Health quality measures are good, but the sheer volume of uncoordinated measures is overwhelming clinicians, hindering the cause of improving care rather than helping it.
That’s the point Tom Daschle former Senate majority leader (D-S.D.), and Michael Leavitt, former governor of Utah and Department of Health and Human Services Secretary under George W. Bush, made at the National Quality Forum conference in Washington, D.C. on Feb. 14.
As opponents politically, at times, Daschle and Leavitt have the same goals in mind for healthcare: the transition to value-based care.
Until all the uncoordinated quality measures are narrowed down to the most important ones, and made uniform across all sectors of healthcare, the task of improving care will remain elusive, the two said during a panel discussion.
“The dilemma we are having in driving quality measurement is we are still trying to fuss with the little gears,” said Leavitt, now co-leader of the Nutrition and Physical Activity Initiative at the Bipartisan Policy Center. “We are going to have to discover the big gears and turn them. That’s all the consumer has interest in dealing with.”
An example of an effective big gear being used to measure healthcare quality today is the focus on readmission days. “As you spin this big gear, you will notice a lot of smaller gears also begin to spin,” he said.
Daschle, now special policy advisor to the law firm of Alston & Bird, hailed HITECH and the Affordable Care Act for laying down the important infrastructure for quality healthcare, but measurements are still in a state of chaos, he said.
In the 15 years since the launch of the NQF, healthcare quality measurement have become more confusing than ever. “It’s the Wild West of today,” he said.
Providers are subjected to too many measures, with some 1,367 for performance in use, all largely unaligned. Daschle predicts that as payment reform leans more and more toward value-based care “it could get even worse than it is today.”
By the same token, the state of chaos also provides an extraordinary opportunity to fix things, Daschle said. He would like to see the NQF become “the gold standard” of measures. Along with that, a dose of tough love and accepting that “you can’t please everyone all the time,” America could make some real headway, he said. “We might not be able to tame the Wild West, but we could bring some urgently needed law and order."
The two leaders agreed on the big gear theory and the need for taming chaotic measurements, but true to their political outlooks, they also diverged.
While Daschle was very optimistic about the infrastructure laid down by the ACA, Leavitt said America shouldn’t be so quick to attribute to the ACA too many changes to the U.S. healthcare system. Improvement is being brought about more by the will of the consumer.
America’s healthcare crisis is an economic crisis, Leavitt said. And he feels optimistic that that crisis will drive citizens to come up with a uniquely American solution to healthcare. “The economic pressure is driving people to do the hard things,” he said.
As far as the ACA goes, the country still needs to ask if it is working, and how it can be made better where it is not working. Those questions will move the U.S. to an entirely different level of reform discussions, Leavitt said, one focused on refinement, rather than repeal and replacement of the healthcare reform law.
Daschle, on the other hand, said the ACA is starting to turn the three big gears of insurance, payment and care delivery reform. The launch of the ACA has begun to bring insurance reform, he noted, and payment reform, still to come, will center on bundled payments, while care delivery will focus more on wellness care than it ever has before.
This story is based on a report appearing on Government Health IT.