Vital Signs Core Metrics for Health and Health Care Progress (2015) / Chapter Skim
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5 Implementation: Putting the Core Measures to Use
5 Implementation: Putting the Core Measures to Use
Pages 185-212
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From page 185... ...
Each of these changes carries the potential for new measure requirements and accompanying reporting burden, underscoring the importance of a new measurement framework -- a framework that registers and reports overall system performance on the most vital dimensions in a comparable fashion at every level while reserving to local prerogative decisions on measures tailored to specific needs. Hence, the core measure set presented herein is prompted by the need for a paradigm change in the approach to assessment and reporting at all levels.
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From page 186... ...
In this way, core measures can serve as tools for measuring progress, recognizing shortfalls, informing and raising public awareness, sharpening focus at multiple levels, improving accountability, fostering diverse data linkages, facilitating informed patient choice, and establishing targets for community efforts. This chapter begins by reviewing in turn each of these practical applications of the core measure set.
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From page 187... ...
Informing and Raising Public Awareness Although the primary purpose of a core measure set is monitoring status and trends to accelerate progress or reverse setbacks, marshaling public support and demand for the necessary action requires a public sense of priority. Inherent in the parsimonious character of the core measure set proposed herein is the ability to educate the public -- indeed, all stakeholders -- about what is really most important to the nation's health and wellbeing.
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From page 188... ...
Using the common language of a core measure set to assess progress presents an opportunity to promote shared accountability across the health system for the goals that matter most for improving health at the national, state, and local levels. Similarly conveyed is the reality that health leadership at each of these levels also is accountable for reaching outside clinic doors to forge partnerships at the community level.
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From page 189... ...
The core measures proposed herein require various data sources, including clinical data, claims data, biometric data, and patient-reported data. Each will need to be collected and shared in a standard way to enable standard reporting, comparability, and benchmarking.
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From page 190... ...
Over time, the core set is intended to carry an element of familiarity and shared ownership of the measurement process to benefit decisions at all levels. Establishing Targets for Community Efforts At the broadest level, the core measure set offers the opportunity for national, state, and local leaders to translate into clear and consistent terms the issues that are most important to progress in health at the levels of their focus and responsibilities.
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From page 191... ...
Critical to realizing opportunities at the community level is coordination and collaboration among a broad group of stakeholders in a community, including public- and private-sector groups, employers, community health organizations, public health agencies, and more. USE IN ASSISTING AND ASSESSING LARGE SOCIETIAL INITIATIVES In addition to the practical applications described above, the core measure set is of central utility in drawing attention to, illustrating, and tracking progress on large, cross-cutting initiatives of social importance.
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From page 192... ...
With consistent application of the core measure set at multiple levels, this report could provide a much more robust sense of the opportunities of particular importance and promise. IHI Triple Aim® The core measure set proposed by the Committee can be used to help track and promote progress toward the Triple Aim.
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From page 193... ...
. For either the Triple AimBitmapped or the four-part aim, a core measure set that affords regular and reliable w/correction access to information at multiple levels on the factors most important to improving health outcomes is a necessary tool for effective action.
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From page 194... ...
In this way, the spirit of the six aims for quality was foundational to the Committee's articulation of the core measure set, and the Committee's definition of quality was the same, though the final framework of the set around the four aims described in the statement of task required an alternative approach to presentation. National Prevention Strategy In 2011, HHS released the National Prevention Strategy, establishing the goal of increasing the number of Americans who are healthy at every stage of life and underscoring the vision of a nation focused on prevention and wellness.
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From page 195... ...
With its focus on systematic, systemic, and continuously improving assessment of such issues as evidence-based care, care match with patient goals, spending burden, and individual and community engagement, the core measure set proposed by the Committee will provide critical multilevel insight and guidance for progress on the National Quality Strategy. Affordable Care Agenda Despite the long-standing and mounting concern about the personal and national impact of health care costs, the rate of increase in those costs continues to outpace cost and price increases throughout the rest of the economy.
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From page 196... ...
Community health Provide well-timed assessment of progress and changing needs planning for attention and resources, especially important to meeting growing responsibilities of health systems for population health improvement. Community benefit Focus community benefit initiatives on issues most important to requirements outcomes, and improve prospects for targeted coordination of efforts involving multiple organizations.
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From page 197... ...
The embedded objectives relate to a range of clinical priorities -- health outcomes, clinical processes, patient safety, care coordination, patient engagement, population and public health, and use of clinical guidelines -- as well as to data and definition standardization and sharing capacity. Incorporation of the core measure set as a basic Meaningful Use feature would provide standardized elements for all electronic health records, contributing reliability and comparability to information on health and health system performance, increasing the prospects for seamless interoperability in the records' sharing and use, and accelerating advancement toward the program's basic clinical priorities.
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From page 198... ...
Application of the core measure set across all payers as commonly collected data points can serve as a valuable tool for assessing basic important outcomes across providers, plans, and circumstances. Further, use of the core measure set can enable employers and health plans to better assess and understand the characteristics and needs of their populations and, by extension, to develop priorities and tailored interventions for achieving better health at lower cost.
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From page 199... ...
In addition, outcomes specific to the grant's targeted condition may not materialize until sometime after the grant has ended, rendering knowledge about life expectancy, well-being, or other possible outcomes of clear importance to the patient inaccessible. Ensuring that all categorical grant programs are generating standardized data points around the core measure set not only can facilitate assessment of various outcomes across time and sites but also may allow look-back assessments for results occurring after a grant's conclusion.
