RESUMEN
The National Committee for Quality Assurance urges socioeconomic risk adjustment to payments, not quality measures.
Asunto(s)
Medicare Part C , Ajuste de Riesgo , Clase Social , Humanos , Garantía de la Calidad de Atención de Salud , Ajuste de Riesgo/métodos , Estados UnidosAsunto(s)
Diabetes Mellitus/sangre , Medicina Basada en la Evidencia , Hemoglobina Glucada/análisis , Guías de Práctica Clínica como Asunto , Indicadores de Calidad de la Atención de Salud/tendencias , Diabetes Mellitus/terapia , Humanos , Valores de Referencia , Factores de Tiempo , Estados Unidos , United States Agency for Healthcare Research and QualityRESUMEN
BACKGROUND: Pay for performance (P4P) initiatives are designed to foster and reward improvement in health care delivery. These programs promote "value-based health care" by rewarding quality care that is characterized by a reduced amount of disproportionate spending. OBJECTIVE: To review the intent and design of P4P initiatives as well as the design and results of P4P programs in current practice. SUMMARY: Three key principles are fundamental to building a value-based health care system: measurement, transparency, and accountability. There are several levers currently driving P4P, each influencing the movement in its own way. Among these are employers, federal agencies such as the Centers for Medicare & Medicaid Services and the Department of Health and Human Services, health plans, providers, accreditors, and Congress. One key player in the P4P movement, the National Committee for Quality Assurance (NCQA), is a private, independent nonprofit health care quality oversight organization that measures and reports on health care quality and unites diverse groups around a common goal: improving health care quality. NCQA, has demonstrated several successful provider-level measurement initiatives connected to P4P programs, notable among them Bridges to Excellence programs in several markets, physician recognition programs, the Integrated Healthcare Association's P4P initiative in California, the National Forum on Performance Benchmarking of Physician Offices and Organizations, and health plan accreditation. CONCLUSIONS: The initial data from developmental P4P programs across the nation have indicated that both financial and nonfinancial incentives motivate significant change in health care delivery, but the return on investment of these initiatives is not yet known.
Asunto(s)
Planes de Incentivos para los Médicos/economía , Garantía de la Calidad de Atención de Salud/métodos , Indicadores de Calidad de la Atención de Salud , Reembolso de Incentivo , Benchmarking , Humanos , Programas Controlados de Atención en Salud , Garantía de la Calidad de Atención de Salud/economía , Responsabilidad Social , Revelación de la Verdad , Estados UnidosRESUMEN
Higher spending does not buy higher quality care, but it often buys unnecessary care. Some remedies include: Eliminate unnecessary care. Provide consumers with reliable and accessible information about quality. Find new healthcare system financial incentives, such as pay for performance.
Asunto(s)
Administración Financiera de Hospitales , Calidad de la Atención de Salud , Costos y Análisis de Costo/métodos , Eficiencia Organizacional/economía , Humanos , Motivación , Estados UnidosRESUMEN
Accreditation has been widely used to promote accountability in healthcare. However, with the rise of both purchaser and consumer demand for broader and more detailed information on performance beyond licensure and professional self-regulation, especially at the provider level, the role of accreditation is less clear. We hypothesize that for accreditation to be a critical part of a market-driven, consumer-focused healthcare system, accrediting bodies must enlarge their scope of assessment with an emphasis on clinical performance of providers, revise and expand their level of reporting and transparency of assessment, and broaden the base of their governance. A new approach to accreditation could enhance accountability by (1) building on an existing framework and data-collection structure that are proven elements of quality assurance in multiple healthcare sectors; (2) expanding existing involvement of both public and private entities in the process; (3) building on existing linkages to professional and regulatory bodies; (4) providing greater flexibility, compared with regulation, in responding to change; and (5) having a defined source of funding. By these means, accrediting bodies will both improve accountability and successfully drive quality improvement.
Asunto(s)
Acreditación , Instituciones de Salud/normas , Responsabilidad Social , Garantía de la Calidad de Atención de Salud , Estados UnidosRESUMEN
There is growing evidence of a negative effect of the current American preoccupation with malpractice on efforts to reduce error, enhance safety, and improve other domains of quality. The use by some insurers of systems assessment and risk analysis programs, linked to rewards for performance--which, taken together, we term proactive risk management--offers an opportunity to enhance our focus on systems and to bring patient safety and malpractice risk reduction into close congruence with other quality improvement efforts. Given the increasing burden of malpractice, as well as the emerging concerns about patient safety, managed care organizations and their providers need to work together with malpractice insurers and quality improvement experts to refocus their efforts on creating systems improvement; driving measurement, analysis, and feedback; and developing incentives for performance that will align quality and risk management efforts and drive breakthroughs in quality, including patient safety.
Asunto(s)
Mala Praxis , Errores Médicos/prevención & control , Garantía de la Calidad de Atención de Salud/organización & administración , Administración de la Seguridad/organización & administración , Predicción , Política de Salud , Humanos , Errores Médicos/estadística & datos numéricos , National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division , Medición de Riesgo/organización & administración , Gestión de Riesgos/organización & administración , Análisis de Sistemas , Gestión de la Calidad Total/organización & administración , Estados UnidosAsunto(s)
Industrias/normas , Sistemas Multiinstitucionales/normas , Gestión de la Calidad Total/métodos , Planes de Asistencia Médica para Empleados/economía , Planes de Asistencia Médica para Empleados/normas , Promoción de la Salud , Humanos , Industrias/economía , Sistemas Multiinstitucionales/organización & administración , Cultura Organizacional , Objetivos Organizacionales , Desarrollo de Programa , Desarrollo de Personal , Estados UnidosAsunto(s)
Toma de Decisiones en la Organización , Planes de Asistencia Médica para Empleados , Programas Controlados de Atención en Salud , Acreditación , Recolección de Datos , Costos de Salud para el Patrón , Planes de Asistencia Médica para Empleados/economía , Planes de Asistencia Médica para Empleados/normas , Humanos , Programas Controlados de Atención en Salud/economía , Programas Controlados de Atención en Salud/normas , Calidad de la Atención de Salud , Estados UnidosRESUMEN
Information therapy, the theme of this issue, is fitting and timely because all of us who are dedicated to, or interested in, improving healthcare quality know that a good strong dose of information is what the healthcare system needs right about now. In an increasingly consumer-driven world, patients, of course, need to know more about how to best contribute to their own care; they need to know which providers are doing the right things consistently, and which health plans deliver the highest caliber of service. They need this information not only to help them self-manage chronic illnesses, but also to help them make educated choices about providers and plans.
Asunto(s)
Servicios de Información , Programas Controlados de Atención en Salud/organización & administración , Garantía de la Calidad de Atención de Salud/métodos , Humanos , Oregon , Participación del Paciente , AutocuidadoRESUMEN
This paper examines the interplay of professionalism, regulation, and the market in shaping accountability on the part of hospitals, physicians, and health plans. We pay particular attention to the role of accreditation. We review the development of accountability and examine its recent evolution in the context of changing information technology, consumer demands, the decline of the staff- and group-model HMO, and the reemergence of health care cost inflation. The market is emerging as the dominant influence on accountability; this development will require changes in the roles and structure of regulation, professionalism, and accreditation in assuring accountability.