Earlier this year, a new consortium of healthcare purchaser, payer, and provider organizations came into being. Stand for Quality — whose purchaser members alone encompass 50 large national employers, representing over three million covered lives — was created in order to promote a very specific set of patient care quality and safety goals for providers. Though numerous other consortia have emerged around quality, some observers note that Stand for Quality represents a particularly potent gathering of healthcare stakeholders. The implications for CIOs are considerable, as the data production and reporting requirements coming out of this development would be quite intense, should Stand For Quality’s recommendations make their way into healthcare reform or Medicare reimbursement reform legislation in the next year or two. Contributing Editor Mark Hagland spoke recently with Peter V. Lee, the executive director, national health policy, for the Pacific Business Group on Health, one of the founding member organizations of Stand For Quality.
MH: How did Stand For Quality come together, and why?
PL: There have been a number of groups that have been working in the whole performance measurement world for years, in the context of the National Quality Forum and other alliances. And about three months ago, we came together, and concluded that there was a lot of talk about healthcare reform, but very little talk about quality, and the realization that healthcare reform should be anchored in quality. And the idea was that we’d better make sure that healthcare quality gets baked into healthcare reform at every level.
MH: Were you surprised at the level of consensus?
PL: It took some back-and-forth discussions to achieve that level of consensus. And at the end, you’ll hear the voice of employers on affordability, and the need for measures about cost and functional outcome and status; but also the voice of physicians, saying, we don’t want measures to be about “gotcha,” but about improving care. The reason we got 165 groups ranging from the AARP to the AMA to the AHA to the Chamber of Commerce is that there was an agreement that we need to improve health care and make it of higher quality and more affordable; and folks could hear their own voices.
MH: What’s your aspiration? This is unprecedented.
PL: I really do think it’s historic in having such a range of groups saying that measuring performance is essential to health care improvement. Ten years ago, we were so far away from this. My hope is that measuring performance and using that information will become table stakes for all healthcare reform discussions. So, rather than it being an afterthought, it becomes a starting point for the discussions in the House of Representatives, in the Senate, inside the White House. We’ve already had very good initial conversations with House staffers, and have been very pleased.
MH: President Obama, in his statements regarding healthcare reform, has strongly yoked his administration’s effort to expand health insurance coverage to the struggle to contain healthcare costs system-wide.
PL: I just thought it was remarkably good news that the President was pounding the drum that if we don’t get good cost control, we won’t make progress. On some levels, he was saying, forget the deficit: long-term economic growth for America hinges on our ability to get our arms around healthcare cost control. And having the President of the U.S. understand and articulate that is tremendously important. So to have the President understand and articulate how we need to change the dynamic of health care is a very exciting and new day.
MH: What are your thoughts regarding the IT and data aspects of this?
PL: In many ways, these recommendations build on the active discussions now taking place around defining what “meaningful use” means. And it relates to those discussions around, to what extent are we wiring America so that information on performance is collected, and fed back at the point of care? In some ways, some of the recommendations in the Stand for Quality document are “mom and apple pie,” yet they’re also recommendations that still aren’t being applied at the level of the doctor’s office in more than 90 percent of cases. So to bake in performance measures and feed them back at the point of care to physicians, that’s a big deal when you get recommendations in that area from a group of 165 big groups.
MH: What should CIOs think of your consortium’s overall thrust?
PL: They can no longer think about their information systems as isolated silos. This is a national call to make sure that what they’re doing in their hospital, in their clinic, in their office, is feeding a national system of clinical data that will be used for performance purposes. And the other message is that this is an issue in many ways of a “get on board” message. Getting performance information, collecting it, using it, and sharing it — not only are consumer groups and employers represented here, but we have every major hospital association and every major physician association standing with us as well.
MH: Is a consensus emerging about what kinds of measures should be collected, that will be helpful to CIOs?
PL: Yes, if you look at the recommendations, and in particular at the last section, which basically says, here’s where the future is, you can see that consensus. We are increasingly going to be looking at functional status measures, outcomes measures, and lab information in ways that are accessible and so on; that’s the direction. And not just functional status measures, and not just focused on, did you do each little thing on the process side; but looking at what the overall results were, and rewarding that; so that is a sea change.
MH: What’s your level of optimism or pessimism with regard to the implementation of the information systems that need to be implemented to make all these processes happen?
PL: Solutions won’t happen overnight; they’ll take years to play out. But they’ll require substantial investments now. Do I think we’ll see big changes? Absolutely. And it’s not like it’ll be overnight changes, but we will see dramatic increases in the level of attention and focus of delivery systems on how they use HIT as a core element of their delivery.
MH: Do you think most doctors now “get it” with regard to demands for transparency, accountability, and performance from stakeholder groups like yours?
PL: I think we’re getting towards a tipping point, towards a majority. And it’s now a part of discussions on maintaining certification, on payment. And though not every doctor gets it yet, it’s on every doctor’s radar screen in terms of what’s important.