUPPORT

STANDARD

METHODS

PR

OM

OT

EP

AR

TN

ER

-S

HIP

S

PROVIDE

TECHNICAL

ASSISTANCE

LEAD

PROVIDEPUBLIC

INFORMATION

STRUCTURE

COVERAGE AND

PAYMENTS

RE

WA

RD

D

ES

IRE

D

PE

RF

OR

MA

NC

E

ESTABLISH &

ENFORCE

REQUIRE-

MENTS

The

Toolkit

1414The Management Framework

ADOPT OR DEVELOP MEASURES

SELECT PRIORITY AREAS

MANAGE PROCESS IN PARTNERSHIP WITH STAKEHOLDERS

COLLECT & ANALYZE DATA

ESTABLISH&

ENFORCE STANDARDS

STRUCTURE COVERAGE

AND PAYMENTS TO IMPROVE

CARE

SUPPORT STANDARD METHODS

GIVE CONSUMERS

INFOR-MATION

AND ASSISTANCE

TO MAKE CHOICES

PROMOTE OR CREATE

COLLABORA-TIONS ANDPARTNER-

SHIPS

GIVE PLANS,

DOCTORS&

PROVIDERS TECHNICAL

ASSISTANCE

REWARD DESIRED

PERFORM-ANCE

IDENTIFY IMPROVEMENT OPPORTUNITIES AND SELECT APPROPRIATE IMPROVEMENT INTERVENTIONS

CMS Quality Council Quality Coordination Team

Patient-Centered Care & Disparities Workgroup

Prevention Workgroup

RO-CO Collaboration Workgroup

Part D Workgroup

Long-Term Care Task Force

Medicaid-SCHIP Workgroup

Health Information Technology Workgroup

Council on Technology

and Innovation

Breakthrough Methods Workgroup

Cancer Care Task Force

Partnerships Workgroup

Measurement and P4P Workgroup

HCQ PTHE HEALTH CARE QUALITY IMPROVEMENT PARTNERSHIPTHE HEALTH CARE QUALITY IMPROVEMENT PARTNERSHIP

1616

What is the Business Case?What is the Business Case?

CMS believes that we can only keep Medicare and Medicaid solvent by focusing on effective care and eliminating ineffective care. Thus, for us, quality is a survival strategy.

HCQ PTHE HEALTH CARE QUALITY IMPROVEMENT PARTNERSHIPTHE HEALTH CARE QUALITY IMPROVEMENT PARTNERSHIP

1717

Hypothesis on Cost and QualityHypothesis on Cost and Quality

90 percent of the benefits of quality improvement will come from free or cost-saving changes.

HCQ PTHE HEALTH CARE QUALITY IMPROVEMENT PARTNERSHIPTHE HEALTH CARE QUALITY IMPROVEMENT PARTNERSHIP

1818

How can this be?How can this be?

• Most of the best-studied treatments with the best evidence that they are effective are also relatively inexpensive.

• The current payment system encourages procedures so strongly that a net increase in their use is rarely needed even when current use is not totally appropriate.

HCQ PTHE HEALTH CARE QUALITY IMPROVEMENT PARTNERSHIPTHE HEALTH CARE QUALITY IMPROVEMENT PARTNERSHIP

1919

Does Better Care Save Money?Does Better Care Save Money?

• Waste and rework are expensive.• In general, better outcomes reduce

downstream costs, although these savings often accrue to the insurer rather than the provider.