[{"innerBlocks":[],"name":"core\/freeform","postId":623,"blockType":{"name":"core\/freeform","keywords":[],"attributes":{"content":{"type":"string","source":"raw"},"lock":{"type":"object"}},"providesContext":[],"usesContext":[],"selectors":[],"supports":{"className":false,"customClassName":false,"reusable":false},"styles":[],"variations":[],"apiVersion":3,"title":"Classic","description":"Use the classic WordPress editor.","category":"text"},"originalContent":"Beauty is definitely in the eye of the beholder. Quality, however, requires assessment tools that operate in a more objective manner. That\u2019s where healthcare performance measurement programs come in.\u201cAll these programs arose out of a very basic need to be able to normalize how people were measuring quality across multiple organizations. While it\u2019s possible to argue whether specific performance measurement programs offer the best ways to measure quality, it\u2019s clear that these programs do create some standardization,\u201d says Cate Higgins, Senior Clinical Consultant at Medecision. As such, performance measurement programs provide a mechanism for health plans to compare quality both across and within organizations.The Healthcare Effectiveness Data and Information Set (HEDIS), for example, provides standardized measures that specify how healthcare organizations collect, audit and report performance information across clinical areas, as well as important dimensions of customer satisfaction and patient experience. Administered by the National Committee for Quality Assurance, HEDIS includes more than 90 measures across six domains of care:

