What about quality? An interview with Peggy O'Kane
The National Committee for Quality Assurance is among the leading organizations in measuring health-care quality and developing systems and interventions to improve it across the system. On Thursday, it will release its latest State of Health-Care Quality report. Today, I spoke with Peggy O'Kane, president of the NCQA, about the report, and what it means for health-care reform.
What did your study find?
The short version is the level of improvement appears to be leveling off. Where we've seen tremendous improvement over the past 10 years, in the past year it's slowed down. We don't think we're sending a strong enough signal about the need to improve quality.
You said we've had huge improvements in the last 10 years. How did we attain them?
Purchasers asking for it. Some large Fortune 500 companies have had bonuses for health plans achieving certain quality targets. Health plans are a convenient entity to hold accountable.
What did the improvements look like?
If you look from 1996 to 2006, the percentage of patients receiving beta blockers after a heart attack went from 62 percent to 98 percent. The rate of having all the right immunizations at the right age tripled over 10 years. People are now following best standards for asthma practice at more than 90 percent. That's really great. It's been a thrill. It's disappointing to see this leveling off.
Has quality had a sufficient role in the health-care reform debate?
We've been very encouraged with the level of attention it's gotten. The hard part is keeping it in there now that everyone is horse trading and trying to dumb down requirements.
It's always seemed to me that quality doesn't get enough attention as a concrete benefit that reform can deliver. If I'm insured, and I'm now less likely to die from an unnecessary infection, or a medical error, that's a benefit for me. But it's not often talked about that way. You don't see people viewing increased quality as a deliverable.
Yeah, although we have a ways to go until we have real clarity on what we really want people to get from health care. There's a very good understanding among policy people that a lot of what we're paying for is not delivering benefits, and may even be putting patients at risk. But non-policy people tend to think more treatment is better. This is part of why health plans have such a black eye with the public. They say no to things that should be said no to. I'm not trying to defend the health plans, but that's one of the sides to this story. In a country where there's national health care, the country plays that role.
What are the three things you most want to see in the bill?
More funding for performance measurement. We're always robbing Peter to pay Paul to get the money to do it. There's money in the bill to fund people like us to do this kind of thing. There's good language on the exchanges that requires performance reporting on health-care quality, feedback from members on their experience with the plans, and standards for patient protection. And then there's payment reform. We need to use public policy to drive greater integration of care. We need to make delivery-system quality the worry of the people who are in it, not just the regulators who come around to look at it.
Why isn't it their concern already?
We currently have a fee-for-service system where you do better by doing more. For example, generating unnecessary visits, or doing procedures that don't need to be done. Think about the new technology available to us. You can do video visits now. Why would you do that? At Kaiser, they have capitated payments, so it makes sense. If you are in most of the system, you would lose money on that. Most of us would love to have our doctor answer our e-mails. But they don't do it because they get paid more for a visit.
Photo credit: NCQA.
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