HCQ P THE HEALTH CARE QUALITY IMPROVEMENT PARTNERSHIP 1 The Business Case for Quality: A CMS Perspective at the Institute for Quality in Laboratory Medicine, April 29, 2005

HCQ P THE HEALTH CARE QUALITY IMPROVEMENT PARTNERSHIP 2Vision The right care for every patient every time

HCQ P THE HEALTH CARE QUALITY IMPROVEMENT PARTNERSHIP 3 What is the right care? Safe Effective Efficient Patient-centered Timely Equitable -- Crossing the Quality Chasm The Institute of Medicine

Pursuing Perfection in Medicare Hospital and Office Care (all states, 24 measures)

HCQ P THE HEALTH CARE QUALITY IMPROVEMENT PARTNERSHIP 6Scope 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.

HCQ P THE HEALTH CARE QUALITY IMPROVEMENT PARTNERSHIP 7 Transformational strategies Work through partnerships Publish quality measurements Pay-for-performance/quality Promote health information technology Create and use evidence about effectiveness

HCQ P THE HEALTH CARE QUALITY IMPROVEMENT PARTNERSHIP 8 Work through partnerships Includes coordination within CMS across Federal agencies between governmental and nongovernmental partners.

HCQ P THE HEALTH CARE QUALITY IMPROVEMENT PARTNERSHIP 9 Publish quality measurements Audiences are both professionals, providers, and purchasers and the beneficiary audience. We must drive out secrecy

HCQ P THE HEALTH CARE QUALITY IMPROVEMENT PARTNERSHIP 10Pay-for-performance/quality Includes paying for prevention disease management patient-centered care.

HCQ P THE HEALTH CARE QUALITY IMPROVEMENT PARTNERSHIP 11 Promote health information technology Includes standards development and promotion systems development encouraging implementation payment for HIT results

HCQ P THE HEALTH CARE QUALITY IMPROVEMENT PARTNERSHIP 12 Create and use evidence about effectiveness 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 PROMOTE PARTNER- SHIPS PROVIDE TECHNICAL ASSISTANCE LEAD PROVIDE PUBLIC INFORMATION STRUCTURE COVERAGE AND PAYMENTS REWARD DESIRED PERFORMANCE ESTABLISH & ENFORCE REQUIRE- MENTS The Toolkit

14 The 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 AND PARTNER- SHIPS GIVE PLANS, DOCTORS & PROVIDERS TECHNICAL ASSISTANCE REWARD DESIRED PERFORM- ANCE IDENTIFY IMPROVEMENT OPPORTUNITIES AND SELECT APPROPRIATE IMPROVEMENT INTERVENTIONS

HCQ P THE HEALTH CARE QUALITY IMPROVEMENT PARTNERSHIP 16 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.

HCQ P THE HEALTH CARE QUALITY IMPROVEMENT PARTNERSHIP 17 Hypothesis on Cost and Quality 90 percent of the benefits of quality improvement will come from free or cost- saving changes.

HCQ P THE HEALTH CARE QUALITY IMPROVEMENT PARTNERSHIP 18 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.

HCQ P THE HEALTH CARE QUALITY IMPROVEMENT PARTNERSHIP 19 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.