Smith and Cropp: It’s Time to Measure Quality Across Our Entire Health Care System
Movies have them. Restaurants have them. Even hotels have them. So when it comes to the quality of our health care, is it really so unrealistic to expect a universal metric to rate performance?
On the heels of the White House budget release, there is no question that Congress and the president will be negotiating on ways to make the Medicare program more efficient and effective. Crucial to those conversations should be ways to drive better value into the system so that we spend our limited health care dollars more wisely.
We believe that the best way to do this is to measure and reward quality, as higher quality care means better care, better value and lower costs. We have started measuring and rewarding quality in the Medicare Advantage program, but we need to expand that across all Medicare.
There is much that we can learn about how Medicare Advantage is creating value in the program for beneficiaries, providers and taxpayers that can be applied across our health care system, including measuring quality, financial incentives to achieve high-quality care and educating consumers about the value of considering quality in their health care decisions.
As our health care system is changing, Congress is grappling with ways to reduce the deficit and change Medicare so it is financially secure for future generations.
We all know that the aging baby boom generation is creating a huge influx of Medicare beneficiaries. And according to the February Journal of the American Medical Association, U.S. baby boomers have higher rates of chronic disease, more disability and lower self-rated health than members of the previous generation at the same age.
This means that these new Medicare beneficiaries will likely need more health care services than their predecessors, so driving better value for the dollars spent becomes even more important in the coming years. Congress started the Medicare Advantage program down the right path by creating incentive payments in the Affordable Care Act that promote health plan efforts to achieve high clinical quality, as well as improved patient outcomes.
Last year, the Centers for Medicare and Medicaid Services instituted the Five-Star Quality Rating program, under which Medicare Advantage plans are measured and rated on how well they perform in five different categories, including member satisfaction, helping senior members stay healthy and managing chronic conditions. The program, which awards plans between one star (poor) and five (excellent), ensures that Medicare beneficiaries, the federal government and American taxpayers are getting better value for their money.
There is also growing evidence that higher star ratings are positively influencing the decisions of Medicare beneficiaries choosing a plan for the first time or switching plans.
A study published in the January 2013 JAMA found Medicare beneficiaries were more likely to choose higher-rated health plans than would be expected without a rating system. The study also notes this may have implications for the inclusion of quality ratings in the health insurance exchange environment where enrollees will face a similar choice of health insurance companies and benefit packages.
The Alliance of Community Health Plans represents some of the highest-quality health plans in the country, with 22 members comprising 46 of the approximately 580 Medicare Advantage plans. Of the 11 plans receiving five stars, eight are ACHP members.
Nationally, ACHP member organizations promote evidence-based practice, engage patients in their care and align incentives with providers to ensure our Medicare patients get the right care when and where they need it.
Is the Star Ratings program perfect? Of course not, but it is a good start. We are eager to work with Congress and other interested stakeholders to improve the Star Ratings system and to create quality measurement systems and metrics that measure across the Medicare program.
We strongly believe that driving value and high quality through quality measurement should be the centerpiece of needed change to Medicare. We cannot afford anything less.
Patricia Smith is president and CEO of the Alliance of Community Health Plans. Dr. Michael W. Cropp is president and CEO of Independent Health of Buffalo, N.Y., chairman of the ACHP board of directors and a board-certified family physician.