Ensuring Quality Health Care

Quality Measurement Issues & Challenges

This session established a foundation for the workshop by providing a common understanding among the participants concerning the basic concepts and issues associated with health care quality measurement and related policy issues.

Helen Smits, M.D., President of HealthRight, Inc., and a former public official responsible for quality-related policy development, began the session with a discussion of recent changes in the health care marketplace, such as the shift towards managed care, that have resulted in an increased emphasis on health care quality.

Dr. Smits also explained that to tackle complex quality issues requires an understanding of the often misunderstood word "quality". She suggested that "quality" can be considered through several different perspectives:

• Technically (in terms of structure, process, and outcomes of care).
• Personally (was the beneficiary of care satisfied?).
• From a public health perspective (was the population as a whole served well?).

Other areas explored in this session were the role of the States in the regulation of managed care organizations, and the States' ability as purchasers to demand quality through their own Medicaid programs.

A specific concern noted with respect to Medicaid is that, due to a lack of true market pressures from consumers, quality problems—especially for special and vulnerable populations—could occur.

To promote quality care, the presenter identified several steps that States could pursue, including creating consistency across and between States and other purchasers in terms of measuring quality, and publicly reporting outcomes of care.

Reference

Health Care Quality Improvement Studies in Managed Care Settings: A Guide for State Medicaid Directors, prepared for the Health Care Financing Administration by the National Committee for Quality Assurance.

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