News & Commentary

Humana Culls Quality Metrics


Humana wants to make it easier for providers to report quality results. The company last month implemented a Clinical Quality Metrics Alignment program (CQMA), which sliced the insurer’s quality metrics from 1,116 down to 208, more than an 80% reduction. HEDIS has also been accused of taking up doctors’ time but now some see it as a way to help bring about value-based care. (See the story HEDIS Is the Hassle That Became a Habit.)

Humana did this by collecting the 1,116 quality metrics from 29 different data sources across the company. Officials vetted the metrics for inconsistencies, duplication, and clinical relevance. Company officials streamlined the metrics with an eye on the health insurance industry’s efforts to standardize measures used to evaluate clinical quality.

CQMA comes on the heels of AHIP’s February introduction of its Core Quality Measurements, which was launched with input from CMS, the National Quality Forum, and various physician organizations. Humana’s program aims to support doctors who are involved in the company’s value-based payment relationships.

Roy Beveridge, MD, Humana’s CMO, said in a company press release that, “Metrics not connected to patient health are obstacles in their transition and distract from the intent of care tied to quality. Through our CQMA program, we hope to greatly simplify quality reporting and alleviate physician burdens.”

The idea is to make quality reporting less arduous for doctors, but just how much of an impact Humana’s CQMA can have on that will have to be seen. According to a 2015 survey by the American Academy of Family Physicians (AAFP) that was sponsored by Humana, 61% of family physicians are paid by seven or more health plans, “which can lead to excessive, inconsistent, and overlapping quality reporting requirements,” according to Humana officials.

Is it any wonder that 49% of physicians are burned out, according to a 2015 Mayo Clinic study. Are they worried about money? Physician practices spend more than $15 billion a year on quality reporting, according to a study in Health Affairs in March.

There’s also this problem, according to the AAFP survey. Many physicians don’t know how a value-based payment system would work. One in four don’t know or are not sure of their practice’s value-based payment strategy or even status, and 32% don’t know if value-based payment models are available in their market. Among those participating in value-based payments, 33% don’t know how the payments are being distributed within their practices (e.g., administration, physicians).

Then there’s the time commitment. More than 90% of physicians cited lack of staff time as a barrier to implementing value-based care delivery.

The survey was sent to 5,000 AAFP members; a total of 779 surveys were completed and 626 were evaluated after a screening process.

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