Aetna exec: Why we were able to finally come up with core quality measures

When the Core Quality Measure Collaborative unveiled a standardized set of quality benchmarks for healthcare providers, it represented a major milestone for an industry that too often struggles with burdensome reporting requirements.

But the process to achieve these long-sought sets of measures was not easy, nor is the work finished, Andrew Baskin, M.D., Aetna's national medical director for quality performance, tells FierceHealthPayer in an exclusive interview.

By Baskin's estimation, there are two main reasons for why this effort succeeded where others in the past have failed.

For one, the Centers for Medicare & Medicaid Services, America's Health Insurance Plans and the National Quality Forum took a unique approach to developing the measures, explains Baskin (pictured right), who was a member of the collaborative. The group began the process by creating measures that served as a starting point, then in stages brought in representatives from the provider community, followed by purchasers and consumers, all of which contributed to designing the final sets of measures.

That approach was critical because "one of the problems in the past has been when you put them all at the table right from the very beginning, it's real hard to make progress," he says. "The idea of bringing in the different stakeholders at stages--while some may have criticized that, saying everyone should have been at the table in the beginning--in reality I think it was one of the reasons that this was able to be successful."

Even with that strategy, it was not a simple task to get each set of stakeholders to agree on individual measures, he says, as predictably each person came in with his or her own set of biases. Upping the stakes, of course, was the fact that many quality measurements are tied to some form of payment or incentive program.

"There was some give and take--it took a little while for everybody to get comfortable that this was the right thing to do, but we got there," Baskin says. "We didn't agree on everything, but we eventually agreed that what we agreed on was valuable."

The other primary reason why this recent effort produced results was thanks to the rise of concepts such as value-based care, bundled payments and accountable care organizations, all of which all require better quality measurement, according to Baskin. "Everyone was already coming to the table saying, 'we know quality measurement has to happen, it's the right thing to do,'" he says. "So there was more of an impetus and motivation for everybody to be at the table and get this worked out than I think there ever was in the past."

Not only do the currently disorganized array of payer quality measures burden providers, they're also problematic for insurers themselves, he adds, as they make working with physicians and hospitals to measure care quality more complicated.

But while the introduction of core measure sets is a positive step, it's by no means the end of the process. There are many specialty practice areas that still need their own quality benchmarks, and as more measures are developed for sets that are presently "perhaps too small," those will need to be added to the current sets, Baskin says.

Plus, he adds, "over time, the evidence-based guidelines will change and measures will have to change with them, so there will always be an updating process that has to occur."

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