Deliverable 2 Cost, Quality And Access Of Care
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Quality healthcare is a national and state objective that the Centers for Medicare and Medicaid Services (CMS) places a high premium on. The CMS’s quality healthcare initiatives aim to ensure that Medicare beneficiaries receive quality care through public disclosure and accountability of the insurance plan (Vu et al., 2016). As a result, the CMS activities that assess quality focus on public reporting, payment for reporting, and quality improvement. Quality measures are tools that facilitate the assessment of healthcare outcomes, service delivery processes, organizational structures, patient perceptions of services, and systems connected with high-quality healthcare goals (Kamal et al., 2020). Quality health care objectives include timely care, equitability, patient-centeredness, efficiency, safety, and effectiveness. Therefore, CMS employs quality metrics to improve patient-centred health care management systems founded on Medicaid accountability, innovation, affordability, accessibility, and care (Conway et al., 2013). The CMS conducts impact assessments on national quality measures and generates reports that drive data-driven actions to support public health improvement – identifying areas for improvement, reducing service provider burdens, implementing initiatives beneficial to providers and patients, and supporting population-based payment models in healthcare systems (van Dover & Kim, 2021). Section 1890A(a)(6) of the Social Security Act mandates this type of assessment and reporting by the CMS (Fishbane et al., 2021). This study examines the most recent CMS 2021 report to determine the level and dynamics of national and state health care quality – ‘2021 National Impact Assessment of the Centers for Medicare & Medicaid Services (CMS) Quality Measures Report’ (Centers for Medicare & Medicaid Services, 2021). The findings will contribute to the identification of a quality measure that can be suggested for Oakridge Health System’s quality improvement plan for the following fiscal year.
Analysis of the 2021 National and State Healthcare Quality by the Centers for Medicare & Medicaid Services (CMS)
The report shows that the patient safety measure portfolio in the 2021 measurements entailed 33 processes, 59 healthcare outcomes, and 18 quality programs. The proportion of the total patient safety measures directly addressed healthcare outcomes stood at 64% in 2020 compared to 47% in 2015 (Centers for Medicare & Medicaid Services, 2021). The report further revealed that the digital quality measures that entailed electronic administrative claims systems, case management systems, clinical registries, health information exchanges, e-health records, and wearable devices accounted for 65% of the patient safety measures in 2020.
The report showed an improvement of communication and care coordination measures from 44% in 2015 to 50% in 2020. There was also a 28% improvement of analyzed persons and family engagement measures, with 54% of the data gathered from digital quality measures (Centers for Medicare & Medicaid Services, 2021). From the 207 total measures on effective prevention and treatment methods portfolio, there were no changes between 2015 and 2020 as it stagnated at 18%. There was also an improvement by 33% between 2015 to 2020 on the working with communities measures portfolio and a 50% improvement of the affordable care measures portfolio within the same period.
Patient Satisfaction Score
From the report, 81% of the Home Health Agencies (HHA) reported various healthcare quality improvement barriers, including 36% turnover of staff, 40% of changing staff behaviour, and 58% of challenging patient mix. It was indicated that inadequate staffing adversely affects the quality of care, attributed to the low patient satisfaction score. As a strategy to address these barriers, 90% of the HHA suggested increasing quality improvement staff, quality champions, and technical assistance from private organizations (Centers for Medicare & Medicaid Services, 2021). Furthermore, 92% suggested training staff on quality improvement strategies and design initiatives directed towards specific measures.
Affordable Care Improvement
The performance on the affordable care measures focused on relevant colonoscopy follow up, which revealed an improvement in the ambulatory surgical centres to 81.3% in 2018, up from 71.6% in 2014. The report further revealed an increment in the hospital outpatient settings by 132,197, which represented 14.8% in 2018 from 74.0% in 2014 (Centers for Medicare & Medicaid Services, 2021). The report also shows that an improvement of service, which helped reduce hospital stay, led to a decline in the median hospital Medicare spending per beneficiary from $22,202 in 2013 to $21,628 in 2018. There was also a significant reduction in total knee/hip arthroplasty cost per episode in a 30-day schedule ($21,905 in 2018, down from $25,613 in 2015) (Centers for Medicare & Medicaid Services, 2021). There was also a significant reduction of patients (by 6,863)that expected complications related to the arthroplasty surgeries.
