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When Peggy O’Kane Speaks, Providers Had Better Listen

February 27, 2015
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The blog last week on the AJMC's website by Peggy O'Kane of NCQA provided a strong element in a clear roadmap for providers going forward

Last week, Margaret E. “Peggy” O’Kane, president of the National Committee for Quality Assurance (NCQA), wrote a blog entitled “Quality’s Quarter-Century,” for the online version of the American Journal of Managed Care (AJMC). NCQA, established in 1990 to manage voluntary accreditation for health plans, individual physicians, and medical groups, is best known for HEDIS (the Healthcare Effectiveness Data and Information Set), for decades now used to measure the care management performance of health plans; and for the Consumer Assessment of Healthcare Providers and Systems (CAHPS) program. This year celebrates its 25th anniversary of existence, while the ANJMC celebrates its 20th.

O’Kane began her blog by noting that “Like The American Journal of Managed Care, the National Committee for Quality Assurance (NCQA) celebrates a milestone anniversary this year. In 1990,” she wrote, “we began our mission to improve healthcare quality and value through measurement, transparency and accountability. Today, we are proud that measurement and accountability are now part of the DNA of our entire healthcare system, and cost and quality are both improving.

Margaret E. O'Kane

“Rather than rest on this success,” O’Kane continued, “we quality advocates must turn to what our experience allows us—and require us—to do next. The accomplishments of the last quarter-century are real and significant. In 1990, measuring quality was just an idea—today it is an everyday reality. Most Americans—more than 171 million—are enrolled in health plans that report NCQA’s HEDIS (Healthcare Effectiveness Data and Information Set) clinical quality measures. Medicare, most state Medicaid programs, and many private insurers use HEDIS to rate the value (rather than the volume) of healthcare. Plans and providers use HEDIS to gauge their performance and determine where they must improve.”

Most importantly, O’Kane made a very strong argument for comprehensive payment reform, reform that would truly reward quality outcomes, rather than allowing the dramatic rise in deductibles in consumer health plans to undercut pay-for-performance gains. In that regard, she wrote, “Payment reform took a giant leap forward in January, when government and private sector leaders committed to specific goals for value-based payment. HHS [Health and Human Services] secretary, Sylvia Burwell announced that it is Medicare’s intent that by 2016, 30 percent of fees will be paid in alternative payment models, and by 2018, 50 percent will be. The Health Care Transformation Task Force, a coalition of healthcare systems and organizations (insurers as well as purchasers and consumer advocates),” she noted, “set a goal that by 2020, 75 percent of payments will be value based. These goals are useful because they are specific, measurable, achievable, results-based and time-bound.”

This information is incredibly important. Indeed, it provides a veritable roadmap for hospital and physician leaders to understand the path that U.S. healthcare is taking into the future. Here’s the thing: I agree with O’Kane that HHS Secretary Burwell’s announcement of intent for Medicare payment to become increasingly value-based over the next several years, is an exceptionally important signal from HHS, one that will certainly push the U.S. healthcare system, and in particular, providers, forward.

So here’s the key point: we now have numerous policy leaders in healthcare—all the way from HHS Secretary Sylvia Burwell, to Peggy O’Kane of NCQA, and everyone in between—making it clear that both the public and private purchasers of healthcare are going to push, push, and keep on pushing, to compel providers forward towards value-based payment and care delivery, based on quality outcomes measurement. How much more clear could that be?

And healthcare IT leaders will be absolutely essential to helping to lead the clinical transformation needed in order to achieve this fundamental shift. That reality offers both challenge and great opportunity to healthcare IT leaders. Everything that needs to be done—data analytics for health risk assessment and population health management and for readmissions reduction; shifts in alignment around incentives for physicians and hospitals; clinical decision support for care and case management; mobile technology for clinician workflow improvement and patient engagement—all of those things will require intensive clinical informatics and technology leveraging work.

So when Peggy O’Kane speaks, yes—it’s time to listen.



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