Quality and Efficiency Priorities
Identifying the most critical deficiencies in health care quality and efficiency will enable states to prioritize health system improvement efforts and target limited resources toward the most promising efforts and greatest needs.
*Milestone details:
*Full name: Identify priority areas for improving the quality and efficiency of the state’s health care system.
*Relevance to the ACA:
Identifying their priority areas for improvement enables states to be strategic when choosing among, targeting, or shaping the many quality and efficiency enhancing provisions in the ACA. Relevant provisions include:
§2801 - Requires the Medicaid and CHIP Payment Advisory Committee (MACPAC) to assess Medicaid and CHIP policies related to the quality of care, including determining the degree to which they achieve stated goals. States may find this information useful when selecting priority areas.
§3021 - Establishes the Center for Medicare and Medicaid Innovation to test and provide funding for innovative payment and service delivery models to reduce program expenditures while preserving or enhancing the quality of care with preference to models that also improve the coordination, quality, and efficiency of health care services.
§3501 - Requires the Center for Quality Improvement and Patient Safety to support research on health care delivery system improvement and the development of tools to facilitate adoption of best practices that improve the quality, safety, and efficiency of health care delivery including the funding of State, multi-State or multi-site quality improvement networks.
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District of Columbia
HHS engaged the multi-stakeholder Measure Applications Partnership to develop a national measurement strategy for the dual eligible beneficiary population, as detailed in this final report. MAP's vision for high-quality care seeks to address the fragmented and episodic nature of the care the dual eligible population receives. MAP identified high-leverage opportunities for quality improvement through measurement and a set of specific measures that address the priorities. States, health plans, advocates, and others are encouraged to consult this strategy.
District of Columbia
MAP's final report on quality measurement in the dual eligible beneficiary population is available here as well as on NQF's website.
Missouri
Missouri Foundation for Health created this report to propose several ways policymakers and health care providers can get a handle on rising costs while improving the care patients receive.
District of Columbia
State Refor(u)m user Logan Grant has shared Tennessee's Patient Safety and Quality Improvement Act of 2011. The legislation expands protections for provider quality improvement committees (QICs), and imposes limitations on admissibility of QIC-related materials in judicial/administrative proceedings.
Logan's comment is available here: http://www.statereforum.org/node/3744#comment-9100. The legislation is also available at left.
Colorado
Colorado Health Institute’s Amy Downs looks at what’s ahead for health reform in Colorado and why federally qualified health centers will play a major role. http://www.statereforum.org/states/co/milestone/108
Colorado
Colorado Health Institute’s Amy Downs looks at what’s ahead for health reform in Colorado and why federally qualified health centers will play a major role. http://coloradohealth.typepad.com/health_relay/2011/08/fqhcs-role-health...
Colorado
Colorado Health Institute’s Amy Downs looks at what’s ahead for health reform in Colorado and why federally qualified health centers will play a major role. http://coloradohealth.typepad.com/health_relay/2011/08/fqhcs-role-health...
District of Columbia
NCQA: the "Gold Standard" in Health Plan Accreditation is a new fact sheet, which outlines the rigorous components of NCQA's health plan Accreditation process for evaluating the quality of care and customer service that insurers provide.
NCQA is the only Accreditation offering performance based scoring, which requires plans to report both HEDIS clinical quality measures and CAHPS patient experience measures.
To learn more, contact NCQA’s Public Policy Department at 202-955-1709 or visit www.ncqa.org.
Maine
Those interested in this milestone may wish to view Pam Silberman's post available here: http://www.statereforum.org/node/6490#comment-8340
Michigan
Based on my studies, the current program in Michigan is extremely costly and ineffective. Many patients presenting to emergency rooms throughout the state are being "overtested" at a great expense to taxpayers. Doctors are performing these tests as "defensive medicine". They are afraid of being sued by savvy patients and those who know how to play the system.
Somehow, these excessive costs must be controlled. It would be difficult to classify certain conditions, as presented in an emergency room situation, as emergent or non-emergent. However, I firmly believe a sore foot or finger or a common cold do not qualify as an emergency.
