Review your most recent visit: How would you rate your health care quality?

Jan. 22, 2024 / By Gina Perna

Many of us are overloaded with requests to review recently purchased products and services, especially at the end of the year after the holidays! Often, reviewing product ratings is part of the product research and purchasing process we as consumers do to find the “best products.” It can be interesting to think about health care through this lens. How would you rate your health care quality? What do you think is a good measure of quality in your own health care experience?  

In full disclosure, I have been known to scan reviews of health care providers in the past, just for personal reference. The interesting dynamic for those of us in health care is that we work tirelessly to analyze and improve cost and quality, and then personally witness these system transformations in our health care experiences.  

The health care industry is focused on paying for quality, not quantity, with the continued expansion of value-based care and transition from fee-for-service payment models. Quality measures galore are available and implemented to ensure the payment models incentivize improved quality outcomes, even adding social determinants of health as a data point to include in the patient record. The Centers for Medicare & Medicaid Services (CMS) has stated its quality mission is, “To achieve optimal health and well-being for all individuals,” and each state is accountable for a quality strategy. Per 42 CFR 438.340(c)(3), each state is responsible for submitting to CMS a copy of its initial quality strategy, as well as any revised quality strategies for CMS review and feedback.  

In addition, states must review and update its quality strategy at least every three years. Volumes of measures are available to use specific to adults, children, health homes, long-term care and others. Several hundred are listed in the CMS Measure Inventory Tool as options for states and managed care plans to select. 

Quality measures provide a framework for providers to ensure pediatric patients receive their wellness visits and adults schedule age-appropriate preventative diagnostic testing, mammograms and colonoscopies. You may have received a reminder yourself, to make these appointments. These are all great metrics to use so that we know preventive care is being included as part of our value-based health care. Several other measures help to support specific chronic diseases, focusing on diabetes and hypertension, admissions for COPD or other chronic conditions and unplanned re-admissions. Hopefully, you and your family have not encountered these health care events.  

As we see more consumerism in health care, what do we as health care consumers expect for our health care spend? Is it a reminder to receive annual diagnostic testing? Is it staying healthy and out of the hospital if you have asthma, COPD or both? Maybe being able to run in a 5k with your family? If you are admitted for an exasperation of a chronic condition, how can a readmission be prevented? Are we measuring the right quality outcomes that we expect for the value we expect? 

In a recent Health Affairs article, “The Elusive Quest For Value: Getting The Details Right,” Rich Averill explores this very topic. It reminded me of a high school teacher who used to repeat to our class the importance of selecting measures that directly align to the variable being tested. 

Rich simplifies the concept by sharing the quest for value-based care as the right balance between cost and quality in two steps:  

Step 1: Determine the cost and quality measures used to judge performance.  

Step 2: Design payment incentives that support quality performance.  

Simple, yet difficult. Are we stuck on step one? Which measures should leaders use? Should we focus on the conditions with the worst outcomes for the specific population or the highest cost conditions? What is reasonable for the facility or provider to manage? Select population-based measures that focus on system-wide trends, perhaps? How should we use the volumes of CMS measures as options for quality measurement?  

Luckily, Rich goes on to provide more guidance! Some simple, yet impactful, criteria can be used to frame the selection process for “measures that matter” including considering the following: 

• Financial impact: The financial impact of the measure must be enough to motivate behavior change. 
• Comprehensive: Measures should address all aspects of quality outcomes, not just specific scenarios. 
• Outcome-based: Measures should focus on the patient outcomes and should not be based on specific process measures.  

Rich specifically discusses the facility portion of health care in this article and the impact of the Inpatient Prospective Payment System (IPPS), yet these concepts and suggestions can be used across the system for multiple sectors and stakeholders. Addressing patient outcomes, regardless of specific health conditions, may provide the insight we need. A few impactful measures for health care leaders to use for monitoring health care quality that can highlight variation across the system and focus on whole-person health seem ideal for us all.  

I cannot help but think, if we as an industry focused on these criteria, would we be able to see specific spikes in issues like maternal mortality sooner to prevent the loss of life? If you or your family member has multiple health issues, would you want the best measure of quality embedded in their health care? I would.  

How many stars would you rate your health care quality? 

Gina Perna, MHA, PMP, state regional manager of regulatory and payer solutions at 3M Health Information Systems.