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Field of Dreams: Driving Provider Clinical Quality Measures Through Patient Engagement

Driving healthier outcomes for your patient base, as well as improving quality measures tied to these outcomes, isn’t as simple as “if you deliver quality care, they will come.”

Why You Shouldn’t Listen to Kevin Costner

I suppose you could take that headline any number of ways. If you’re a purist, Costner’s Bull Durham and Field of Dreams are easily two of the best baseball movies ever made.  If you’re a big-time Hollywood investor, Costner’s Waterworld might make you think twice about believing in his ideas.

In Field of Dreams, novice Iowa farmer Ray Kinsella hears a voice that whispers, “If you build it, he will come,” and has a vision of a baseball diamond where his corn fields stand. He plows under his corn to build the field, and after a meandering cross-country journey involving James Earl Jones (playing a reclusive author) and near-bankruptcy, he eventually is reunited with the ghost of his estranged father on the baseball field and hundreds of paying customers come to see it.  Great movie.

Unfortunately, driving healthier outcomes for your patient base, as well as improving quality measures tied to these outcomes, isn’t as simple as “if you deliver quality care, they will come.”

Do you have a plan in place? 

Improving population health, increasing your patients’ compliance with screening and immunizations, reducing avoidable readmissions and enhancing care for the chronically ill require planning.  In fact, having a comprehensive, analytical strategy for targeting specific quality measures, rallying staff and engaging patients is essential under our emerging accountable care model. Through our team’s experience working with leading providers and population health management companies, we’ve defined eight imperatives for improving CQM performance – the first several of which center on the identification and prioritization of a manageable subset of measures.

Which measures are most prevalent?

There are more than a thousand quality measures in use across a variety of programs nationwide. It’s entirely possible that your organization may be subject to more than one hundred. To find focus, it’s fast becoming a best practice to identify measures (often through a “matrix” approach) that are most prevalent across the multiple “pay for quality” or accreditation programs in which you may be involved (e.g., Medicare ACO, Meaningful Use, IHA, Star, etc.), and therefore impact the largest percentage of patients. Once you’ve done this, you’ll be able to more easily identify a unique subset of CQMs that represent good opportunities for your organization to leverage resources and maximize incentives.

Where are the rewards?

Projecting the potential rewards of the various measures will help you further refine and prioritize your subset of measures. Each measure set has a different point system for evaluating performance and reward. It’s important to understand the nuance of each structure so you can make informed decisions. For example, within Medicare Pioneer and Shared Savings Programs, the Care Coordination/Patient Safety domain includes six measures and accounts for 25 percent of an organization’s total score. The At-Risk Population domain has twice as many measures and accounts for the same percentage. Thus, improving a measure within the Care Coordination/Patient Safety domain has twice the impact on points and potentially on monetary compensation.

Which measures can you impact through engagement programs?

Identifying the most rewarding measures is not enough, though.  Rate of compliance with some measures may be easily impacted by outreach efforts through staff, your website, contact center, direct mail, etc.  Don’t forget to consider that optimal patient engagement (the right message, at the right time, via the right “channel”) – likely means using media like automated voice, texting, smartphone push and email – but more about that in my next blog post. But patient engagement efforts may not be enough to “move the needle” against measures that require changes in clinical practice, such as avoiding overuse of bone scan for low-risk prostate patients. As you work toward an objective overall ranking of measures, organizations should factor in potential impact.

Are you aligned with organizational initiatives?

Before finalizing CQM targets, be sure they align with your organization’s mission, goals and ongoing initiatives.

If your plan for improving CQM performance can be positioned as a means of achieving an existing and understood goal, then it will be easier to build support, enthusiasm and participation in your efforts.  Introducing a new focus will create a second and possibly competing set of priorities and will require you to fight for mindshare. Success lies in alignment. For example, if your organization’s 2014 initiatives include a focus on women’s health, then CQMs like mammograms or prenatal care programs will be in line with established priorities. Attempting to focus staff on improving performance around diabetes or readmissions may prove more difficult.

Don’t just plow under a cornfield

The bottom line is that you shouldn’t just build a baseball diamond without planning and prioritizing – or something to that effect.  And ensuring that the above factors have been considered as you prioritize your measures – and population health outcomes – is just the start.  In my next blog post I’ll focus on the keys to engaging your patient base and staff in improving those measures.  I may even take a stab at some Bull Durham metaphors along the way.

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Vance Clipson

About Vance Clipson

Vance Clipson, senior principal, industry solutions for Nuance Communications, focuses on vertical-specific strategy and marketing with an emphasis on healthcare, financial services and government. Clipson brings 25 years of experience translating industry needs and data into market strategy and programs for Milliman, PacifiCare Health Systems and other organizations.