Forward on Quality: How Do We Get to Breakthrough?

February 26, 2016 · Jennifer Zutz

Peggy O’Kane Delivers Keynote at P4P Summit

For 25 years, Peggy O’Kane, president of NCQA, has stewarded many developments in health care quality. As keynote speaker at the 11th annual National Value-Based Payment and Pay-for-Performance Summit, she tapped into her knowledge and expertise. O’Kane and other quality leaders shared insights throughout the two-day conference—some recurring themes:

• MACRA is a core driver in value-based payment—everyone should get up to speed.
• Specialists have a key role in value-based payment.
• Data sharing and infrastructure are critical for pushing the agenda forward.

In her keynote speech, O’Kane highlighted the pathways to achieving real breakthrough in quality improvement. What should quality leaders focus on in the next few years? How does quality win?

Here’s what she had to say about…

Clinical practice redesign:

Patient-centered medical homes—a leading example of redesign—will be an integral solution to future quality care. O’Kane noted, “Many chronic conditions are managed effectively by primary care practices. We need to understand that effective primary care—with the data, with the systems we see in the best practices—is extremely successful at taking care of people with chronic conditions.”

Payment reform:

Capitation (or “population-based payment”) is the ultimate goal in payment reform—as long as it is tied to appropriate quality measurement. O’Kane referenced panel presentations by John Bertko, of Covered California, and James Whistler, of Deloitte, who noted that for sophisticated organizations, capitation works great. But not all organizations are as fortunate as those. Many are still trying to move up the scale and need to mitigate risks along the way. Risk corridors (you could say “training wheels”) would encourage less-sophisticated organizations to develop the capabilities to manage populations efficiently.

O’Kane applauded Peter Lee, of Covered California, for his tireless efforts to shed light on the conflict between quality and high deductibles. That organization has been performing systematic engineering of what comes before the deductible—such as doctor visits or medication for a chronic condition. Its work to refine how cost-sharing works might make people think twice before choosing a health plan.

Clinical integration:

Patient experience should be part of the evaluation process. As patients, we shouldn’t be too intimidated to share our experiences with our practitioners. It’s up to us to make sure practitioners are held accountable; the sicker the patient, the more important this is. It’s sad that we aren’t even close to where we need to be on this issue—this is especially evident in behavioral health. We can’t sit idly by: data driven management is the future.

Process redesign/outcome measures:

To drive better outcomes, practitioners need to practice at the top of their license. Quality is not just about measurement; it’s also about organization structure and process. Dr. Jürgen Unützer’s study on depression screening is a great example of demonstrated improvement by altering the system. It’s about what the practices do to get good results. Outcome measures ultimately keep us honest. If we have more of them, we may be surprised that certain types of care aren’t really helping the patients’ outcomes and they are costing us all money.

As O’Kane and other quality leaders set their sights on tackling these issues, it’s entirely possible that our quality breakthrough might be coming faster than we think.