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Working for Quality > About the NQS > National Quality Strategy: Overview

National Quality Strategy: Overview


This set of 22 PowerPoint slides provides essential background about the NQS. Each slide includes notes that you can access by selecting “View” and then “Notes Page” in PowerPoint.

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Overview

Contents

1: National Quality Strategy: Overview
2. National Quality Strategy (NQS) Introduction
3. Background on the National Quality Strategy
4. The Strategy is to Concurrently Pursue Three Aims
5. The Relationship Between the IHI Triple Aims and NQS Three Aims
6. And Focus on Six Priorities
7. Ongoing Implementation Activities
8. Priority 1: Making Care Safer by Reducing Harm Caused in the Delivery of Care
9. Priority 1 (continued): Making Care Safer by Reducing Harm Caused in the Delivery of Care
10. Priority 2: Ensuring That Each Person and Family are Engaged as Partners in Their Care
11. Priority 2 (continued): Ensuring That Each Person and Family are Engaged as Partners in Their Care
12. Priority 3: Promoting Effective Communication and Coordination of Care
13. Priority 3 (continued): Promoting Effective Communication and Coordination of Care
14. Priority 4: Promoting the Most Effective Prevention and Treatment Practices for the Leading Causes of Mortality, Starting With Cardiovascular Disease
15. Priority 4 (continued): Promoting the Most Effective Prevention and Treatment Practices for the Leading Causes of Mortality, Starting With Cardiovascular Disease
16. Priority 5: Working With Communities to Promote Wide Use of Best Practices to Enable Healthy Living
17. Priority 5 (continued): Working With Communities to Promote Wide Use of Best Practices to Enable Healthy Living
18. Priority 6: Making Quality Care More Affordable for Individuals, Families, Employers, and Governments by Developing and Spreading New Health Care Delivery Models
19. Priority 6 (continued): Making Quality Care More Affordable for Individuals, Families, Employers, and Governments by Developing and Spreading New Health Care Delivery Models
20. Highlighted Initiatives
21. Highlighted Initiatives (continued)
22. Questions/Comments?


1: National Quality Strategy

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Overview

January 2014

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2: National Quality Strategy (NQS) Introduction

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The Affordable Care Act (ACA) requires the Secretary of the Department of Health and Human Services (HHS) to establish a national strategy that will improve:

  • The delivery of health care services.
  • Patient health outcomes.
  • Population health.

Note: The National Quality Strategy is one element of the 2011 Affordable Care Act (ACA). It aims to increase access to high-quality, affordable health care for all Americans, and it sets priorities to work toward that goal.

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3: Background on the National Quality Strategy

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  • The Strategy is for the nation and serves as a catalyst and compass for nationwide focus.
  • The Strategy has been iteratively designed by public and private stakeholders and provides an opportunity to align quality measures and quality improvement actions.

Note: The National Quality Strategy is a nationwide effort, led by the Agency for Healthcare Research and Quality (AHRQ) on behalf of the U.S. Department of Health and Human Services. The private sector, as well as State and local communities, are involved in this nationwide strategy. Public and private stakeholders across the health care system came together to develop the National Quality Strategy. The wide range of stakeholders included Federal and State agencies, local communities, provider organizations, clinicians, patients, businesses, employers, and payers.

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4: The Strategy is to Concurrently Pursue Three Aims:

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Image of a pyramid with "Better Care" at the top, and "Healthy People/Healthy Communities" and "Affordable Care" in the bottom.

Notes:

  • Through the Better Care aim, the Strategy pursues improvement to the overall quality of health care by making health care more patient-centered, reliable, accessible and safe.
  • Through the Healthy People/ Healthy Communities aim, the Strategy guides the nation in improving population health by supporting proven interventions to address behavioral, social, and environmental determinants of health in addition to delivering higher-quality care.
  • And through the Affordable Care aim, the Strategy seeks to reduce the cost of quality health care for individuals, families, employers, and government.

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5: The Relationship Between the IHI Triple Aims and NQS Three Aims

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Slide shows the logos for the IHI Triple Aim and the National Quality Strategy. The IHI Triple Aim shows a triangle. Above the top point are the words "Improving the patient experience of care (including quality and satisfaction)". On the left-hand point are the words: "Improving the health of populations". The right-hand point has the words "Reducing the per capita cost of health care".

