Stakes rise with clinical outcomes measures

ADA, HCFA, FAcct, NCQA team up

A diabetes initiative launched by four leading health care organizations promises to usher in the next era of outcomes management in which physicians and health plans report the clinical outcomes and functional health of patients with chronic diseases.

Currently, the Health Plan Employer Data and Information Set (HEDIS) of the National Committee for Quality Assurance (NCQA) focuses largely on preventive health measures, such as mammograms, pap smears, and cholesterol screening. Some critics complain that HEDIS relies too much on "process measures," or measures of actions taken by providers, rather than clinical outcomes that indicate improvement in the patients’ conditions.

By the end of 1998, the Diabetes Quality Improvement Project will release a "comprehensive diabetes measurement set," which is expected to include clinical measures such as glycosylated hemoglobin as well as health status scores. The project is a collaboration of the NCQA in Washington, DC, American Diabetes Association in Alexandria, VA, the Foundation for Accountability (FAcct) in Portland, OR, and the Health Care Financing Administration (HCFA) in Baltimore.

David Lansky, PhD, president of FAcct, called the project "a milestone" and "a very broad statement about the importance of measuring outcomes in a significant way."

New measures adopted by the four groups are likely to become national benchmarks for the care of diabetics. HCFA, the largest purchaser of health care, purchases care for one-fourth of all people with diabetes in this country. And more than 90% of health plans use NCQA performance measures.

More elaborate outcomes measures place greater demands on physician practices to collect and report data. "I don’t think anyone will want to recommend measures that will present an unreasonable burden on providers," says Lanksy. "But responsible medicine in this information age includes knowing some things systematically about the patients you’re caring for."

NCQA also has created Measurement Advisory Panels to develop measures for behavioral health, cardiovascular disease, asthma, and women’s health. Additional panels on geriatrics and pediatrics are also planned.

Along with this growth in the development of measures, NCQA reports a 20% rise in reporting by health plans. The latest version of Quality Compass, released in September, contains data from about 300 health plans.

HCFA has required HEDIS reporting for Medicare plans, a move that influenced commercial plans, as well. HCFA also awarded NCQA a $2.37 million grant to support HEDIS data collection and development.