NIHCR Policy Analysis No. 11
Emily Carrier, Dori A. Cross
Gaps in hospital safety and quality have prompted public and private payers to push for greater accountability through clinical quality measurement and reporting initiatives, which have grown rapidly in the past two decades. With U.S. health care costs high and rising, purchasers increasingly are seeking to identify high-value hospitals that deliver good care at a reasonable price. Some payers are incorporating clinical quality measurement into health plan contracting and benefit designs to alter provider networks and patient cost sharing to guide patients toward higher-performing hospitals. Yet, amid the proliferation of new quality measures, reporting requirements and transparency efforts over the past 20 years, employers often find it difficult to separate the signal from the noiseto determine what hospital quality measures are important, how to interpret and use quality information in a meaningful way, and how to present useful and actionable information to consumers. To pursue purchasing strategies that push providers to meet standards of care for cost and quality, employers must understand the availability, validity and relevance of existing quality measures for their own enrollees. Purchasers also might consider how to promote more effective quality reporting by streamlining provider reporting requirements, supporting consistency in quality designations and exploring new ways to measure aspects of quality important to both patients and payers.
This article is available at the National Institute for Health Care Reform Web site by clicking here.