Quality of care means different things to different people depending on their perspective. As a result, defining and delivering quality can be elusive. The Institute of Medicine defines quality as “the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” A simpler definition might be doing the right thing—at the correct time and in a proper manner—for the right person, and getting the best possible health outcomes.
Managed care organizations are charged with delivering on this promise of quality care and measuring the results through various standards, including NCQA HEDIS measures and Medicare Star ratings. For the most part, these measures are objective and quantifiable.
But the consumer’s point of view can be wildly different from that of a health care executive because it is based on an individual experience. For example, a long wait to see a doctor could drastically affect the quality of someone’s health care experience.
For managed care organizations, member perceptions of quality are measured by the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey and the Health Outcomes Survey (HOS) for Medicare Advantage plans. These can certainly provide insight into the consumer perspective, but some information gets lost. Based on sampling methodology, the survey results are aggregated so specific individual member data are not available. And it’s not always apparent which subpopulations are faring well (or poorly).
Despite these limitations, health plans utilize CAHPS and HOS results as a starting point to improve the consumer’s experience and perspective on the quality of care delivered through their plan.
Here are five steps to take that incorporate the consumer point of view when formulating your action plan for improving quality and the patient experience:
CMS continues to push on measuring and reporting information from the consumer perspective for Medicare Advantage and Part D contracts. Others will follow, and we can expect more emphasis on member-reported outcomes and experience measures across all lines of business. So the time to focus on the consumer and, more specifically, improving member perceptions of care quality and experience, is now.