Kate also leads the CMS effort to develop and implement the CMS quality strategy, and co-leads a U.S. Department of Health and Human Services effort to align quality measures and quality measurement policies across the Department. CMS is a founding member of NQF. Kate serves on many NQF committees and frequently attends the Board of Directors meetings representing CMS. NQF spoke with Kate about Medicare and the importance of quality measurement in quality improvement.
NQF: Medicare celebrates its 50th anniversary this year.
How has the program improved the quality of healthcare for all Americans?
KG: There is really a lot to celebrate about the improvement
in quality overall. If you look at readmissions, hospital-acquired infections,
improvement in care processes that are performed within hospitals, for example,
there has been a significant upward trend in the quality of care that’s
provided across the board. There’s still a lot of room for improvement—there’s
no question about that. Our work is not done. But the quality measurement,
public reporting, and value-based purchasing programs have made an important
contribution to the improvement in the quality of care.
Our actions and our policy decisions have much broader
impact beyond the nation’s Medicare and Medicaid beneficiaries. They impact all
Americans who are in the healthcare system because other payers look to see
what CMS is doing in order to decide what their policies and payment structures
should be and what quality measures they should use.
NQF: CMS is transforming the nation’s healthcare delivery
system with new payment models that reward value, not volume. Can you talk
about the importance of quality measurement in these efforts?
KG: New payment models are sometimes viewed as being mostly
about reducing costs. Eighteen percent of our nation's gross domestic product
comes from what we spend on healthcare, so reducing costs is important. But
it's not enough just to lower costs. That has to come with improved health
outcomes, as well.
Quality measures are a very important tool in transforming
the delivery system. If we can gain consensus across payers on where we need to
make improvements, focus our quality measures across the public and private
sectors on the same areas, and hold providers accountable to the same quality
measures, we'll have much greater improvements than if any single payer acts
alone, including CMS.
CMS is transitioning—what I call rebalancing—our measure
portfolio to be more weighted towards outcome and experience measures, as well
as to emphasize care coordination and appropriate use measures. We’re seeing
other measure developers do the same. These measures carry with them more
challenges, but it’s incumbent upon the measurement community—and specifically
CMS—to push the boundaries of measurement science, in particular around the development
of patient-reported outcome measures. We have to be very intentional in how we
use our resources and how we develop our policies to be sure that we are able
to successfully use those measures to drive change.
NQF: What opportunities do you foresee for Medicare in
the next 50 years?
KG: One very interesting opportunity is to look at how we
can use the different levers within CMS, whether it is quality measure
development and use or different types of payment models, to drive improvement
in the health of populations, not just individual patients seen by a provider
who is being held accountable by CMS. How can we encourage providers to think
about their role in the health of not just their patient panel but also in the
health of their community that they live and work in?
We have funded NQF to do some early work in population
health measurement, and we are having conversations with not only NQF but also
many of our partners in the quality space about helping providers understand
and improve the health of their communities in addition to achieving better
outcomes for their individual patients.