However, gaps within this measure were revealed about the clinical setting. On the acute steps, the report shows a challenge on under/overutilization of imaging, radiation therapy, and chemotherapy in cancer care. There are also critical gaps in low-value care minimization and pre-operative testing. In post-acute care, challenges exist on the appropriateness of transfers and low-value care minimization. On clinical ACO, gaps exist in diagnostic efficiency, use of optimal therapy courses to reduce cost and patient harm, out-of-pocket costs from beneficiaries, healthcare delivery inefficiencies as well as overuse of services that necessitate fraud and high prices (Centers for Medicare & Medicaid Services, 2021). Emergency department utilization and out-of-pocket costs are identified as gaps in managed care.
In efforts to improve quality measures performance, several findings reported by HHAs outlined in the recommendations are divided into two sections: provider training; and care process redesigning. On provider training, some of the performance improvement efforts include the demonstration of OASIS, side-by-side charting, and in-service training. The HHA suggests a joint assessment with healthcare staff and clinicians to ensure consistency in supervision and education that would enhance the healthcare outcomes. On care process redesign, on the other hand, the report outlined interdisciplinary teaming, shifting of patterns of visits, and adopting telehealth strategies (Centers for Medicare & Medicaid Services, 2021). One of the suggestions was the development of wellness call systems that can help in emergency care.
Interoperability and EHRs
When it comes to interoperability and EHRs, several areas seem to have quality gaps to communication asymmetry between the care providers and the HHA, which pose a challenge to efficient healthcare provision. Electronic delivery of patient-doctor was therefore considered a significant gap in information such as lab test results, prescribed medications, treatment summaries and diagnostic and discharge instructions.
Health Outcomes: Impact of effective treatment and prevention
Improved effectiveness of prevention and treatment revealed some positive health outcomes between 2014 and 2018, including; 39.3% increase in clinical depression screening and follow up; 5.1% blood pressure control;1% decline in hyperkalemia;11.6% increase in special needs plans beneficiaries of the annual health needs and risk assessment; 20.6% increase in osteoporosis treatment or screening; 10.9% increase in patients in psychiatric facilities; 8% yearly increase of influenza immunization especially among low-income and black Medicare beneficiaries; 9.4% increase beneficiaries of colorectal cancer screening and 3.9% of breast cancer screening (Centers for Medicare & Medicaid Services, 2021).
However, some areas showed a worsening of disparities or a decline in measure performance. These areas include Poor hemoglobin A1c control rates; increased mortality of chronic obstructive pulmonary diseases; and increased mortality of coronary artery bypass graft among the native Americans in Alaska and mainland U.S. these three areas led to a significant increase in the hospital stay as well as increased cost of treatment and control (Centers for Medicare & Medicaid Services, 2021).
Quality Measure Initiative for Oakridge Health System: Improving Patient Satisfaction Measures
Patient experience and healthcare facilities are the critical quality component that helps in the evaluation of the performance of healthcare facilities that could potentially lead to bonuses or penalties. Patient experience alongside a reduction of per capita healthcare cost and the improvement of population health is considered an essential dimension of the healthcare industry (Al-Abri & Al-Balushi, 2014). It is therefore critical for Oakridge Health System to optimize its health operations and systems to improve performance quality. Although patient satisfaction cannot be used as a driver for outcomes, it can be a critical tool to balance the measure of products as it provides insights into the quality of services offered to patients (Flott et al., 2016). In that case; there are five key recommendations that Oakridge Health System can consider to significantly improve the experiences of patients:
