3 ways to align quality goals across payers

Different insurers define healthcare quality in different ways, so to accelerate the shift toward high-quality, high-value care, payers need to adopt common standards.

A new issue brief from the Center for Health Care Strategies and the Milbank Memorial Fund examines quality alignment strategies in Maine, Vermont and Wisconsin and found several keys to success.

1. Prominent leadership: Leadership and support from the state government will ensure commitment to the alignment process. Wisconsin's Statewide Value Committee (SVC), which aligns ambulatory and hospital performance measures across public and private payers in the state, is jointly staffed by the Wisconsin Department of Health Services and the Thedacare Center for Healthcare Value. It also has a leadership council for guidance and decision-making.

2. Multi-stakeholders: Quality alignment efforts require diverse stakeholders to encourage informed decision-making, according to the report. In Vermont, its Quality and Performance Measures Workgroup includes various stakeholders that range from providers, ACOs and state agencies to commercial payers and consumer advocacy organizations. The multi-stakeholder group holds monthly meetings on quality measurement activities.

Such multi-stakeholder collaboration can improve quality through lower readmission rates, according to a February report involving 67 executives from employer organizations, health plans, hospital systems and suppliers. That's because it fosters shared data, integrated care, employee engagement and economic sustainability, FierceHealthcare previously reported.

3. Data: To successfully align quality standards across public and private payers, there must be a foundation of solid technical information. With that in mind, Maine Quality Counts and Maine Health Management Coalition collaborate with the state's Medicare program on collecting, measuring and publicly reporting quality data.

Meanwhile, Wisconsin's SVC has put increased focus on enhancing its IT infrastructure for better data analysis. The report also cites evolving electronic medical records and health information exchanges offering new data to stakeholders about quality measures.

The report concludes that common quality standards have great potential to improve care because multiple payers and plans aligning their quality measurement goals allows providers to target improvement efforts and staff resources more effectively.

For more:
- here's the issue brief (.pdf)