Q UALITY IN HEALTH C ARE What is it? How do we measure it? How do we know if we are providing quality?

NJ’s ACO – The Importance of Quality The NJ ACO law provides the opportunity to share savings In exchange, NJ ACOs have the responsibility to provide quality care Federal laws also require quality – Protect patients ability to access medically necessary care – Prevent providers from denying care to save money Important elements to protecting quality – Meaningful ways for patients to provide feedback – Consistent monitoring of care 2

What is it? Quality is the standard of care that should be provided to everyone Health Care Quality is anything that impacts: PROCESSES of care – how we give care OUTCOMES of care – the result of care EXPERIENCE of the patient – how they felt about how they were treated Quality looks at patient care processes, outcomes of care, and patient satisfaction with care delivery. Whose “QUALITY” are we concerned with? Coalition programs Services by ACO member providers in their offices 3

How do we measure it? We collect data and information on specific INDICATORS in each of these categories: PROCESSES of care OUTCOMES of care SATISFACTION with care 4

Example - Core Measures Core Measures demonstrate how often hospitals give recommended treatments known to get the best results for patients with certain medical conditions or surgical procedures. They are based on scientific evidence about treatments that are known to represent “best practices.” Information about these treatments are taken from the patients’ records and converted into a percentage. This is one way to compare the quality of care that hospitals give. The hospital Process of Care measures include: – Ten measures related to heart attack care (AMI) – Four measures related to heart failure care (HF) – Seven measures related to pneumonia care (Pneumonia) – Ten plus measures related to surgical care improvement project (SCIP) 5

How do we knowhow we’re doing? We collect data and compare how we are doing to reports on the same indicators from other organizations, and can therefore MEASURE our results to those of others – this process is called BENCHMARKING INTERNAL benchmarking – compare to our own past scores EXTERNAL benchmarking – compare ourselves to other, top-performers 6

Monitoring Quality How does a hospital monitor QUALITY and address issues? Quality committee – Includes doctors, nurses, program managers – Investigate issues – Determine appropriate response Corrective action concept Internal and external benchmarking 7