Feds’ National Quality Strategy: Improving the Quality of Quality Improvement

By Scott Harris

Suffering from quality campaign fatigue? You can’t be alone. For whatever reason, sweeping, splashy initiatives are common in the quality improvement arena. All have noble intentions, but it can be hard to tell where rhetoric ends and results begin, particularly on a topic like quality improvement, where change literally spreads on a person-to-person level.

The United States Department of Health and Human Services (HHS) has its own entry: the National Quality Strategy. But a new progress report from the department aims to demonstrate how this federal campaign, mandated by the Affordable Care Act and established in 2011, has more teeth than the average iteration.

“There are a plethora of initiatives and measures, but not necessarily a coherent framework,” said Nancy Wilson, M.D., M.P.H., of the Agency for Healthcare Research and Quality (AHRQ), which is helping to lead the strategy. “This will provide that framework, and a focused alignment around measurement and payment reform. It should simplify the life of providers.”

Wilson and others guiding the strategy are looking to state agencies and private payers, as well as fellow federal entities, to develop national consensus around things like clinical measures, data sources, and data collection procedures.

“The strategy itself serves as a framework for quality measurement, measure development, and analysis of where everyone can do more, including across HHS agencies and programs as well as in the private sector,” stated the progress report, released in late April. “In the past year, HHS has also adopted a more transparent process for selecting quality measures for new and existing programs.”

In other words, the federal government is trying to figure out what the health care system should monitor, how providers should monitor it, and how to bake the results into practice and reimbursement. Even more simply put, the end goal is improving the quality of quality improvement.

“What measures do we use for blood pressure control, and can we agree on one? We want to be aligned and parsimonious around our measures,” Wilson said. “We want to keep our compass pointed toward the evidence.”

The strategy also has established a “pre-rulemaking” process, through which HHS will publish a list each December of new measures under consideration.

Of course, any campaign that unspools beneath the auspices of the federal government has one key advantage going for it: payment. According to Wilson, the National Quality Strategy will directly inform payment decisions across the HHS portfolio, including not only Medicare and Medicaid but the Center for Medicare and Medicaid Innovation, the Health Resources and Services Administration, and the “meaningful use” health IT regulations. Indirectly, states and the private sector can pick up the new standards, and several are already doing so, according to the progress report.

“HHS has developed a checklist for use in the review of proposed activities to ensure that all new initiatives align with National Quality Strategy priorities,” the report stated. “The National Quality Strategy has led to collaboration with state partners and has spurred state efforts to redesign their quality improvement efforts.”

Moving forward, the strategy will set targets for success on a greater number of measures and expand into areas like care coordination.

Wilson said the National Quality Strategy will likely not be affected if the health care reform law is overturned by the Supreme Court.

“This is full steam ahead,” she said. “The strategy has been embraced. These are principles that transcend legislation. Hopefully.”