Aligning quality agendas to drive system-wide transformation

Quality measurement is critical to evaluating healthcare delivery across settings, and to designing incentives that reward value. Proliferation of measures has furthered our ability to quantify healthcare quality, but has often yielded diverse information that is difficult to compare or trend. Public agencies are increasingly focused on performance improvement in healthcare, but misalignment and lack of strategic direction in quality initiatives further hinders our ability to foster system-wide transformation. The spectrum of work conducted by various agencies informed by quality measurement is broad, and bureaucratic structures foster competition between agencies while failing to incent alignment. Two recent initiatives in Massachusetts demonstrate the key challenges to achieving alignment. We convened healthcare-related public agencies, consumer and provider stakeholders to develop a set of quality measures for public reporting, improvement initiatives and payment incentives. The statewide quality advisory committee evaluated over 300 measures on factors such as ease of data collection, alignment with current state, federal, and private reporting efforts, and utility to providers and consumers. Consensus on priority areas, such as the Triple Aim, was apparent, but there was little alignment in measure utilization. Dispersion analysis of measures utilized in public and private sectors underscored the variation between programs. Particularly in public sector agencies, measurement priorities are set without an eye to alignment across settings. We then convened a multi-agency collaborative to develop the framework for a statewide quality strategy. Key challenges identified include a fragmented legacy data infrastructure, policies and laws that limit efficiency of data collection and sharing, resource constraints that limit data set linking, and competition for resources between agencies. Implementation of a quality strategy that aligns incentives, public reporting initiatives, and quality improvement programs will facilitate administrative simplification, reduce the reporting and analytical burden on providers and agencies, and inform future state, regional, and national measurement alignment efforts.