The system itself is currently overrun with regulations, reduced payment to providers and an over-abundance of paperwork. Insurance companies now dictate who gets what treatment in a hospital, which hospital they may be admitted to, and which procedures and tests will be performed. This should be left up to the doctor or medical team at the treating hospital.
This, I believe, would save much money as it would cut down on expensive ambulance transfers, unnecessary tests, and would streamline processes.
Maine
I'm with NASHP, and I help moderate discussions on State Refor(u)m related to quality. Thanks for posting, Roger. I think reducing unnecessary ED utilization and the defensive medicine that you alluded to are key issues across the country. State Refor(u)m user Sarah Goodell uploaded some related documents here: http://www.statereforum.org/node/115. Do any State Refor(u)m users have relevant reports or analyses on this topic? Any public documents that show Michigan's work on this issue would be valuable for the community as well.
District of Columbia
Here is the website for New York's Medicaid Redesign program mentioned by Greg Allen, Director of Financial Planning and Policy for the New York State Department of Health on the State of Implementation Webinar. The Medicaid Redesign Team was tasked to find ways to reduce costs and increase quality and efficiency in the Medicaid program for the 2011-12 Fiscal Year. The link for the site is here: http://www.health.state.ny.us/health_care/medicaid/redesign/
Maine
Those interested in this milestone may wish to see Kentucky's application for a Medicaid Incentives for Prevention of Chronic Diseases grant. Please find that document at left. Kristina Hayden of Kentucky shared the grant and introduced it online here: http://www.statereforum.org/node/2903#comment-8031
Oklahoma
Community members who are interested in this milestone may wish to learn more about Oklahoma’s Patient Centered Medical Home program for SoonerCare members. To learn more, please follow this link:
http://www.statereforum.org/node/602#comment-7932
Massachusetts
In order to get a handle on our state’s health care costs, the Health Care Quality and Cost Council, a public entity responsible for setting quality and cost targets for the Commonwealth, issued the Roadmap to Cost Containment. The Roadmap outlines 11 key strategies to allow the Commonwealth to meet its goals of sustainably containing cost growth in health care as well as improving the quality of health care. The Roadmap states that all stakeholders in the Commonwealth must enact policies and changes to create a health care system that supports, encourages, rewards and augments health care system redesign and population health management in order to be successful and have the maximum impact on cost and quality.
Read the report at:
http://www.mass.gov/Ihqcc/docs/roadmap_to_cost_containment_nov-2009.pdf
Alaska
Please read with interest this Final Report from the Alaska Medicaid Task Force dated April 6, 2011. The focus of the task force was on cost savings and the report outlines eight options for doing so, in the areas of Patient-Centered Medical Home; Care Management; Increased Substitution to Generic Medication; Increased Generic Medication Utilization; Enhanced Preferred Drug List; State Maximum Allowable Cost (SMAC); Psychiatric Medication Policy and, Community First Choice (PCA)
District of Columbia
This report examines the impact of health reform on Rhode Island and makes recommendations on a number of topics, including: Exchanges, insurance, capacity, public health and delivery systems. Access the report here: http://www.statereforum.org/sites/default/files/healthy_ri_task_force_re...
District of Columbia
This presentation by the Oregon Health Authority outlines key action steps the state must take to implement its comprehensive health reform plan and includes elements of federal reform. Access it here: http://www.statereforum.org/sites/default/files/or_axn_plan_12.10.pdf
Maine
Those interested in Oregon's progress in this area may wish to see State Rep Mitch Greenlick's post here: http://www.statereforum.org/node/3422
District of Columbia
This document highlights research conducted for the state of Oregon through HRSA's State Health Access Program on six priority areas of health transformation identified by the state: 1) payment reform strategies, 2) integrated care organizations, 3) the post-2014 uninsured, 4) evidence of cost savings from reforms; 5) primary care medical homes, and 6) disparities.
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