The Future of Performance

Measurement
Margaret E. OKane, NCQA President
Partnership to Fight Chronic Disease
March 6, 2015

Gap analysis
What we have

What we want

Many structure and

process measures,
some intermediate
outcomes

Outcome measures and

performance reporting
across systems

Uneven knowledge
about
specialty care

Measurement that comes

naturally from workflow,
rather than being imposed
on workflow

Partnership to Fight Chronic Disease

Use outcome measurement for

procedures

Hips
Knees
Backs
Cataracts
Heart surgery,
stents

Make sure to get patient-reported

outcomes
Make sure procedures are
appropriate
Partnership to Fight Chronic Disease

Patient-reported outcomes in
quality framework
STRUCTURE

PROCESS

OUTCOME
Biology

HEALTH SYSTEM
CHARACTERISTICS
Provision of treatment
Availability of care
Knowledge and beliefs of
providers
Provider communication
ENVIRONMENT
CHARACTERISTICS

PATIENT FACTORS
Behaviors
Use of care
Knowledge and beliefs
Expectations
Adherence to treatment

Symptoms
Function

Demographics
Age, Gender, SES

General
health
perception
Overall
quality of life

Health characteristics
Severity of condition
Co-morbid factors

Partnership to Fight Chronic Disease

Use patient safety measures in

hospitals
Infection rates
Sepsis
Medication errors
Iatrogenic preterm
deliveries
HCAHPS
Etc.

Partnership to Fight Chronic Disease

Then theres the really hard stuf

Cancer
Multiple chronic
conditions
(e.g., frail elderly)
Intractable illness

Partnership to Fight Chronic Disease

Where do we go from here?

Partnership to Fight Chronic Disease

Emulate successful examples

Cystic fibrosis
benchmarking
Untzer et al.
IMPACT

Partnership to Fight Chronic Disease

Getting to outcome measures

(diabetes)
Structure
Pre-visit planning
including labs
Collection of
relevant patient
reported data
Team with defined
roles, training

Process
Use data (e.g., risk
models like Archimedes
and patient reported
tools) to present
information to patient
and clinical teams

Decrease risk of
harmful events

Elicit patient priorities

Maintain or
improve
functioning

Develop shared
understanding

Who is
accountable
?

Outcome
Decrease
symptoms

Agree on care plan and

self management goals

Diabetes today:
Target threshold for
A1c, BP, statin use,
BMI

Diabetes in the future:

select patient-centered
targets for clinical,
functional measures
Partnership to Fight Chronic Disease

Diabetes complications are down

Source: NEJM/CDC, 4/14

10

Benchmarking works
Benchmark
outcomes
Study what works
Spread best
practices
Engage parents

Partnership to Fight Chronic Disease

11

Kids are living longer with cystic

fibrosis

Source: Cystic Fibrosis Foundation

12

Building an accountability
framework
1. Begin with
structure
measures
2. Then focus on
process measures

3. Build up to
outcome measures
Partnership to Fight Chronic Disease

13

IMPACT is a system of care

Primary Care Practice with Mental Health Care Manager

Outcome
Measures

Treatment
Protocols

Population
Registry

Psychiatric
Consultation

14

IMPACT doubles efectiveness of

care for depression

50 % or greater improvement in depression at 12 months

Participating Organizations
Untzer et al., JAMA 2002; Psych Clin NA 2004

15

Global Cardiovascular Risk (GCVR)

RWJF grant to
NCQA to develop
measures to
manage CV risk
Predictive risk
calculators
identify, manage
patient risks to
improve outcomes

Partnership to Fight Chronic Disease

16

What is the model?

1. Organize for success

2. Manage against
process benchmarks
and patient-reported
outcomes
3. Use accountability
for quality
improvement where
benchmarking
outcomes is unfair
Partnership to Fight Chronic Disease

17

Thank you

Partnership to Fight Chronic Disease