Category Archives: Quality Outcomes

Quality of care; pay for performance; quality-based reimbursement; case mix index; quality scores; quality report cards; data analytics; value-based purchasing; performance ratings; mortality rates; hospital report cards; POA; present-on-admission; HACs; hospital-acquired conditions; PPRs; potentially preventable readmissions; SOI; severity of illness; ROM; risk of mortality; healthcare reform; HealthGrades; P4P; potentially preventable complications; PPCs; state initiatives; federal funding

Care coordination and the community health worker (CHW) – The time has come

Improving care coordination for the sickest, most vulnerable and highest cost patient segments remains an important component of population health management and achieving the goals of the Triple Aim – better outcomes, lower costs and improved patient satisfaction. Yet, even as we acknowledge the importance of care coordination and devote considerable resources to this effort, the next question is whether these resources are being diverted to the right places to make a meaningful difference in health outcomes, cost and patient satisfaction. Continue reading

Working 22.6 hours a day: Alert fatigue, guidelines and “left of boom” opportunities in health care

Where do alerts fit in a physician’s 22.6 hour day?

When I’m travelling around the country interacting with healthcare leaders and health systems, I mostly see valiant efforts to improve outcomes through improved management of diseases. While improving disease management through guideline adherence is certainly a good thing, this is a problematic strategy given the current reality of our tools, the design of our workflow and our ability to recognize and address the multiple non-disease factors that weigh heavily on outcomes. Continue reading

Is the accountable care community the next evolution of the ACO?

The move to accountable care is ultimately about achieving better health outcomes at lower cost while creating a better experience for the patient. This is the Triple Aim. A narrow view of health focuses on health care, which is understandable in the United States, since a wide range of health-related expenditures are funneled through the medical system. The United States has long been the leader among industrialized countries in healthcare spending, while other nations have led in health outcomes, such as lower infant mortality rates, lower mortality amenable to health care and longer life expectancy. Continue reading

WIFM? Engaging physicians in quality outcomes improvement

WIFM (what’s in it for me) is a common question in health care. With too many patients and not enough hours in the day, compounded by requests for additional documentation regarding medical necessity/continued need for inpatient admission, quality outcomes data can quickly fall down to the bottom of the provider’s to-do list.

Let me be clear on one thing. Providers do care about quality data and how their care is perceived, some more than others. Asking any surgeon to comment on a potential complication is fairly easy. But providers need better, more detailed information about how quality beyond operative complications impacts them and their practice of medicine. What follows is a partial list of WIFMs for providers from a quality perspective: Continue reading

Why are we hoarding quality measures?

It’s hard to get rid of something you use but don’t like, even if it’s no longer practical. Things that are familiar have a lot of staying power. That may be why we can’t seem to shed ourselves of the suffocating layers of quality measures that have accumulated over the years.

There are over 4,600 healthcare quality measures and measure sets in the public repository set up by the National Quality Measures Clearinghouse. Granted, these measures represent all settings and aspects of care delivery and management. The numbers are still staggering: Continue reading

Social Determinants of Health- Are They Still Relevant?

What is the impact of the social determinants of health, such as income, education and occupation, as U.S. health care moves from volume to value-based care with a focus on population health management? Providers of health care have been well-trained to focus on the clinical manifestation and treatment of disease, but often struggle with the environmental and social context within which they occur. Continue reading

Half of Primary Care Physicians Think Quality Metrics Have a Negative Impact on Quality

In a Commonwealth Fund/Kaiser Family Foundation survey, 50 percent of PCPs report that quality metrics have a negative impact on their ability to provide quality care to their patients.i

Quality Metrics Chart

Click to Enlarge

If you spend any time in a primary care office practice this should come as no surprise. PCPs tend to be deeply dedicated to their patients and want very much to do the right thing. Continue reading

It’s Time to Redefine an Achievable Triple Aim

This blog offers further commentary on the excellent conversation that Paul Levy began in his column, “The Triple Aimers have Missed the Mark.” In his blog, he provides a succinct definition of the Triple Aim as “improving the individual experience of care; improving the health of populations; and reducing the per capita costs of care for populations.” Continue reading

The Logistics of Population Health Under the IHI Triple Aim

The Triple Aim is a construct developed to move past the trade-offs typical in health care improvement: improved quality at the expense of increased costs, decreased costs at the expense of quality or access, improved guideline adherence at the expense of patient experience of care, etc. The Triple Aim defines success as simultaneous improvement in population health and outcomes, patient experience of care, and cost trends. Continue reading

TMI: How Much Is Too Much Information?

We are in the midst of an information explosion in healthcare, which brings more responsibility to healthcare payers, providers, and patients themselves. Providers must be able to help patients distinguish between information that is useful for achieving important healthcare objectives, such as those espoused by the Triple Aim, and what is just noise. Continue reading