Monday Musings

Have you heard of the “Triple Aim”? The Triple Aim is a framework developed by the Institute for Healthcare Improvement (IHI). The concept is that as we reform our healthcare system, we should simultaneously optimize three dimensions: 1) improve the patient experience of care (including quality and satisfaction); 2) improve the health of populations; and 3) reduce the per capita cost of health care. Every Monday in April I have been discussing what I learned at the recent annual National Quality Forum (NQF) meeting in Washington, DC, where there was much discussion about how quality measurement could support the Triple Aim. Across the USA, there are states like Minnesota where 84% of primary care clinics and hospitals participate in the public reporting of quality measures. In fact, 360 primary care medical groups contribute data to a statewide, publicly reported database of patient experience of care measures. The Network for Regional Healthcare Improvement (NRHI) is a national organization representing over 30 member Regional Health Improvement Collaboratives (RHICs). These multi-stakeholder organizations collaborate in hopes of transforming the healthcare delivery system across a broad geographic area (http://www.nrhi.org/). Five states are using consistent measure specifications in a distributed model of patient risk adjustment.

If you want to get a glimpse of what this could mean in wound care, check out Minnesota Health Scores (http://www.mnhealthscores.org/). The “Minnesota Community Measurement” (MNCM) project is pioneering efforts to collect, analyze and publicly report health care quality, cost and patient experience information within the state. Many regional and national organizations utilize the quality measures developed and the information collected by MNCM for a wide range of purposes from reporting on health care topics nationally to determining how much health insurance companies will reimburse providers for care they give to patients. Additionally, the process used by clinics and medical groups to submit data to MNCM helps them easily participate in local and national programs that reward high quality care.

Aligning Forces for Quality (AF4Q) is the Robert Wood Johnson Foundation’s signature effort to lift the overall quality of health care in targeted communities and is the largest effort of its kind ever undertaken by a U.S. philanthropy. AF4Q asks the people who get care, give care and pay for care to work together to improve the quality and value of care delivered locally. (Learn more about AF4Q at http://www.forces4quality.org). The National Committee for Quality Assurance, a nonprofit dedicated to transforming health care, along with the Robert Wood Johnson Foundation, have strongly advocated for the use of composite measures and scores as a potential new gold standard for quality measurement in managing diabetes and have developed what they call the “D5 Measure” for Diabetes. The D5 five indicators include:

1) A blood pressure reading lower than 130/80,
2) A low-density (LDL), or bad cholesterol, reading lower than 100 mg/dL,
3) A blood sugar or HbA1c reading of less than 8 percent,
4) Living tobacco-free,
5) Taking a daily dose of aspirin as appropriate.

In 2009 the Health Collaborative of Greater Cincinnati brought together a group of physicians to discuss the more than 32,000 adult residents diagnosed with diabetes. With a diabetes rate of 12%, higher than the national average, the group decided to take action to improve diabetes care in their communities through public reporting and composite measures. The group began to provide physicians with a “daily dashboard” of their patients’ progress. And after the data are validated, the group shares them with the public. A community average is generated for each measured condition and a score given for each physician practice. The scores are reported on the patient-focused web site: YourHealthMatters.org (http://yourhealthmatters.org/). You might also want to check out the “Physician Compare” website where provider PQRS data will be publicly reported (http://www.medicare.gov/physiciancompare/staticpages/aboutphysiciancompare/about.html).

Next week I am going to talk about where all of this is really headed.