Alliance Notes on Quality, 2017

Many feel that Quality as it applies to healthcare is a difficult thing to define. I favor the following definition from the Institute of Medicine (especially as it applies to a clinically integrated network like the Alliance dedicated to promoting Population Health): Quality is “The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.”

Not only is quality in healthcare difficult to define, it is difficult to measure and quantify. It reminds me of what Justice Potter Stewart said about pornography in the famous obscenity case of Jacobellis v.Ohio in 1964 when he commented that “hard-core pornography” was hard to define, but that “I know it when I see it”. Things like compassion, empathy and deductive reasoning are all important features in caring for patients but are very hard to measure. Our quality measures need to be discreet, quantifiable, relatively simple to measure and reproducible. GPRO (Group Practice Reporting Option) measures, which are a component of the MSSP (Medicare Shared Savings Program) which we have been participating in since 2015, meet these criteria. The following table documents our GPRO performance in both 2015 and 2016. The embargo on releasing this data to the public was recently lifted by CMS and, therefore, you are now free to discuss this excellent quality performance outside the confines of the Alliance. The “Status” column shows that 11 of the 18 measures were performance measures in 2016. 2015 was a reporting year only. “Statin Therapy” was not a reported measure in 2015. It is apparent that 11 of the measures improved year over year, some dramatically so (Fall Risk Screening, Composite Diabetes Score and Depression Screening). The only one that went down significantly was “Breast Cancer Screening” and this is only because CMS did not accept 3-D mammograms in 2016. 3-D mammography will be accepted as complying with the measure in 2017.

This improvement is a testament to the Alliance IT team which accurately quantified our performance, mined real-time data from our EMRs, reported this to you regularly throughout the year and instructed our practices on how best to comply with these measures. And, of course, it reflects our practices and providers having cooperated with our Alliance team in doing the work necessary and having documented it accurately in their EMRs. This bodes well for the future success of the Alliance; i.e. that we can identify opportunities for improvement, put together an appropriate plan and then put that plan into action. We have made a commitment to value-based care. As such, our payer partners will continue to monitor our performance to ensure that we are delivering more efficient care without compromising the quality of the care we deliver. Our quality performance to date is testimony to our capacity to do so.