Quality Measures

Overview

The Washington Healthcare Forum (the Forum) is a coalition of health plans, physicians, hospitals, and purchasers that has been working to improve the health care system. Our mission is two-fold: to streamline and simplify the financing and delivery system and to advance a public dialogue on sustainable solutions to the various challenges the health care system faces.

Tackling Quality Improvement

We know what high quality patient care looks like and we’re working to make sure every Washington state resident receives that care. We are collaborating with health care organizations across the state to spread the use of proven health care practices.

The Problem

• Many local and national organizations use different systems for measuring quality.
• While all of these local and national quality initiatives are well intentioned, inconsistent approaches can make it difficult for doctors and hospitals to improve quality.
• These different approaches also make it confusing for patients to interpret quality scores and compare quality between providers.

Our Solution

Our goal is to improve care for patients by agreeing where possible on the clinical measures that health plans would use to measure hospital and physician performance. We’ve developed a starter set of clinical measures for both the hospital and ambulatory setting.

 

Ambulatory Measures

After developing the ambulatory guidelines in 2005, we shared them with the Puget Sound Health Alliance for implementation. And the Forum’s Chronic Care Workgroup continues to work closely with the Alliance to identify additional measures that make sense for our community.

» click here to view our Ambulatory Measures

 

Hospital Measures

For the hospital setting, four leading health plans — Aetna, Group Health Cooperative, Premera Blue Cross and Regence BlueShield — commit to use either the measures or a subset of the measures if they provide individual hospital reports. While supporting efforts to develop uniform measures, health plans and hospitals may add additional metrics that are needed to meet the requirements of other entities or programs such as national organizations, national associations, government agencies, purchasers or incentive plans. While the hospital workgroup does not control individual health plan decisions, the health plans agreed to discuss any new metrics they plan to adopt in a timely manner with the hospital workgroup.

In the beginning of 2007, we again shared our work with the Puget Sound Health Alliance, which will incorporate these measures as part of their public report cards.This standardization using evidence-based measures, should improve care across the state.

» click here to view our Hospital Measures

Background On Our Process

We convened a steering committee to oversee the process and two workgroups, one for ambulatory care and the other for hospital care. The workgroups included quality experts from across the state.

• We developed the following guiding principles to identify our ambulatory measures:
  • Use measures developed by national stakeholders
  • Minimally intrusive and supported by claims-based data
  • Peer reviewed and evidence-based
  • Collaborate with other statewide efforts, such as Puget Sound Health Alliance and Washington State Medical Association
    
    
• We developed the following guiding principles to identify our hospital measures:
  • Strong evidence-based with risk adjustment if appropriate
  • Prioritized based on the strength of evidence
  • Consistent with national standards such as those used by the National Quality Forum, Centers for Medicare & Medicaid Services, Agency for Healthcare Research and Quality, and Joint Commission on Accreditation of Healthcare Organizations
  • Available either through claims data or through medical records but making sure the data request does not require additional extraction efforts
  • Includes process and outcomes measures

Next Steps

• We plan to communicate widely with health industry and government leaders regarding the standardization and quality improvement process.
• We will invite additional health plans to adopt our starter set.
• We will continue to collaborate closely with the Puget Sound Health Alliance.

Additional information on our Quality Measures can be found here:

» Ambulatory Measures

» Hospital Measures