A brief guide on how to measure quality improvement in healthcare

Every day we see healthcare initiatives being introduced that impact patient care, improve health outcomes, and enhance a patients’ quality of life. From research uncovering a groundbreaking drug, to surgical care advancements that reduce hospital stays, to patient/physician engagement initiatives that elevate the patient’s treatment and care plan, improved health results are achieved.

The improvement possibilities are endless – and the work is never ending. That’s why healthcare quality improvement (QI) is so important. Quality improvement creates a framework and structure to achieve targeted results and improve outcomes for patients, healthcare systems, and health plans. It’s a continuous effort to improve patient care outcomes, and it’s the responsibility of everyone involved in the care journey.

But if quality improvement can occur in so many ways, how can we as an industry best approach the initiative and track our progress? This blog explores ways to measure, track, and impact quality improvement within the healthcare arena.

Use data and quality measurement to drive success

Data is key to identifying, developing, implementing, and tracking quality improvement initiatives. Successful QI programs use data to identify areas of poor performance where improvement efforts should be initiated. The data is also used to measure and evaluate QI program progress. A common challenge organizations face is the ability to collect and effectively gain insight into their vast volumes of complex data sources in their effort to initiate QI programs.  Software solutions are often used to consolidate and process analytics to provide insight for healthcare organizations.

Quality measures help quantify and report on healthcare processes, outcomes, patient perceptions, and organizational systems that relate to quality goals. Quality measures offer health plans and providers detailed insights into populations by age, conditions, demographics, and more.

Quality measurement, however, is not always straightforward and often complex in nature. For health plans, there are hundreds of quality metrics that can be measured to drive improvement activities. NCQA HEDIS®, CMS Five Star, and State Medicaid quality indicators are examples of quality measure that are mandated by federal, state, and accredited programs  (i.e., Centers for Medicare & Medicaid Services, National Committee for Quality Assurance, State Medicaid). With bonus dollars often obtainable for high performing results, organizations regularly include quality measures as part of their QI program.

Our HEDIS® quality measurement software, Converged Quality, puts insights into organizations’ hands faster with analytics that create a honed, personalized strategy to engage members and improve outcomes and ratings performance.  Analyzing healthcare performance on nearly 190M lives each year, including 80% of all NCQA-covered lives¹, this solution helps plans quickly understand their quality results and tailor their quality improvement outreach efforts to address areas of poor performance.

Paired with Inovalon’s Converged Provider Enablement solution, health plans can improve the care experience for patients by arming physicians with timely, comprehensive, patient-specific data that informs care strategies.

Data fuels Quality Improvement efforts

While quality measures are extremely valuable in understanding population-level outcomes and risks, a patient’s data can tell us much more about treatment considerations, resource allocation, and cost effectiveness, if data insights are available to guide for use in quality improvement efforts.

Some ways include:

Generating real-world evidence

Real-world data includes data derived from multiple sources such as electronic health records, medical claims data, disease registries, as well as from multiple other sources (including digital health technologies). Real-world evidence generation enables organizations across healthcare to analyze and measure quality improvement in targeted ways.

One study may focus on disease progression while another may analyze the effectiveness of a new drug. Yet another study could compare two treatment options against each other or focus on understanding how access to care affects treatment outcomes.

Each of these can have a substantial impact informing important patient behaviors, utilization patterns, treatment discoveries, and much more. Inovalon’s primary source real-world data and data solutions team help organizations across the continuum of care answer their toughest healthcare questions, and understand their patient populations to empower and improve the care provided.

Understanding and leveraging social determinants of health data

Social determinants of health offer additional patient perspectives often unavailable in care settings. It’s important to understand how SDOH factors create barriers to care impacting patient health results – and how two patients with the same condition may have drastically different health outcomes based on the resources in their area, their access to care, and other SDOH non-medical conditions.

With Inovalon’s SDOH Market Insights, health plans can understand patients’ SDOH factors across payer markets and therapeutic areas with dashboards that feature quality outcomes within the context of demographic, clinical, and social risk profiles. These details establish a much clearer, more detailed understanding of every patient’s needs within a specific population, providing actionable insights for healthcare organizations to better address those needs.

Understanding patient-level quality care needs in skilled care

Addressing patient needs, for skilled nursing facilities (SNFs), the Minimum Data Set (MDS) summarizes resident care to inform quality improvement. It helps medical personal enhance the patient’s quality of life with better understanding of their residents by utilizing quality measures to gain insight with comparison to similar facilities. This insight drives improvement when disparities are identified.

The MDS is also used in SNF survey assessments and for reimbursement processes, which helps improve quality in healthcare performance and cost-effectiveness.

None of this can occur without an accurate MDS, though. Inovalon helps SNFs simplify and ensure accuracy in their reporting with MDS Assessment Software.

Don’t lose focus on the patient experience

The final strategy to measure quality improvement in healthcare is to keep patients at the heart of every effort. How much they engage is often a good indicator of how well an improvement effort is working, regardless of if that effort is in streamlining patient intake at a hospital, coordinating member outreach across health plan programs and priorities, improving treatment encounters at a private practice, or even in clinical trial recruitment.

Throughout the care continuum, it’s patients who are most impacted by quality improvement efforts.

To enhance their experience, consider leveraging tools that:

• Save time for patients during registration, so they can see their provider faster while trusting their information is accurate
• Automate prior authorizations and simplify infusion patient management to get medication in patients’ hands faster
• Deliver patient health history to authorized providers during treatment, allowing the interaction to be more personalized and truly patient-centric
• Empower health plans to plan and coordinate targeted, effective, and unified member-centric outreach campaigns

These efforts streamline, enhance, and improve the patient care experience.

How to measure quality improvement in healthcare with Inovalon

Quality improvement in healthcare is a constant effort. Every day is an opportunity to make a difference in patient lives and impact how the industry as a whole operates. The only question is: What is your organization’s next step in improving quality measurement, data analytics, or the patient experience?

Our team is here to help you, whatever your next big initiative is.

Contact us to learn how we help payers, providers, pharmacies, and life sciences organizations harness the power of data to improve the outcomes and economics of healthcare.

---

Source:

¹ Inovalon calculation based on HEDIS® MY2021 data. June 2022.

Inovalon and design^®, Inovalon^® are trademarks of Inovalon, Inc.