Marilyn Tavenner, Karen DeSalvo: Why healthcare needs standard care quality measures

For health plans, providers and consumers alike, the alignment of care quality measures across programs is a "critical" component of the transformation of the delivery system, healthcare leaders said Wednesday at the National Quality Forum's annual conference.

At the conference, America's Health Insurance Plans CEO Marilyn Tavenner and National Coordinator for Health IT Karen DeSalvo described their organizations' roles in the industry's ongoing effort to standardize care quality measures.

"I feel like I have been talking about quality for over 20 years," Tavenner (right) said, adding that "I think we can all agree that the measurement enterprise has matured significantly both in the development and in the implementation of new measures."

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But one of the unintended consequences of this progress has been variability in how measures are used and specified across public and private healthcare programs, she said, which has resulted in increased burden on providers and confusion for consumers.

"Letting a thousand flowers bloom is something that we started with, but we really have to start narrowing that down," DeSalvo (left) added in a subsequent session. At this point, she added, the complexity of the system has become unwieldy.

Tavenner noted there has been measureable progress in the effort to weed out duplicative and unnecessary measures, pointing out AHIP's work with the Centers for Medicare & Medicaid Services to develop the first core set of measures for use across the spectrum of payers.

While she's encouraged by that effort, Tavenner acknowledged that it is only the "first step in a long journey of transforming quality measures."

Even the first set of core measures must be phased in over a period of time, she said, given the need for better technology infrastructure--a need that requires a focus on interoperability of systems.

To that end, ONC has been able to secure a commitment across the public and private sectors to strive to give consumers more seamless access to their health information, avoid blocking data and start to compete within standards rather than between them--i.e. move away from proprietary standards, according to DeSalvo.

"We've basically all reached a point within the trajectory of health IT where we are recognizing that we need to put the consumer first," she said.

It is especially important to create and maintain a cohesive set of quality measures now that the healthcare industry is moving away from fee-for-service to value-based care, Tavenner added. 

But as alternative payment models evolve, Tavenner said, so too must the measures the industry uses. In particular, the industry must begin to focus more on patient-reported measures.

"Many of these measures that we've all worked on for the last 20 years were created to be used in a fee-for-service system," she said. "We will need new frameworks to measure quality under alternative payment systems rather than trying to retrofit existing measures into these models."

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