Quality′s Quarter-Century

February 19, 2015 · Margaret E. O'Kane

The following is excerpted from the American Journal of Managed Care. To read the full article click here.

In 1990, we began our mission to improve healthcare quality and value through measurement, transparency and accountability. Today, we are proud that measurement and accountability are now part of the DNA of our entire healthcare system, and cost and quality are both improving.

Rather than rest on this success, we quality advocates must turn to what our experience allow us—and require us—to do next.

Steady Gains and New Highs

The accomplishments of the last quarter-century are real and significant. In 1990, measuring quality was just an idea—today it is an everyday reality. Most Americans—more than 171 million—are enrolled in health plans that report NCQA’s HEDIS (Healthcare Effectiveness Data and Information Set) clinical quality measures.

Medicare, most state Medicaid programs, and many private insurers use HEDIS to rate the value (rather than the volume) of healthcare. Plans and providers use HEDIS to gauge their performance and determine where they must improve.

Measurement will help even more people this year when the new Marketplace or Exchange plans begin reporting quality results for their more than 10 million enrollees.

Read the rest on the AJMC’s web site.