About Health Care Quality Measures
Why do we need quality measures and greater transparency?
Today’s health care system generally pays for health care services based on the volume of services provided, with few incentives for quality or value. To the degree that financial incentives for quality exist today, they are relatively uncoordinated, which results in conflicting signals to health care providers from different payers about what the priority areas for quality improvement are.
There are often a number of slightly different ways to measure the same aspect of health care quality. Without coordination of quality measurement, the health care system incurs extra costs to measure and report on quality in different ways for different payers. This lack of coordination also makes it more difficult for consumers to understand and compare health care quality information.
What kind of measures are being developed?
The Commissioner of Health is charged with developing a standardized set of measures to assess health care quality, including measures related to health care homes. The quality measures must be based on medical evidence, must be developed through a process in which health care providers participate, and must be reviewed on at least an annual basis. In addition, the measures must:
- Include uniform definitions, measures and forms for submission of data, to the extent possible;
- Seek to avoid increasing the administrative burden on health care providers;
- Be initially based on existing quality indicators for physician and hospital services, which are measured and reported publicly by quality measurement organizations including, but not limited to, Minnesota Community Measurement and specialty societies;
- Place a priority on measures of health care outcomes rather than processes where possible;
- Incorporate measures for primary care, including preventive services, coronary artery and heart disease, diabetes, asthma, depression and other measures as determined by the Commissioner.
How will the measures be used?
Under the 2008 health reform law, a statewide system of quality-based incentive payments to health care providers will be established. These payments are sometimes also called “pay-for-performance” incentives. This system will be used by public and private health care purchasers. This more coordinated approach to measuring, reporting, and paying for health care quality will create stronger incentives for health care providers to improve quality and will put more useful and understandable information in the hands of Minnesota health care consumers.
The measures developed by the Commissioner of Health will be used to develop the system of quality incentive payments to health care providers, based upon achieving target levels of performance or based on improvement over time.
Using the measures, the Commissioner of Health is also charged with establishing a system for risk-adjusting quality measures and publishing annual reports on provider quality.
When will the new system take effect?
The payment system must be developed by July 1, 2009. Health plan companies are required to begin using the standardized quality measures by January 1, 2010, and health plans will no longer be able to require providers to use and report health plan-specific quality measures. By July 1, 2010, the incentive payment system must be implemented for participants in the state employee health plan and enrollees in state public insurance programs (in a manner consistent with other federal and state laws and regulations).
The annual reports on provider quality must be published beginning July 1, 2010. Physician clinics and hospitals must submit the necessary data on health care quality by January 1, 2010.