Clinical Quality Measures: Certainty (& Solvency) In An Uncertain Reimbursement Environment

Clinical quality looks a little different inside of a community health center. How are CHC’s working to achieve their targets, what’s being measured, and what’s their relationship to the top-line?

What is now AllianceChicago originally came into being about twenty years ago. Founding members shared a common philosophy and a singular objective: To improve personal, community, and public health through innovative collaboration. The structural framework that we adopted was based upon the Heath Resources and Services Administration’s (HRSA) Health Center Controlled Network, which supported our mission and sharpened our focus on delivering high quality care to the most vulnerable populations.

As our network has continued to grow over the intervening years, so too has the volume of patients we serve. And with—or maybe in spite of—that growth, we’ve simultaneously tried to avoid compromise. We have remained steadfastly committed to the idea and practice of improving care. That hasn’t always been easy. Volume and value are often opposing forces when viewed in the context of a services organization. But we have found that these forces can be complementary, even catalysts for achieving positive outcomes “at scale.”

They key, for us, has been to provide our care teams with the tools they need to continuously monitor patient health and provider performance through the lens of clinical quality measures.

Measuring Clinical Quality

HRSA, like other federal agencies, has aligned its health center quality improvement initiatives with the National Quality Strategy published by the Agency for Healthcare Research and Quality. For health centers pursuing quality improvement, HRSA administers a host of programs, including funding, training, and data sharing. In addition to services, it also provides recognition to health centers meeting national quality standards through affiliations and partnerships with the Joint Commission and the National Committee for Quality Assurance. To help measure quality, and as a condition of grant funding, HRSA requires health centers to report their performance in a standardized fashion using the Uniform Data System, or UDS.

Performance measures defined by UDS include quality of care measures, which generally relate to intermediate outcomes (i.e. process measures). Examples include childhood immunizations, screenings and tests (e.g. colorectal cancer screening, mental health screening, etc.), as well as medication management such as lipid therapy to treat coronary artery disease patients. As was suggested above, and to support the consistent application of health policy, UDS measures have been aligned with the Centers for Medicare and Medicaid Services’ (CMS) e-CQMs.

Continuous improvement vis-à-vis the UDS measure set has been associated with good long-term outcomes and improved health status.

Relationship to Financial Performance

Despite the turbulence we’re observing in Congress, one constant of health policy has been the central focus on quality as the new index for benchmarking provider performance—and by extension, payment. The impact of this shift from pay-for-volume to pay-for-value isn’t limited to fee-for-service. It is being felt in federal Medicare and state Medicaid programs, as well. CMS has grown geometrically its initial short-list of innovation programs into a library of well-supported programs defined by physician specialty, patient cohorts, and financial incentives. And what’s sitting underneath the 20+ programs spread across 14 healthcare domains, including population/community health? CMS’ Quality Measures Inventory.

For its part, the National Association of Community Health Centers published a statement, which in part reads, “quality management is not only the ‘right thing to do’ for health centers and their patients, but also an important element of organizational survival – and thriving – in today’s dynamic health care environment.” CQMs are today (and will be tomorrow) the equation for gauging performance and determining reimbursement universally. To identify and select the CQMs that the Alliance prioritizes, we consider several criteria, including the epidemiological, demographic, and socio-economic characteristics of the communities we serve.

As I think about the future of healthcare delivery, I am encouraged by the bi-partisan commitment to fund healthcare innovation and address population health crises. At the AllianceChicago, I see care teams that are empowered to make encounter-room decisions with confidence because diagnosis and treatment options are informed by the latest medical evidence and available to our clinicians in their workflow and at the point of care. I see the informatics team monitoring health improvement in complex cohorts, making real-time adjustments to care plans to account for the confounding factors such as access to care, mental health, and literacy. I see the entire organization working as a team toward better clinical and financial outcomes, so that we can extend the reach of our work without sacrificing quality in the process.

It’s in this light that clinical quality measures are emerging as new currency of population health management. By putting health intelligence in the hands of those on the front-lines of care, we give our care teams the forward-looking radar they need to pre-empt unnecessary medical events, to improve the health of patients and the solvency of the community health centers that serve them.

Andrew Hamilton, RN, BSN, MS, is the Chief Informatics Officer & Deputy Director of AllianceChicago.

Information About Enli Solutions and Services:

Andrew Hamilton