Since mid-2016 the foundation’s Patient Care Program has supported the National Committee of Quality Assurance (NCQA) to develop measures aimed at ensuring that high-need patients receive high-quality care in the community. High-need, or seriously ill, patients have serious chronic conditions such as diabetes, heart disease and chronic obstructive pulmonary disease, and they are also limited in their ability to perform everyday tasks such as eating, bathing and walking.

NCQA is a Washington, DC-based nonprofit organization that works to improve health care quality through the administration of evidence-based standards, measures and accreditation/certification programs for individual physicians, health plans and medical groups. With its current grant from the foundation, NCQA is developing measures for community-based serious illness care, starting with what matters most to patients and their families. Their team is focused on developing more meaningful and useful measures by linking them to a person’s goals and outcomes for care. These“person-driven,” measures will be considered for inclusion in NCQA’s existing and future accountability programs.

In a newly published paper, “Serious Illness Care: Person-Driven Measures for Accountability,” NCQA details its measure development efforts over the last 21 months. Research scientist Maureen Henry, in an NCQA blog, discusses the need for new measures to hold accountable programs that care for seriously ill patients. In the blog, she explains how these programs are proliferating across the country, filling a gap in the U.S. health care system; she cautions that moving too quickly without standardized measures for accountability may result in compromising quality.

“As the country moves toward value-based purchasing, community-based serious illness care programs are becoming popular because of their potential to decrease costs by giving people only the care that will help them achieve their goals: not too much, not too little. But a rush to reduce costs could also reduce care quality.”

Highlights of the NCQA paper include:

  • Mary’s story: A 72-year-old widow with multiple chronic conditions is worried about having to move into a nursing home. Socializing with friends and family, going to church and living in her condo are most important to her. For her health care, she wants less hassle (calling a nurse or doctor instead of in-person visits every other week) and care that meets her goals. Frustrated by how the health system doesn’t track or understand what is important to her, she wants to see changes made so care matches what is important to her and her life.
  • Family and caregiver input: To guide the creation of more meaningful measures, NCQA has engaged with patients, caregivers and experts in health care delivery and payment. Valuable perspective has been gained from: high-need patients who serve as paid members of the project team; organizations representing patients and families; and people managing health plans and health systems. Additionally, NCQA gathered leaders from 11 serious illness programs located in nine states, representing a mix of hospices, medical groups, health systems and the Veterans Administration, who will work with their patients to test the new measures.
  • Assessment of community-based care: NCQA is now developing and testing three new measures for assessing community-based serious illness care. These include:
  1. the percentage of patients who receive specific elements of a comprehensive assessment (elements may include physical health, behavioral health, cognitive function, physical function, spiritual needs, activities of daily living, and caregiver strain and capabilities);
  2. the completion of a care plan, which serves as an action plan for achieving patient goals and a yardstick for tracking progress; and
  3. whether patient goals used to create the care plan are documented in the patient’s health record. (More details about these measures can be found on pages 12-13 of the NCQA paper.)

As this work progresses, we look forward to sharing what is learned. We want to see a strong consumer protection system built for this kind of care and we know that measuring care in the community requires the effort and input of many to make a positive difference for people with serious illness.

Learn more about the foundation's support for improved serious illness care

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