By Jay Baker

Most quality reporting programs are implemented by a government-sponsored health care program. For example, under the Hospital Inpatient Quality Reporting Program, CMS collects quality data from hospitals paid under the Inpatient Prospective Payment System. The goal is to drive quality improvement through measurement and transparency by publicly displaying data to help consumers make more informed decisions about their health care. It is also intended to encourage hospitals and clinicians to improve the quality and cost of inpatient care.

The intent is to move away from a strict Fee-for-Service compensation model and tie the cost and quality of care to the payment model, creating an additional burden on the health care system to accurately document and report the results of quality measures.



The industry standard in quality reporting is the Healthcare Effectiveness Data and Information Set (HEDIS) that is administered by NCQA. HEDIS® quantifies measurement of performance for health plans, risk-bearing entities and providers. In reporting year 2018, NCQA has grouped the quality measures into the following categories: Effectiveness of Care, Access/Availability of Care, Experience of Care, Utilization and Risk-Adjusted Utilization, Relative Resource Use and Health Plan Descriptive Information.

HEDIS® measures results that are often tied to financial incentives, first, as a financial bonus or reduction in a capitated premium, and second, by directing or varying passive member enrollment to plans with more favorable quality outcomes.

Best practices: Strategies to improve quality measure reporting
The challenges in delivering quality care, documenting outcomes and accurately reporting them are systemic and not simply isolated to health plans or providers. Successful quality programs share key factors:

• Alignment of incentives and objectives between patients, providers, payers and the government
• Integrate risk assessment, care management, and quality reporting into a holistic care program not managed in silos or departments
• Deploy a technology infrastructure that supports an integrated program from start to finish and year-round

Aligning incentives and objectives
Solving the most common issues that impact quality reporting requires cooperation and active involvement from all stakeholders in the delivery of care. Health plans must understand and implement quality programs that satisfy government requirements, and engage both providers and members. To achieve this, providers need training and financial incentives to change their practices to deliver the desired quality outcomes, while members require information and relationships to ensure active participation in their care.

Average programs align some of these stakeholders but rarely include everyone. Many of the best quality programs utilize ongoing interventions that provide actionable information to providers and members when and where they need the information. They also encourage relationships and involvement in the care of members. The best quality insights programs include the entire care team for a member, including spouses, parents and/or children, and provide a complete care plan.

The main benefit of aligning incentives across stakeholders is that everyone is engaged and working toward similar outcomes. Generating awareness and obtaining buy-in, however, are the two most challenging objectives, but nevertheless essential for a successful quality program.

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