If Medicare beneficiaries remain healthy while on their plan<\/li><\/ul>
- Effectiveness of care<\/li><\/ul>
  - Access\/availability of care<\/li><\/ul>
    - Experience of care<\/li><\/ul>
      - Utilization and risk-adjusted utilization<\/li><\/ul>
        Health plan descriptive information<\/li><\/ul>
        Measures collected using electronic clinical data systems<\/li><\/ul>The Centers for Medicare and Medicaid Services (CMS) uses the CMS Star Ratings to assess the quality of Medicare-sponsored plans. Star Ratings for these plans are established by an analysis of six factors:
        If Medicare beneficiaries remain healthy while on their plan<\/li><\/ul>
        Management and improvement of beneficiary chronic conditions<\/li><\/ul>
        Member experience with health plans<\/li><\/ul>
        Customer service performance<\/li><\/ul>
        Member complaints with health plans<\/li><\/ul>
        Changes in overall health plan performance<\/li><\/ul> Via participation in these performance measurement programs, health plans can: Make sure members are receiving top-notch care.<\/i><\/b> <\/i>\u201cPerformance measurement programs provide a nice way to ensure that members are getting a higher quality of care. Are they the be-all and end-all? No, they\u2019re not. But by leveraging these programs, a health plan might be more likely to ensure that a member gets their blood pressure checked, gets their annual mammogram, and gets their colonoscopy. And, when members receive these services, outcomes are likely to improve,\u201d explains Rebecca Molesworth, Senior Product Manager, Clinical Informatics & Analytics at Medecision.Save costs by reducing utilization<\/i>.<\/b> As health plans steer members toward receiving quality care, overall utilization could be reduced. \u201cIf members are in good health or stable condition, then they are staying out of the hospital and that obviously keeps overall costs down,\u201d Molesworth points out.Address quality issues with providers. <\/i><\/b>Performance measurement programs make it possible to participate in an honest, quality discussion with providers. \u201cIf everyone acknowledges that the performance standards are used across the industry, then providers will not look at the measures as something that the health plan has made up to trick them out of reimbursement. This way they become a means for taking the natural distrust out of the equation, which is especially important when providers are sharing risk with health plans under value-based programs,\u201d says Nan Sloan, Senior Director, Government and Accreditation Programs, Medecision.Keep tabs on performance in a variety of areas.<\/i> <\/b>\u201cCMS Star Ratings enable health plans to perform some level of a quality assessment on how well they are functioning across multiple areas. The measures don\u2019t just assess quality of care but also other factors such as the level of member satisfaction with the plan\u2019s services,\u201d Molesworth notes.Provide consumers with a comparative metric<\/i>.<\/b> \u201cConsumers are likely to look at the Star Ratings to decide which plan to enroll in. And, if members are in a poorly performing plan, Medicare will send them a letter and the consumers can opt to change plans. If a plan loses a half Star of rating, there will most likely be a significant reduction in enrollment,\u201d observes Connie Webster, Senior Director for Clinical Consulting, Medecision.Perhaps most important, though, participation in performance measurement programs can help health plans lay the foundation for comprehensive quality improvement initiatives."From a strategic level, these measurement initiatives can serve as the building blocks of more comprehensive quality improvement programs,\u201d Higgins adds. Health plans can support these initiatives with technology solutions such as Medecision\u2019s Aerial offering, which now includes Aerial Quality Measures, powered by SPH Analytics, a solution that measures performance in advance of required HEDIS data submission so that health plans can continually take action to improve performance.\u201cHealth plans can cull the performance measures down to a cohort that makes sense to them. So if they really care about Hemoglobin A1c, for example, or they care about certain physician practices, they can focus on the relevant outcomes and the care managers can work to close those gaps. Thus not only do plans have access to performance information, they\u2019re going to have a way to make that information actionable,\u201d Molesworth concludes. ","saveContent":"Beauty is definitely in the eye of the beholder. Quality, however, requires assessment tools that operate in a more objective manner. That\u2019s where healthcare performance measurement programs come in.\u201cAll these programs arose out of a very basic need to be able to normalize how people were measuring quality across multiple organizations. While it\u2019s possible to argue whether specific performance measurement programs offer the best ways to measure quality, it\u2019s clear that these programs do create some standardization,\u201d says Cate Higgins, Senior Clinical Consultant at Medecision. As such, performance measurement programs provide a mechanism for health plans to compare quality both across and within organizations.The Healthcare Effectiveness Data and Information Set (HEDIS), for example, provides standardized measures that specify how healthcare organizations collect, audit and report performance information across clinical areas, as well as important dimensions of customer satisfaction and patient experience. Administered by the National Committee for Quality Assurance, HEDIS includes more than 90 measures across six domains of care:
        If Medicare beneficiaries remain healthy while on their plan<\/li><\/ul>
        Effectiveness of care<\/li><\/ul>
        Access\/availability of care<\/li><\/ul>
        Experience of care<\/li><\/ul>
        Utilization and risk-adjusted utilization<\/li><\/ul>
        Health plan descriptive information<\/li><\/ul>
        Measures collected using electronic clinical data systems<\/li><\/ul>The Centers for Medicare and Medicaid Services (CMS) uses the CMS Star Ratings to assess the quality of Medicare-sponsored plans. Star Ratings for these plans are established by an analysis of six factors:
        If Medicare beneficiaries remain healthy while on their plan<\/li><\/ul>
        Management and improvement of beneficiary chronic conditions<\/li><\/ul>
        Member experience with health plans<\/li><\/ul>
        Customer service performance<\/li><\/ul>
        Member complaints with health plans<\/li><\/ul>
        Changes in overall health plan performance<\/li><\/ul> Via participation in these performance measurement programs, health plans can: Make sure members are receiving top-notch care.<\/i><\/b> <\/i>\u201cPerformance measurement programs provide a nice way to ensure that members are getting a higher quality of care. Are they the be-all and end-all? No, they\u2019re not. But by leveraging these programs, a health plan might be more likely to ensure that a member gets their blood pressure checked, gets their annual mammogram, and gets their colonoscopy. And, when members receive these services, outcomes are likely to improve,\u201d explains Rebecca Molesworth, Senior Product Manager, Clinical Informatics & Analytics at Medecision.Save costs by reducing utilization<\/i>.<\/b> As health plans steer members toward receiving quality care, overall utilization could be reduced. \u201cIf members are in good health or stable condition, then they are staying out of the hospital and that obviously keeps overall costs down,\u201d Molesworth points out.Address quality issues with providers. <\/i><\/b>Performance measurement programs make it possible to participate in an honest, quality discussion with providers. \u201cIf everyone acknowledges that the performance standards are used across the industry, then providers will not look at the measures as something that the health plan has made up to trick them out of reimbursement. This way they become a means for taking the natural distrust out of the equation, which is especially important when providers are sharing risk with health plans under value-based programs,\u201d says Nan Sloan, Senior Director, Government and Accreditation Programs, Medecision.Keep tabs on performance in a variety of areas.<\/i> <\/b>\u201cCMS Star Ratings enable health plans to perform some level of a quality assessment on how well they are functioning across multiple areas. The measures don\u2019t just assess quality of care but also other factors such as the level of member satisfaction with the plan\u2019s services,\u201d Molesworth notes.Provide consumers with a comparative metric<\/i>.<\/b> \u201cConsumers are likely to look at the Star Ratings to decide which plan to enroll in. And, if members are in a poorly performing plan, Medicare will send them a letter and the consumers can opt to change plans. If a plan loses a half Star of rating, there will most likely be a significant reduction in enrollment,\u201d observes Connie Webster, Senior Director for Clinical Consulting, Medecision.Perhaps most important, though, participation in performance measurement programs can help health plans lay the foundation for comprehensive quality improvement initiatives."From a strategic level, these measurement initiatives can serve as the building blocks of more comprehensive quality improvement programs,\u201d Higgins adds. Health plans can support these initiatives with technology solutions such as Medecision\u2019s Aerial offering, which now includes Aerial Quality Measures, powered by SPH Analytics, a solution that measures performance in advance of required HEDIS data submission so that health plans can continually take action to improve performance.\u201cHealth plans can cull the performance measures down to a cohort that makes sense to them. So if they really care about Hemoglobin A1c, for example, or they care about certain physician practices, they can focus on the relevant outcomes and the care managers can work to close those gaps. Thus not only do plans have access to performance information, they\u2019re going to have a way to make that information actionable,\u201d Molesworth concludes. ","order":0,"get_parent":{},"attributes":[],"attributesType":{"content":{"type":"string","source":"raw"},"lock":{"type":"object"}},"dynamicContent":""}]

Leveraging Standardized Performance Measurement to Optimize Quality Improvement

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