The National Quality Strategy side shows the following aims:

Better Care: Improve the overall quality, by making health care more patient-centered, reliable, accessible, and safe.

Healthy People/Healthy Communities: Improve the health of the U.S. population by supporting proven interventions to address behavioral, social and, environmental determinants of health.

Affordable Care: Reduce the cost of quality health care for individuals, families, employers, and government.

Note: These aims will be used to guide local, State, and national efforts to improve health and the quality of health care. The National Quality Strategy's three aims closely resemble IHI's Triple Aim, and it builds on the work that IHI has done by giving additional consideration to the health of communities at different levels and affordability for multiple groups.

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6: And Focus on Six Priorities:

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  • Making care safer by reducing harm caused in the delivery of care.
  • Ensuring that each person and family are engaged as partners in their care.
  • Promoting effective communication and coordination of care.
  • Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease.
  • Working with communities to promote wide use of best practices to enable healthy living.
  • Making quality care more affordable for individuals, families, employers, and governments by developing and spreading new health care delivery models.

Note: The National Quality Strategy's six priorities are based on the latest research, input from a broad range of stakeholders, and examples from around the country. These priorities can be achieved only with the active engagement of clinicians, patients, provider organizations, and many others in local communities across the country— something the National Quality Strategy supports. Since different communities have different assets and needs, they will likely take different paths to achieving the six priorities.

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7: Ongoing Implementation Activities:

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  • Annual meetings of the Interagency Working Group on Health Care Quality, including senior representatives from 24 Federal agencies.
  • Annual updates to the Agency-Specific Plans developed by HHS operating divisions, which are available on the Working for Quality Web site.
  • Active engagement of stakeholders in the dissemination of the National Quality Strategy through the National Priorities Partnership and the Measures Application Partnership.
  • Publication of toolkits and presentations for use by community partners.
  • The Priorities in Action series, which offers a snapshot of some of our nation's most promising and transformative quality-improvement programs and describes their alignment to the NQS' six priorities (updated monthly, these programs represent private sector, Federal, State, and local efforts).

Notes:

The Interagency Working Group on Health Care Quality includes leaders from 24 Federal departments and agencies. These 24 departments and agencies have missions related to health care and quality improvement. The Working Group provides an ongoing opportunity for collaboration across Federal programs, facilitates shared learning, and helps avoid duplicative efforts.

Each HHS agency develops an Agency-Specific Plan to describe how it is supporting National Quality Strategy priorities and implementation (as required by the ACA legislation).

The National Priorities Partnership is a collaborative of major health care stakeholders that sets national priorities and goals for improving health care quality throughout the country, in all settings. Its membership includes a wide variety of stakeholders, including consumer organizations, public and private purchasers, physicians, nurses, hospitals, and health research organizations.

The Measures Application Partnership is a multi-stakeholder group that provides ongoing, detailed analysis of measures being considered for use in Federal public reporting and performance-based payment programs. The Measures Application Partnership ensures these measures are aligned with the National Quality Strategy aims and priorities, and it fosters the use of these measures across the private sector.

The Priorities in Action series offers a snapshot of some of our nation's most promising and transformative quality improvement programs, and describes their alignment to the NQS' six priorities. Updated monthly, these programs represent private sector, Federal, State, and local efforts.

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8: Priority 1: Making Care Safer by Reducing Harm Caused in the Delivery of Care

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Long-Term Goals

  1. Reduce preventable hospital admissions and readmissions.
  2. Reduce the incidence of adverse health care-associated conditions.
  3. Reduce harm from inappropriate or unnecessary care.

Note: The National Quality Strategy has identified three long-term goals related to patient safety: reduce preventable hospital admissions and readmissions, reduce the incidence of adverse health care-associated conditions, and reduce harm from inappropriate or unnecessary care.

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9: Priority 1 (continued): Making Care Safer By Reducing Harm Caused in the Delivery of Care

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National Tracking Measures

Measure Focus Measure Name/Description Most Recent Rate Aspirational Target
Hospital-acquired Conditions Incidence of measureable hospital-acquired conditions 145 HACs per 1,000 admissions* Reduce preventable HACs by 40% by the end of 2014.
Hospital Readmissions All-payer 30-day readmission rate 14.4% based on 32.7 million admissions* Reduce all readmissions by 20% by the end of 2014.

