In accordance with the Patient Protection and Affordable Care Act, the Secretary of the United States Department of Health and Human Services (the “Department”) issued its report to Congress on the National Strategy for Quality Improvement in Health Care on March 21, 2011 (“National Quality Strategy”). The Department will use the National Quality Strategy to develop programs, regulations, new initiatives, and tools for evaluating the Federal health care efforts.
The National Quality Strategy is based on three (3) broad national aims:
- Better care by making healthcare more patient-centered, reliable, accessible, and safe;
- Healthy people/healthy communities by improving the health of the U. S. population with supportive proven interventions to address behavior, social, and environmental determinants of health in addition to delivering higher-quality care;
- Affordable care by reducing the cost of quality healthcare for individuals, families, employers, and government.
The National Quality Strategy sets forth six (6) priorities which were developed from research and input from more than 300 different types of stakeholders from the health care industry. The six priorities are:
- Making care safer by reducing harm caused in the delivery of care;
- Insuring that each person and family is engaged as partners in their care;
- Promoting effective communication and coordination of care;
- Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease;
- Working with communities to promote the wide use of best practices to enable healthy living; and
- Making quality care more affordable for individuals, families, employers, and governments by developing and spreading new healthcare delivery models.
The National Quality Strategy is designed to be updated annually by the Agency for Healthcare Research and Quality based on information from providers and communities that deliver high quality, affordable care. The National Quality Strategy is designed to be a “broad roadmap” and does not include in the “first-year Strategy” any agency-specific plans, goals, benchmarks, or standardized quality metrics even though such details are required by the Affordable Care Act. Instead, these types of details will be developed with additional collaboration and engagement of participating agencies and private sector consultation. The 2012 report to Congress on the National Quality Strategy will include additional detail on how the federal agencies will address the priorities and goals in “agency-specific strategic plans.”
The 2011 report to Congress did identify 10 principles to be used when designing specific initiatives to achieve the National Quality Strategy’s three aims:
- Payment arrangements to offer incentives that foster better health, promote quality improvement and greater value while creating an environment that fosters innovation. The report anticipates that new payment incentives and delivery models will be launched under Medicare and Medicaid.
- Public reporting to offer consumers and payers the ability to compare costs, review treatment outcomes, assess patient satisfaction, hold providers accountable. The report refers to www.healthcare.gov website as an example of improvements to transparency.
- Quality Improvement/Technical Assistance such as the use of quality improvement organizations (“QIOs”) that work with physicians, hospitals and others to “disseminate research evidence to the point of care, share best practices and technical assistance.” The report indicates that the Department is contracting with QIOs to “drive quality improvement through collaboratives at the State level.”
- Certification, accreditation, and regulation by State, Federal, or federally-approved accrediting organization in order for consumers to know that a clinician or organization meets certain quality standards for health services. An example given in the report is that provider participation in public programs will be conditioned on “more rigorous screening” to ensure that providers meet “appropriate standards.”
- Consumer incentives and benefit designs to promote better health such as financial assistance for tobacco cessation programs and “value-based insurance” to incentivize consumers to choose high quality, efficient providers.
- Measurement of care processes and outcomes using consistent, nationally-endorsed measures to provide timely, actionable, and meaningful information. The Department will develop ways to align measurement efforts with “value-based purchasing programs” with a move toward outcomes and patient experience.
- Increased use of electronic records in order to cut health care costs, reduce paperwork, improve outcomes, and give patients more control over their healthcare. The report references the substantial financial incentives for the adoption and meaningful use of certified electronic health record technology provided for the by the 2009 HITECH Act and the efforts of the Office of the National Coordinator for Health Information Technology on engaging the private sector to make health information exchange a reality.
- Timely evaluation and feedback to providers to improve through the use of new innovations in delivery and payment such as private patient safety organizations (“PSOs”).
- Training, professional certifications, and workforce and capacity development to provide for quality improvement and a new generation of health care professionals. The report makes reference to the $1.5 billion over 5 years to expand the National Health Service Corps (“NHSC”) in addition to the $300 million investment already made by the 2009 American Recovery and Reinvestment Act. The NHSC provides physicians, nurse practitioners, physician assistants, and other health professionals with loan repayment and scholarships who work in underserved communities.
- Promotion of innovation and rapid-cycle learning via the Center for Medicare and Medicaid Innovation, which supports new models of care and innovative practices for Medicare, Medicaid, and CHIP beneficiaries.
In 2011, the Federal Interagency Working Group on Health Care Quality comprised of senior-level members of Federal departments and agencies with jurisdiction over health care quality and improvement will begin working on disseminating strategies, goals, models, and timetables to advance the priorities outlined in the National Quality Strategy. A complete copy of the 2011 report to Congress on the National Quality Strategy can be found at www.healthcare.gov.