Talking about The Challenge of Quality in Health Care Policy Development
Last week, I spoke at the National Quality Forum Annual Conference in Washington, D.C. about the role of health care quality in policy making on the Hill.
The challenge of policy making on the Hill is that many people know that quality is important. Policy makers know they need to be talking about health care quality. Unfortunately, too often quality is just a buzz word. It’s much like how folks talk about medical homes. If you are at a cocktail party and people are talking about health care policy, you know you will sound smart if you mention the important role medical homes will play in the future of health care regardless of whether you can explain what a medical home actually is. Of course it does beg the question, why are you at a cocktail party talking about health care policy?
The problem is that policymakers lack an understanding of health care quality that is second nature to them in other economic endeavors. The information available to individuals in deciding on a mobile phone, the type and the features, and the carrier for their mobile phone, the best reception and lowest cost for the service, are decisions made with significant, comparable information. Health care quality is still a long way away from being viewed similarly.
Even as data is becoming available to produce comparable, quality metrics, that doesn’t mean those initial quality metrics provide the right information to make health care decisions. The speaker that followed my panel at the Conference, Billy Beane of the Oakland A’s, is from the baseball world. For generations, baseball considered the Triple Crown (batting average, home runs, and runs batted in) to be the gold standard of statistics. I doubt Billy Beane pays much attention to the Triple Crown stats in evaluating players today. Now baseball uses complex metrics like BABIP and VORP and other acronyms I can’t comprehend, and I’d like to think I am a baseball geek. It is reasonable to think that health care quality metrics will undergo a similar evolution where initially accepted metrics are replaced by more accurate and expressive metrics over time.
For policymakers, progress in health care quality remains to be seen in a way they can understand. Fortunately, the Medicare and CHIP Reauthorization Act (MACRA) of 2015 devotes significant resources to the development of quality metrics. I know the system will benefit from the progress made towards better quality metrics.