A Health Plan's Journey to Identifying Meaningful Quality Measures

Am J Med Qual. Nov/Dec 2018;33(6):657-661. doi: 10.1177/1062860618772905. Epub 2018 Apr 30.

Abstract

The number of quality measures in health care is overwhelming, and reporting requirements are inconsistent. Value-based payments emphasize the need to prioritize quality measures and align across organizations. This article describes the process Humana undertook to reduce the quality measurement burden, refine measure consistency across the organization, ensure alignment with national standards, and relate quality measures to improved health outcomes within the health plan. Of the 1100 measures identified in use at Humana, 699 were duplicative or inconsistent. The biggest challenge was reaching consensus on similar measures while staying within regulatory and accrediting agency constraints. After review, physicians, quality experts, and business leaders prioritized 208 quality measures grounded in evidence, supported by credible organizations, and impactful to health outcomes. A governance committee was created to provide ongoing, proactive quality measure review. These efforts allow Humana to better support value-based payments by reducing complexity and helping physicians focus on meaningful measures.

Keywords: efficiency; health plan; quality; quality measures; quality metrics.

MeSH terms

  • Hospitals / standards
  • Leadership
  • Quality Indicators, Health Care*
  • Quality of Health Care*
  • United States