GSK Public Policy Brief - Quality

GSK U.S.
Public Policy Brief

Promoting Healthcare Quality: Critically
Important to Patient-Centered Reforms
Despite an increased focus on improving the quality of care in the U.S., our nation’s healthcare system often
remains fractured with misaligned payment systems, a lack of information and transparency, and gaps in care
delivery. The healthcare marketplace traditionally has rewarded our providers for the volume of care they
deliver and even though utilization of healthcare is high, there are significant differences between the
healthcare that should be received and the healthcare actually received. Those gaps result in increased
i
costs, and in some cases, harm to patients.
Provisions in the Affordable Care Act (ACA) are facilitating a shift from volume of services provided to the
value of services provided by linking provider and physician payment to outcomes, implementing payment
models that require providers to carry greater risk for patient care, encouraging care transitions and
ii
coordination across care settings, and testing new payment and delivery models as a means to lower
overall healthcare costs and improve patient safety and quality of care. As these changes take place, a
patient-centered approach to improving healthcare quality is critically important to transform our health
system.
Defining Quality
The Institute of Medicine
In a series of consensus reports, the Institute of Medicine (IOM) has helped
define the healthcare quality gaps and establish a common definition of defines healthcare quality
quality. The IOM defines healthcare quality as “the degree to which health as “the degree to which
services for individuals and populations increase the likelihood of desired health services for
iii
health outcomes and are consistent with current professional knowledge.” individuals and
Working from this common understanding of quality, experts have developed populations increase the
hundreds of quality measures in use today and continue to develop and refine likelihood of desired health
new ones. outcomes and are
consistent with current
Enhancing Quality professional knowledge.”iii
Healthcare reforms aimed at enhancing quality are closely linked with
improving the way healthcare delivery is structured and paid for in the U.S.
The ACA, for example, included:
 establishing a National Quality Strategy,
 setting quality benchmarks and allowing additional payments for providers achieving them,
 allowing penalties for providers with indications of lower quality, and
 increasing transparency on the quality of care provided by specific hospitals, physicians, and
other providers as well as health plans to help them make better informed decisions about the
care they deliver.
The National Quality Strategy released in 2011 focuses on better care, better health, and
lower costs with six priorities for improving quality:
 Making care safer by reducing harm caused in the delivery of care
 Ensuring that each person and family are engaged as partners in their care
 Promoting effective communication and coordination of care
A Publication of GSK Public Policy and Government Relations

(continued from front)
 Promoting the most effective prevention and treatment practices for the leading causes of
mortality, starting with cardiovascular disease
 Working with communities to promote wide use of best practices to enable healthy living
 Making quality care more affordable for individuals, families, employers, and
governments by developing and spreading new health care
delivery models
The trends of linking quality of care to reimbursement and using quality In a landmark report, “Crossing the
information to inform patient choices will continue to grow as they are Quality Chasm: A New Health System
critically important to assuring that healthcare reforms preserve and for the 21st Century,” the Institute of
enhance the quality of health care. Medicine documented the significant
gaps in the quality of care in the United
Measuring Quality States and proposed ways to address
The three basic types of quality measures capture different things: them. Specifically, the consensus report
 Structure - Does a provider have the tools to provide quality care? recommends that the U.S. health care
 Process - Did a provider follow care recommendations? system be aligned to deliver care
 Outcomes - Did health outcomes improve? meeting six aims critical to quality
improvements. Care should be:
For example, measures for a doctor treating patients for asthma may
include: using electronic medical records (structure), putting an asthma 1. Safe – avoiding injuries to patients from
control plan in place (process), and helping patients achieve specific
the care that is intended to help them.
asthma management goals (outcomes).
2. Effective – providing services based
on scientific knowledge to all who could
Public Policy Implications benefit and refraining from providing
 Evidence-based cost and quality measures will help the healthcare services to those not likely to benefit.
system evolve from one rewarded for the volume of services to one 3. Patient-centered – providing care that
promoting the value of services. is respectful of and responsive to
 Because medical advances occur rapidly, quality measures need to be individual patient preferences, needs,
updated regularly to reflect the latest medical knowledge. Continuous and values.
reassessment is required to avoid penalizing early adopters of care 4. Timely – reducing waits and
improvement and to facilitate medical innovations. sometimes harmful delays for both
those who receive and who deliver
Public Policy Opportunities care.
 Encourage adoption of evidence-based measures endorsed through a 5. Efficient – avoiding waste, including
transparent multi-stakeholder process (e.g., National Quality Forum) waste of equipment, supplies, ideas,
 Encourage the adoption of outcomes based measures that improve and energy.
patient health 6. Equitable – providing care that does
 Encourage regular updates to reflect the latest medical knowledge, not vary in quality because of personal
clinical guidelines, and innovation characteristics.
 Encourage the development and adoption of measures from prevention
through diagnosis, treatment, hospitalization, and maintenance of IOM, “Crossing the Quality Chasm: A New
st
Health System for the 21 Century,” (2001).
chronic disease
i
Institute of Medicine, “Crossing the Quality Chasm: A New Health System for the 21st
Century,” National Academies Press 2001. Available online at http://books.nap.edu/openbook.php?record_id=10027.
ii
Patient Protection and Affordable Care Act, P.L. 111-148 §124 (2010).
iii
Institute of Medicine, “Crossing the Quality Chasm: The IOM Health Care Quality Initiative,” Announcement. Available online at
http://www.iom.edu/Global/News%20Announcements/Crossing-the-Quality-Chasm-The-IOM-Health-Care-Quality-Initiative.aspx.
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GSK U.S.

Public Policy Brief

A Publication of GSK Public Policy and Government Relations

A Publication of GSK Public Policy and Government Relations

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