If your healthcare provider got a report card, what would it say?
Beatriz Coningham from the National Committee on Quality Assurance has the information at her fingertips, but do the decision makers in your Human Resources department?
In the most recent Healthcare Simplified episode we interviewed Beatriz, who is the NCQA’s Assistant Vice President of Human Resources. NCQA’s mission is to improve healthcare by measuring quality.
Here are the highlights from that interview.
Balancing Quality versus Affordability
When Beatriz selects a healthcare plan for her company’s employees, just like other companies, she looks for a combination of qualities. It is a balancing act between quality of care and affordability.
Beatriz looks for healthcare plans and providers that have gained and maintained accreditation through NCQA. NCQA uses a data-based grading system that helps CFOs and HR managers make informed decisions about the best performing healthcare options and providers for their employees.
Whose Report Card is the Best?
With all that data and all those report cards at her fingertips, one of the first questions we asked Beatriz is about what type of healthcare plan or strategy is the leader of the class with the best scoring report card.
When we look at the results, there is a strategy that stands out called the Patient Centered Medical Home. PCMH care is a model in which integration of healthcare is key. Integration of data. Integration of scheduling. Integration of prescriptions and treatments.
In PCMH models, a General Practitioner acts as a first contact for the patient and works to connect them to other providers as needed. But the main differentiator of this mode of care is that all the data is connected and integrated in a centralized matter. Everyone looking after a patient can see all the data on vaccinations, on visits, on prescriptions, on treatments—the entire team working with the patient sees all the same data.
It’s an integrated care approach and the research shows that this approach is more effective at reducing cost and providing value for the patient. Beatriz herself is enrolled in a PCMH home plan for this reason.
How do you grade?
NCQA believes strongly that measurement, combined with transparency and accountability, improves quality. But what exactly are they measuring?
Through the data NCQA receives in the accreditation and recognition programs and other measured reporting data that are collected, they produce a report card that shows the key measures they feel are essential for quality.
NCQA’s evaluation process is complex, but these are the top level priorities that contribute most directly to the quality of care.
Access and service. This means how easy it is to access care when needed and the quality of customer service received.
Qualifications of providers. This means checking that all the providers are properly trained and licensed for the care that they are providing and that patients are satisfied with the care received.
Staying healthy. NCQA looks at how successful the program is at helping to prevent sickness and maintain health.
Major Treatment Programs. NCQA looks at specific treatments and processes for chronic diseases such as heart disease and diabetes and evaluate whether these processes follow established standards.
Chronic Disease Care. NCQA looks specifically at the quality of treatment and service for patients who must live with chronic diseases.
What about the tough subjects?
We also spoke with Beatriz about some of the most difficult problems facing the healthcare system today, such as obesity and addiction which are huge drivers of rising costs.
Most of these types of diseases are usually approached from the prevention side or from an angle of promoting wellness.
Beatriz sees that most of what is being done now in the way of prevention and wellness is little more than a communication effort in which employers and providers focus on providing informational resources, but the takers are very limited and so are the results.
In a few cases businesses are trying models of rewarding those who engage in behaviors that promote health, such as joining a gym, there is little data behind these attempts at this point.
We need more science and behavioral economics applied to health and lifestyle decisions. We need to go deeper to understand how people make decisions to drive their health. Then we can use this information to design health benefits.
Beatriz and her team are finding success in providing great and affordable healthcare to their employees as well as working to provide all of us the information we need to make informed choices for ourselves and our employees.
The more difficult challenge is getting patients to engage in their own health and to see themselves as a part of their own healthcare system.
When the patient is more engaged and sees themselves as part of the healthcare process they are more mindful of their decisions. But we must find ways to overcome the barriers to engagement.
One way to be engaged is to access the resources available from NCQA. You can find the report cards at NCQA.org or you can call their customer support number: 888-275-7585 and associates can help you find answers and resources for the questions you are interested in.
This post is based on an interview with Beatriz Coningham from the NCQA for The Healthcare Simplified podcast.