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NCQA to Test Pioneering Way to Measure Quality, Foster Wider Use of Prevention Strategies

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The National Committee for Quality Assurance (NCQA) and the Robert Wood Johnson Foundation (RWJF) recently announced a new approach to measuring quality that will provide a more sensitive gauge of risk factors and make it possible to create clinically meaningful incentives for providers to improve disease prevention.

Under a grant from RWJF, NCQA will evaluate a new measurement tool that focuses on improving the health outcomes of patients with heart disease and diabetes. The “Global Cardiovascular Risk” (GCVR) score, which is being co-developed by NCQA and Archimedes, Inc., is the “next generation” quality improvement tool that measures how well providers reduce the risk of future adverse outcomes—such as heart attacks, strokes, and diabetic complications—in the populations they serve. GCVR is also a powerful new use of electronic health records (EHRs), drawing upon clinical information from EHRs to provide the data needed to assess improvement in preventing bad outcomes.

“This new tool has the potential to become the first customized, outcomes-based electronic health record measure used by Medicare and commercial payers,” says NCQA President Margaret E. O’Kane. “Its widespread adoption could have a profound impact on health care costs because it assesses how well providers engage in prevention and goal-setting for their high-risk patients. We believe it could become the new gold standard of quality measurement, replacing some traditional measures that have been the cornerstone of quality improvement for years.”

The traditional approach to quality measurement focuses on processes of care, and reaching clinically artificial treatment goals for biomarkers, rather than the actual disease outcomes. Traditional approaches provide little quantitative information about the outcomes that actually occur based on the care patients receive. In contrast, the GCVR measures how much patients’ risk of future adverse health outcomes have been reduced. Unlike current measures, which focus on a particular process or biomarker, the GCVR measure is a single metric that captures what every provider can do to prevent adverse outcomes, all integrated in a medically and clinically realistic way.

Under the project, NCQA will:

  • Evaluate the feasibility of collecting data from EHRs to calculate a measurable result for different providers and provider organizations; and
  • Evaluate provider views on how useful and meaningful the GCVR score is for predicting risk.

“The GCVR program will change how providers, patients, and payers think about the measurement of quality and will provide much more accurate and effective incentives for preventing adverse outcomes than has been possible in the past,” says David Eddy, MD, PhD, founder of Archimedes Inc., a San Francisco-based healthcare modeling company. “Preventing bad outcomes is the ultimate purpose of the health care system, and this measure will directly address that goal,” he says. “And because bad outcomes cause expensive admissions, tests, and procedures, this new measure will be more effective in controlling costs, at the same time that it helps improve patients’ lives.”

“The GCVR is a game-changer for measuring quality, promoting prevention, and assessing the impact of health care decisions on patient outcomes,” says RWJF President and CEO Risa Lavizzo-Mourey, MD. “Measuring quality in this way could have major implications for improving patient care and lowering costs because this is focused on preventing adverse health outcomes, not just on care processes or goals, which has been the standard until now.”

Over the next 18 months, NCQA will evaluate the feasibility of extracting the electronic health data it needs to calculate the measure from a number of health systems and health plans that use EHRs from around the country. It is now in the process of recruiting organizations to participate. The data collection and analysis will occur over the summer and fall of 2013, and NCQA expects to report findings by summer 2014.

Watch the video A Pioneering Way to Measure Health Care Quality in which Helen Darling of The National Business Group on Health discusses how the GCVR will benefit employers.

Source: Robert Wood Johnson Foundation