Quality Critical to Health Care Reform

Expanding healthinsurance coverage is a critical step in health reform, but reforms willnot be successful if they fail to also address the quality and cost of care.

That is the conclusion of The Quality Crossroads Group, a broad groupof stakeholders drawn together to identify strategies to address thecomplex challenges confronting the U.S. health care system. The group laysout a five-point agenda in an article published today in Health Affairs that serves as a vision for quality in an election year when patient safety, the plight of the uninsured, and rising costs are making front-pagenews.

"Quality improvement is intricately connected with containing costs andexpanding coverage. Yet too often, quality is left out of the equation,"says co-author Margaret E. O'Kane, president of the National Committee forQuality Assurance. "Poor quality care is a major contributor to runaway health care costs.

Improving quality is a key part of making coverage affordable."

"The future of health care reform rests on the ability for diversegroups, at national, state, and community levels, to work to achieve consensus. We cannot achieve the important policy goals outlined in this paper without collaboration," says co-author Janet Corrigan, president and CEO of the National Quality Forum. "The thinking in this paper, by leadersin the quality movement across the country, represents a successful effort to collaborate in moving beyond rhetoric and sparking real change," sheadded.

If taken up by the new President, Congress and others, the five-point reform plan put forward by the 13 authors of the paper would mobilize true change in the nation's vast, complicated, and expensive health care system.

The reform plan calls for:

A national center to support effectiveness research. The U.S. invests too little in understanding what works and what does not for a whole array of technologies, drugs, and treatments. In order to ensure that our health care dollars are wisely spent, we need to systematically identify where critical gaps in evidence exist and fill them.

Models of accountable health care entities capable of providing integrated and coordinated care. The sickest patients often suffer the most from lack of care coordination across settings. They see multiple specialists, get an array of tests, and take multiple medications - usually without a "health care home" or central coordinator of care. Achieving high levels of coordination will require investments in organizational supports that go beyond information technology. IT is a critical enabler of management, but is not sufficient to produce high-quality, efficient, and patient-centered care.

Payment models that reward high-value care. There are nearly 10,000 codes for payment for medical procedures, but not one for outcomes or results. The Quality Crossroads Group believes that if quality is not tied to payment, providers' behavior will not appreciably change, and if it does not change, access to insurance and care will continue to decline.

We need to aggressively develop models of payment that reward clinically effective and efficient care and yield high patient satisfaction. Those might include innovative ideas like bundled chronic care episodes.

A national strategy for performance measurement, including standardized measures of patient and population health. We need a common vision of what quality care means. To get there, we need to agree on what we are measuring and how we are measuring it. Performance information is a public good and federal funding for the National Quality Forum, a private sector standard-setting organization, will facilitate development of a comprehensive portfolio of standardized measures that is continually assessed and updated.

A multistakeholder approach to improving population health. Obesity is a national crisis that demands solutions that lie mostly outside of health care. The public sector can do much to promote population health. For example, in Arkansas, nearly 38 percent of young people are overweight or at risk of becoming overweight. State officials implemented a strategy to target children in schools, focusing on what they eat and how often they exercise. We must make a concerted public- and private-sector effort -- similar to the one we mounted for tobacco control -- to achieve the outcomes we know are possible.