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From page 200... ...
IMPLEMENTATION CHALLENGES FOR STAKEHOLDERS AT MULTIPLE LEVELS The development, adoption, implementation, maintenance, and continuous improvement of the core measure set will face many challenges at every stage -- challenges that require explicit acknowledgment and aggressive cooperative engagement on the part of the entire stakeholder community if the full potential of the core measures is to be achieved. These challenges include limitations of the existing measurement infrastructure, variability in the approaches to measurement taken by different actors, the need for financial and personnel investments, legal and regulatory barriers, the need to assess relevance to multiple circumstances and stakeholders, and issues of trust and attribution.
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From page 201... ...
Despite an investment of significant resources, there remains a patchwork of independent claims data and electronic health record systems that fail to capture key data elements in consistent formats and cannot readily exchange those elements across systems. To develop a core measurement environment that encompasses the full breadth of the health system and provides high-quality, useful data, significant advances and improvements in digital infrastructure and analytic capacity will be necessary.
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From page 202... ...
organizations that can combine claims data from all or most of the payers in the community and are capable of generating more robust analyses of spending, as well as payer-specific analyses in a common format. These emerging data sources will provide important resources for the use of a set of core measures, yet many barriers to consistent and comprehensive access to the data remain.
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From page 203... ...
In addition, various policies governing the collection, reporting, and use of health information must be engaged in the widespread application of a core measure set. One particularly important issue centers on privacy protections under the Health Insurance Portability and Accountability Act (HIPAA)
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From page 204... ...
A specialist in allergy and immunology, for example, may not immediately find relevance in a core measure set that does not link explicitly to that specialty. On the other hand, progress in that arena is clearly dependent on widespread attention to such issues as well-being, community health, use of evidence-based practices, care match with patient goals, and individual and community engagement.
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From page 205... ...
Leadership The Committee believes that the Secretary of HHS is the appropriate official to take on the leadership and governance roles required for successful stewardship of the core measures and their implementation and continuous improvement. It is the Secretary of HHS who directs the agencies most involved in the collection and use of health data; who signs off on reporting requirements and responsibilities; who is centrally positioned to convene and work with the key stakeholders; and who, as the leader most responsible for the nation's effectiveness and efficiency in delivering better health at lower cost, has the greatest potential to ensure that the capabilities of the core measure set are realized.
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From page 206... ...
A first-order leadership opportunity lies in the Secretary's ability to embed the use of the core measure set in the programs administered within HHS, as well as to help overcome the obstacles inherent in the many entities with vested interests in maintaining the varied measures and measure sets that suit their particular programs and priorities. Some entities design measurement and reporting products as part of their business model for a specific audience; some prefer particular measures for their internal improvement efforts; and product developers may prefer unique measure sets for market differentiation.
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From page 207... ...
Strong leadership will be needed to meet the formidable challenge of standardization. (Table 5-2 lists potential horizon measures for the core measure foci and example participants in their development.)
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From page 208... ...
Dependence • Trust for America's Health Unintended Unintended pregnancy • The Child and Adolescent Health pregnancy rate Measurement Initiative • Guttmacher Institute • National Partnership for Women and Families Healthy Environmental • Institute for People, Places and Possibility communities quality, green space, • Minnesota Community Measurement socioeconomic • National Association of Community Health status, social capital Centers (composite index) • Network for Regional Healthcare Improvement • Robert Wood Johnson Foundation • Trust for America's Health Preventive Proportion of people • National Association of County and City services receiving the full range Health Officials of the U.S.
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From page 209... ...
• National Committee for Quality Assurance • National Quality Forum Care match Patients reporting • Consumer Reports with patient goal discussion and • Institute for Patient- and Family-Centered goals follow-up Care • Patient-Centered Outcomes Research Institute • Society of Participatory Medicine Personal Out-of-pocket health • The Commonwealth Fund spending spending as share of • Health Care Cost Institute burden income • Health Care Incentives Improvement Institute Population Total spending as a • Health Care Cost Institute spending share of income or • Health Care Incentives Improvement burden revenue in a specific Institute population • National Business Group on Health Individual Involvement in self- • Consumers Union engagement care, family health, • Institute for Patient- and Family-Centered and community health Care (composite index) • Patient-Centered Outcomes Research Institute Community Community focus/ • Consumers Union engagement progress on health • Institute for Patient- and Family-Centered improvement Care (composite index)
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From page 210... ...
Evaluating Success If core measures are to lead to positive change, the performance measurement enterprise must both be part of a local system for change represented by a community health management system and capable of demonstrating contributions to accelerated progress toward better health at lower costs. At the community level, for example, several cities -- such as Aurora, Colorado; Camden, New Jersey; and Kansas City, Missouri -- have formed coalitions representing a comprehensive approach to health that have applied geocoding and other measurement strategies to design and implement population health initiatives.
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From page 211... ...
These devices also will pose new challenges, such as their interoperability, the capabilities needed to analyze and use these new data, and the privacy and security of the data. Updating and Amending the Core Measure Set Although the best measures for many of the core measure foci have yet to be developed, the Committee believes the measures as a set stand as the vital signs of the nation's health and health prospects.
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From page 212... ...
2011. HHS action plan to reduce racial and ethnic health disparities: A nation free of disparities in health and health care.
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