1. Transition to value-based care.
Value-based care is a framework used in healthcare systems to incentivize caregivers by attaching payment or rewards on patient health search rewards or incentives can be capitation or fee-for-service approach (Salvatore et al., 2021). The goal of this model is to improve the quality of care and service delivery in a manner that improves patient health outcomes (Brown et al., 2022). It is therefore focused on making healthcare service delivery proactive rather than reactive and mitigating errors that may hamper positive health outcomes. Some of these critical components of value-based care that Oakridge Health System could consider are; broadening access to care; building a robust healthcare infrastructure; attaching rewards to care quality improvement; enhancing healthcare professionalism and leadership; designing shared and clear vision for facilities’ caregiving (O’Kane et al., 2021).
To achieve this, a consumer assessment on the Oakridge Health facilities systems and healthcare providers needs to be conducted through patient experience surveys. The surveys can be administered randomly to patients. They are required to give feedback on a number of areas that include; discharge information, communication about treatment and medicine, pain management, hygiene and a general environment of Oakridge Health Systems. Facilities, facility staff responsiveness, and clinicians communication.
2. Offering training on patient experience to care providers and staff.
Facilities staff need to understand the impact of care quality on patient experience in healthcare facilities. Although patients might not have formal medical training, the encounter and expertise can be confounded by multiple factors aligned to the expectations and priori desires (Wolf et al., 2021). If patients’ expectations are not met accordingly, patients feel discouraged. In that case, training should focus both on the service quality, patient engagement, care coordination, healthcare assessment accuracy, improved data collection procedures, improved robustness of healthcare outcomes measurement approaches to ensure that information is collected promptly, and understanding emerging caregiving models (Mosadeghrad, 2014).
3. Use of healthcare analytics to understand staff satisfaction, systems alignment, and patient satisfaction.
Studies have shown that employee satisfaction predicts the quality of caregiving or service delivery. Demotivated employees may not be quick to engage patients, systems, management, or conduct the following stipulated procedures and policies. The use of healthcare analytics helps establish this relationship as it bears patient experience applications that can help. A good example is the Health Catalyst’ Patient Experience Explorer Application that allows for data analysis by healthcare outcomes improvement and demographics goals (Merkley & Bickmore, 2017). The data is gathered from patients who feed the level of satisfaction, whose summary is then integrated with the healthcare data and clinical applications to help decision-making. It is therefore imperative to integrate data into the healthcare systems daily workflow to facilitate balanced quality measures.
Evaluation of Quality Measure Outcomes: Using Quality Improvement Principles
Outcome measures help determine the impact of quality improvement initiatives in healthcare services on patients’ health status. The outcome measures, therefore, represent the gold standard of determination of facilities quality (Boyce et al., 2014). The evaluation of quality measure outcomes, however, should follow principles of quality improvements which include: healthcare quality improvement it should be incremental; must be aligned with the goal of continuous improvement; must respect people including patients and employees; must align with improving standards; all staff must identify areas of improvement; and should use technology for visual management of data (Goodridge et al., 2015).
One of the quality measure outcomes evaluation methods that Oakridge Health System can adopt include: risk-adjustment methods that encompass mathematical models to assess the changes in patient health status. The risk adjustment method can be instrumental in minimizing inaccurate information within the Oakridge Health System.
Another evaluation measure could be structural measurement methods which could focus on the processes, systems, and capacities of providing high-quality care (Santana et al., 2017). This could look at the ratio of caregivers to patients, the number of board-certified doctors and clinicians, and whether the facilities use electronic systems in medication ordering and entry and medical recording (Cater et al., 2015).
The other is the process measurements evaluation method that seeks to establish whether the service providers airline in the clinical practices with acceptable recommendations (Boyer et al., 2012). In that case, the focus could be the proportion of patients receiving immunization and other preventive services and the number of recipients of blood sugar control and testing in a facility.
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