NCQA study to gauge provider success in hitting patients’ goals

The National Committee for Quality Assurance, which measures health plan performance data to enable comparisons between insurers and also supports other programs to improve healthcare processes, now wants to measure individual outcomes for older individuals with complex medical conditions.

In particular, NCQA will measure quality of care by evaluating how effectively healthcare providers or insurers are helping patients achieve the health goals that most matter to them.

For example, a grandmother may want to improve her health to the point where she can play with her grandchildren for two hours before taking a break, or babysit two days a week, or be able to engage in other activities that she’d like to do.

“We create quality measures and are trying to understand how to measure the quality of care for patients with multiple conditions, along with their social factors and the overall health goals they want to achieve,” says Erin Giovannetti, leader of the project at NCQA.

The three-year demonstration project, funded by the John A. Hartford Foundation and the SCAN Foundation, will include more than 800 participants with NCQA measuring patient-driven outcomes.



“Most everyone agrees that individuals’ priorities and health goals should guide their care,” says Margaret O’Kane, president at NCQA. “Are people more concerned about lowering their A1C levels or being able to walk to the corner market? Existing quality measures do not effectively evaluate what is most important to people, particularly older adults with complex needs, and we hope to change that.”

Four provider or payer organizations will participate in the program.

Priority Health in Grand Rapids, Mich., will engage patients with telephone visits from nurses or social workers. Community Health Plan of Washington in Seattle will use a combination of telephone or office visits with a nurse or social worker. And MedStar Good Samaritan Hospital Center for successful aging in Baltimore will engage using office visits with a physician, nurse, social worker, clinical pharmacist or occupational therapist, depending on a patient’s needs. Kaiser Permanente Northwest in Portland, Ore., which collected data via its electronic health record system, will conduct home visits.

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NCQA has developed a mechanism to collect person-driven outcomes that use a combination of individualized and standardized person-reported outcome measures to track goals over time. These measures will be used to demonstrate the importance, reliability, validity and usability of quality measures derived from use of person-driven outcomes.

In a NCQA pilot program, participating patients from Priority Health, Community Health Plan and MedStar are given an iPad to receive information on how to improve their care status, and they can enter data in the iPad to report and track outcomes measures and achieved goals over time.

NCQA is taking free text from the iPads and attaching structured data elements to analyze how well goals are being met, Giovannetti says. This is being aided by patients and doctors defining outcomes in four categories—better than expected, much better than expected, worse than expected and much worse than expected. Further, participating patients reported being more motivated to achieve their goals and providers learned from patients about new goals that they wanted to further improve wellness.

“By streamlining and focusing quality measures—and all of healthcare—on what truly matters to older adults living with complex conditions, we can achieve better outcomes and greater value for payers, providers, and older patients and their families,” says Terry Fulmer, president of the John A. Hartford Foundation.