Role of quality measures in the health management of the cardio-renal metabolic syndrome population
Neil Minkoff, MD: One of the things we think about on the payer side is quality metrics. There are the HEDIS [Healthcare Effectiveness Data and Information Set] originally designed for employers to measure the quality of health plans. These started with mammogram rates and colon screening rates and moved on to A1C levels and other things. They are now often applied to commercial populations. The clinics take care of these commercial populations as a quality assessment. Then there are the Stars measures, which are aimed more at the population and Medicare or Medicare Advantage clinics, or at least those who take risks on them. There are also measures in the hospital setting, and some seem relevant: percentage of patients with blood pressure control, percentage of patients with A1C control, and admission and readmission rate, especially since Medicare measures them. specifically around heart problems. diagnostics. I can see plans looking to try and do value-based healing, i.e. trying to reward entities that show either the best of these levels or the most improvements in a set of these levels. . Medicare is aggressive enough with reimbursement already, but these are widespread measures. Are there things you would recommend that would help define the value of the care provided in your clinics beyond basics like blood pressure, A1C, and admission or readmission rates? How do you think we should measure quality in a clinic like this?
Nihar R. Desai, MD, MPH: Let’s try to measure the things that matter to the patients we serve. If we take this as the norm, it will guide us to different places. One concerns endpoints important to patients, such as hospitalizations, rates of cardiovascular events, and other factors that affect their quality of life. We should try to align a set of quality measures around the best evidence-based care, measures so auspicious that measure what the guidelines codify as the best medical care for a patient with cardiovascular disease, diabetes, medical conditions. metabolic. renal syndrome or dysfunction. We can offer advice that approves the use of SGLT2 [sodium-glucose cotransporter-2] inhibitors and other similar therapies because of the value they provide to patients. If we are talking about reinventing the business of quality measurement to best align the interests of the patient with the interests of providers, payers, and systems (those who bear risk and provide coverage for these patients), then c This is a good framework for what a quality metric program should look like on the cardiometabolic and cardiorenal side of things. Next, you’re going to look at the total cost and usage, but that quickly brings you to the power of these therapies, as the effects are neither small nor negligible. The effects are quite deep. There is no way we can provide these therapies to pockets or subsets of our populations. We cannot see the types of disparities that have arisen and have persisted for too long in cardiovascular medicine and other parts of our health care system. It must mean the best care for all patients. Ultimately, this will generate value to the point of reducing overall usage, because the benefits of these therapies are so spectacular and so important.
Transcription edited for clarity.