New President, New Opportunities: A Memo to President-Elect Biden
January 14, 2021 · Matt Brock
With a Biden administration taking office in just a few days, it’s a perfect time to be thinking about the future of healthcare.
We thought we could help, by crystalizing our own priorities and sharing them with the incoming administration—all of them, we believe, will 
improve the quality of health care delivery across the nation. And though NCQA is a non-partisan organization, we believe that the new administration has a distinct opportunity to make revolutionary change—revolutionary improvements—to how care is delivered and how performance is measured.
Our recommendations—our vision for the future of health care quality—is divided into four key objectives—four issues we must tackle to achieve significant improvement in our health care system’s performance.
Enabling a Digital Quality System
We want digital quality infrastructure that reduces waste and burden in quality reporting. We want this digital frame to cover all levels of the healthcare system. It will allow the health care system to more readily identify and promote high-value care. It also sets the foundation for a “learning health system,” an ever-improving structure that allows plans, providers and payers alike to intervene and improve care in real time.
In a later post, we’ll talk in more detail about digital measurement’s benefits and challenges—and next steps in our own pursuit of this new, faster and more efficient way of measuring performance and providing feedback where and when it can be most useful to patients and practitioners. But suffice it to say, the future of health care quality depends on a digital measurement transformation supported and strengthened by leadership from CMS and HHS.
The Urgent Need to Advance Health Equity
Disparities in access, outcomes and cultural awareness continue to plague the healthcare system, as exemplified by the disproportionate impact of COVID-19 on minority communities. The pandemic has added millions of Americans to an already too large cohort of individuals whose health and well-being are negatively affected by the socioeconomic challenges they face. Progress will require commitment, resources, data, and strategy.
Moving the country toward more equitable health outcomes involves addressing the longstanding structural, institutional, and interpersonal racism that drive disparities in healthcare and society at large. But it also requires that we understand the demographic make-up of our healthcare populations better and identify tools for tacklng social determinants of health. Policy-level change is required to ensure organizations have the necessary resources and infrastructure (including standards and measures) to reduce disparities.
NCQA is working on a multi-pronged approach to developing health equity standards and measures for value-based payment arrangements. Along with our existing work to improve data collection and stratification, we are taking steps to build a framework capable of driving awareness, improvement, and justice in the healthcare system.
Digital Patient Experience Measurement
Twenty-five years ago, the Agency for Healthcare Research and Quality launched the Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys. CAHPS established a standardized approach for measuring patient experience of care. It was a revolutionary step, but it has failed to keep pace with changes in the healthcare industry.
Surveys are mostly paper-based mail or via telephone, costly and slow. The survey also goes to a random patient sample, making it poorly suited to identify concerns of specific patient groups, like racial and ethnic minorities or patients with multiple chronic illnesses. Even more, CAHPS focuses on
clinician-level care, so it makes it somewhat difficult to differentiate between health insurance plans with similar networks. All of this severely limits the ability to support value-based purchasing arrangements that become more widespread and sophisticated every day and to accurately assess the patient experience. CMS is increasing the weighting of patient experience measures in the Medicare Advantage Stars program so that, by 2023, these will be counted more than clinical outcome measures – heightening the need to make sure they are accurate, timely and targeted.
There is broad and growing agreement on the need to develop better tools to measure patient experience. Some health plans are already moving toward alternative survey platforms similar to others that consumers use regularly, like ratings on Yelp and Amazon.
Without the administration’s leadership, we run the risk of creating parallel patient experience enterprises. We simply can no longer afford to dilute the positive effects of measurement, distract plans from a focus on their members or cling to a system outgrown by advances in technology and measurement.
So this year, NCQA plans to convene an expert panel of stakeholders from across the healthcare landscape to inform the plan for a bold, digitally-based reimagining of patient experience measurement. The best solutions must combine the standardized approach that is essential for consistent, high-quality measurement with the adoption of leading-edge technology driving improvement in quality and consumer choice in other industries. A more robust, rapid, and targeted patient experience measurement system that empowers individuals and enhances the effectiveness of value-based payment (VBP) arrangements in driving higher quality and better outcomes.
Strengthening Medicare Value-Based Programs
We support the growth of value-based purchasing programs that drive patient-centered coordination, alignment, and accountability across levels of care, with reduced burden and the data necessary to identify, improve, reward and fund equitable, high-quality care for Medicare beneficiaries.
In a later post, we’ll discuss program-specific areas in which we can build on CMS’s success with value-based purchasing. But several high-level themeshave already emerged. In the design of fu
ture value-based programs, stakeholders (payers, clinicians, evaluators, quality measurement experts, etc.) should be involved early in design and development. These programs should move healthcare toward systems of care (not just clinicians), which are better prepared to improve coordination and outcomes. The “carrots” of financial incentives should be balanced with down-side risk or “sticks,” such as penalties for poor performance. And as critical outcomes measures are being defined and developed, it is essential to leverage evidence-based process measures closely tied to outcomes in the interim.
Value-based programs only succeed when the data is validated and audited, the metrics of success are clear and meaningful, and performance is comparable. The move to a digital quality system offers to dramatically bolster accuracy and effectiveness while reducing burden, enabling “smarter” measurement, and generating significant savings. The process of collecting and utilizing data used in performance and payment should be built into clinical workflows and provide both decision support and ongoing performance feedback. The measurement of patient experience must be reimagined to allow for a more targeted approach and greater engagement.
Medicare has blazed a trail for value-based programs in healthcare and should work to consolidate the gains already realized and learn from the successes and setbacks. We believe the government should align its value-based payment around a few fundamental pillars: integrity (of data and performance assessment); coordination (of structure and expectations across programs with the goal of moving toward systems of care); and collaboration (with all relevant stakeholders in designing and implementing VBPs).
Looking Ahead
We know there’s a lot to unpack here. We are working hard to make sure the Biden administration, and you, fully understand our objectives. Here on the blog, we’ll dive deeper on each of these in the coming weeks.
If you don’t want to wait. Read the memo for yourself.
It’s complex, but the overall objective is pretty simple. We want to build upon our stated vision. Better health care. Better choices. Better health.
