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Putting Measurement to Work: Improving the Quality of Health Care Delivered to Adults

Can States Partner for Quality?

Presenters:

Dr. Antonio P. Linares, Medical Advisor, California Department of Managed Health Care.

Laurel B. Karabatsos, Quality Assurance Manager, Colorado Department of Health Care Policy and Financing.

Dr. W. Cyrus Jordan, Medical Director, Vermont Program for Quality in Health Care (VPQHC).

Dr. Mary Uyeda, Director of Health Information and Program Evaluation, Washington State Health Care Authority (HCA).


There are many stakeholders with whom policymakers can partner to measure and improve the care delivered to adults.

For example, Dr. Linares, Medical Advisor to California's Department of Managed Health Care, reported that his agency, which has regulatory authority over health plans, is charged with working toward an accountable and viable managed care delivery system that promotes healthier Californians. The agency works with stakeholders (health plans, providers, and consumers) to ensure high quality health care. The agency has, among other efforts, implemented an independent medical review that is available to all health plan enrollees. Information from these reviews is used to identify areas where more systemic changes may be needed.

Ms. Karabatsos, Quality Assurance Manager for Colorado's Medicaid program, reported that her agency partners with disability advocates, contracted plans, and providers to conduct quality improvement studies. Disability advocates help select the study topic, design the study, and conduct the study. Plans and providers also help design the study. Partnering not only improves the studies but also fosters communication and understanding between the advocates and providers. Colorado found that successful partnering with disability advocates required effort. Advocates may need:

  • Training on quality improvement concepts to be effective partners.
  • To clearly understand resource limits.
  • Support to attend meetings.
  • To see that their input is respected and used.

The Vermont legislature authorized the Vermont Program for Quality in Health Care (VPQHC), a non-profit organization, to build consensus and coordinate efforts to improve quality by involving all stakeholders in the State. Dr. Jordan, VPQHC's medical director, explained that payors, consumers, and providers work within the VPQHC to collaboratively select projects in which they will voluntarily participate to improve the delivery of care. One factor considered in project selection is how the project will be sustained after the coalition starts it.

The Washington State Health Care Authority (HCA) purchases health insurance for State employees among other groups. According to Dr. Mary Uyeda, HCA partners with consumers by providing information about plan performance so that consumers can choose the plan that offers the best value. Aspects of performance considered include:

  • Access, including network access and capacity, statewide coverage, and network stability and continuity.
  • Quality, including Health Plan Employer Data and Information Set (HEDIS) measures of clinical effectiveness, Consumer Assessment of Health Plans (CAHPS®) survey results, and results of TEAMonitor visits.
  • Affordability, including cost trends, employee contribution, plan bid rate, plan bid score, and demonstrated cost efficiency.

Dr. Uyeda anticipates that this partnership will become even more effective after HCA implements its electronic decision support tool that will help consumers select a plan based on plan performance, and will be linked to HCA's online enrollment system.


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