the business case for quality: a cms perspective
DESCRIPTION
at the Institute for Quality in Laboratory Medicine, April 29, 2005. The Business Case for Quality: A CMS Perspective. Vision. The right care for every patient every time. What is the right care?. Safe Effective Efficient Patient-centered Timely Equitable - PowerPoint PPT PresentationTRANSCRIPT
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The Business Case for The Business Case for Quality: Quality: A CMS PerspectiveA CMS Perspective
at the Institute for Quality in Laboratory Medicine, April 29, 2005
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VisionVision
The right care for every patient every time
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What is the right care?What is the right care?
• Safe• Effective• Efficient• Patient-centered• Timely• Equitable
-- Crossing the Quality Chasm The Institute of Medicine
0
50
100
150
200
0% 100%LEVEL OF PERFORMANCE
NU
MBE
R O
F O
BSER
VATI
ON
S
1998-1999
2000-2001
2024-2025(Projection)
Pursuing Perfection in MedicareHospital and Office Care (all states, 24 measures)
2 0 2 4
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ScopeScope
• This vision is transformational, not incremental
• To serve Medicare and Medicaid we must transform the entire healthcare system.
• Transforming the system requires, in turn, transforming CMS, which is often a part of the problem as well as a part of the solution.
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Transformational strategiesTransformational strategies
• Work through partnerships• Publish quality measurements• Pay-for-performance/quality• Promote health information technology• Create and use evidence about
effectiveness
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Work through partnershipsWork through partnerships
Includes coordination • within CMS• across Federal agencies• between governmental and
nongovernmental partners.
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Publish quality measurementsPublish quality measurements
• Audiences are both professionals, providers, and purchasers and the beneficiary audience.
• We must drive out secrecy
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Pay-for-performance/qualityPay-for-performance/quality
Includes paying for
• prevention • disease management• patient-centered care.
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Promote health information Promote health information technologytechnology
Includes • standards development and
promotion• systems development • encouraging implementation• payment for HIT results
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Create and use evidence about Create and use evidence about effectivenesseffectiveness
CMS becomes part of post-marketing surveillance
When effectiveness is not absolutely clear, coverage may be conditional on registering data
At the same time coverage decisions become faster
PATI-ENT
SUPPORT
STANDARD
METHODS
PR
OM
OT
EP
AR
TN
ER
-S
HIP
S
PROVIDE
TECHNICAL
ASSISTANCE
LEAD
PROVIDEPUBLIC
INFORMATION
STRUCTURE
COVERAGE AND
PAYMENTS
RE
WA
RD
D
ES
IRE
D
PE
RF
OR
MA
NC
E
ESTABLISH &
ENFORCE
REQUIRE-
MENTS
The
Toolkit
1414The Management Framework
ADOPT OR DEVELOP MEASURES
SELECT PRIORITY AREAS
MANAGE PROCESS IN PARTNERSHIP WITH STAKEHOLDERS
COLLECT & ANALYZE DATA
ESTABLISH&
ENFORCE STANDARDS
STRUCTURE COVERAGE
AND PAYMENTS TO IMPROVE
CARE
SUPPORT STANDARD METHODS
GIVE CONSUMERS
INFOR-MATION
AND ASSISTANCE
TO MAKE CHOICES
PROMOTE OR CREATE
COLLABORA-TIONS ANDPARTNER-
SHIPS
GIVE PLANS,
DOCTORS&
PROVIDERS TECHNICAL
ASSISTANCE
REWARD DESIRED
PERFORM-ANCE
IDENTIFY IMPROVEMENT OPPORTUNITIES AND SELECT APPROPRIATE IMPROVEMENT INTERVENTIONS
CMS Quality Council Quality Coordination Team
Patient-Centered Care & Disparities Workgroup
Prevention Workgroup
RO-CO Collaboration Workgroup
Part D Workgroup
Long-Term Care Task Force
Medicaid-SCHIP Workgroup
Health Information Technology Workgroup
Council on Technology
and Innovation
Breakthrough Methods Workgroup
Cancer Care Task Force
Partnerships Workgroup
Measurement and P4P Workgroup
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What is the Business Case?What is the Business Case?
CMS believes that we can only keep Medicare and Medicaid solvent by focusing on effective care and eliminating ineffective care. Thus, for us, quality is a survival strategy.
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Hypothesis on Cost and QualityHypothesis on Cost and Quality
90 percent of the benefits of quality improvement will come from free or cost-saving changes.
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How can this be?How can this be?
• Most of the best-studied treatments with the best evidence that they are effective are also relatively inexpensive.
• The current payment system encourages procedures so strongly that a net increase in their use is rarely needed even when current use is not totally appropriate.
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Does Better Care Save Money?Does Better Care Save Money?
• Waste and rework are expensive.• In general, better outcomes reduce
downstream costs, although these savings often accrue to the insurer rather than the provider.