*Source: Agency for Healthcare Research and Quality (AHRQ), Centers for Disease Contro and Prevention (CDC), and Centers for Medicare & Medicaid Services (CMS), 2010.

Note: To track progress against the long-term goals, quantitative targets have been established specific to patient safety. The incidence of Hospital-Acquired Conditions (HACs) and Hospital Readmissions measures were adopted from the Partnership for Patients. These key metrics for monitoring performance allow us to track nationwide quality improvement under this priority.

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10: Priority 2: Ensuring That Each Person and Family Are Engaged as Partners in Their Care

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Long-Term Goals

  1. Improve patient, family, and caregiver experience of care related to quality, safety, and access across settings.
  2. In partnership with patients, families, and caregivers—and using a shared decision making process—develop culturally sensitive and understandable care plans.
  3. Enable patients and their families and caregivers to navigate, coordinate, and manage their care appropriately and effectively.

Note: Person-centered care means defining success not just by the resolution of clinical symptoms but also by whether patients achieve their desired outcomes. Some examples of person-centered care could include ensuring that patients' preferences, desired outcomes, and experiences of care are integrated into care delivery; integrating patient-generated data in electronic health records; and finding additional ways to involve patients and families in managing their care effectively.

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11: Priority 2 (continued): Ensuring That Each Person and Family Are Engaged as Partners in Their Care

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National Tracking Measures

Measure Focus Measure Name/Description Most Recent Rate Aspirational Target
Timely Care Adults who needed care right away for an illness, injury, or condition in the last 12 months who sometimes or never got care as soon as wanted 14.1%*

Reduce to <10% by 2017

Decisionmaking People with a usual source of care whose health care providers sometimes or never discuss decisions with them 15.9%*

Reduce to <10% by 2017

*Source: Agency for Healthcare Research and Quality, Center for Financing, Access, and Cost Trends, Medical Expenditure Panel Survey, 2010.

Note: Timely Care and Decision Making are two key components person-centered care. These measures provide insight into how well providers are engaging persons and family members as partners in their health care at a national level.

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12: Priority 3: Promoting Effective Communication and Coordination of Care

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Long-Term Goals

  1. Improve the quality of care transitions and communications across care settings.
  2. Improve the quality of life for patients with chronic illness and disability by following a current care plan that anticipates and addresses pain and symptom management, psychosocial needs, and functional status.
  3. Establish shared accountability and integration of communities and health care systems to improve quality of care and reduce health disparities.

Note: When all of a patient's health care providers coordinate their efforts, it helps ensure that the patient receives appropriate care and support, when and how the patient needs and wants it. Effective care coordination models, such as patient-centered medical homes, have begun to show that they can deliver better quality care at lower costs in settings that range from small physician practices to large hospital centers.

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13: Priority 3 (continued): Promoting Effective Communication and Coordination of Care

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National Tracking Measures

Measure Focus
Measure Name/Description Most Recent Rate Aspirational Target
Patient-Centered Medical Home Percentage of children needing care coordination who receive effective care coordination 66.1%*

Increase to 90% by 2017

3-item Care Transition Measure®
  • During this hospital stay, staff took my preferences and those of my family or caregiver into account in deciding what my health care needs would be when I left.
  • When I left the hospital, I had a good understanding of the things I was responsible for in managing my health.
  • When I left the hospital, I clearly understood the purpose for taking each of my medications.
45%**

Increase to 50% by 2017

*Source: HRSA, Maternal and Child Health Bureau; CDC, National Center for Health Statistics, National Survey of Children's Health, 2011/12.
**Source: CMS, 50 Hospital Mode Experiment, October 2012.

Note: Patient-Centered Medical Homes and the 3-Item Care Transition Measure allow the National Quality Strategy to track progress of Effective Communication and Coordination of Care at a national level.

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14: Priority 4: Promoting the Most Effective Prevention and Treatment Practices For the Leading Causes of Mortality, Starting With Cardiovascular Disease

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Long-Term Goals

  1. Promote cardiovascular health through community interventions that result in improvement of social, economic, and environmental factors.
  2. Promote cardiovascular health through interventions that result in adoption of the most healthy lifestyle behaviors across the lifespan.
  3. Promote cardiovascular health through receipt of effective clinical preventive services across the lifespan in clinical and community settings.

Note: Improving the quality of American health care demands an intense focus on preventing and treating cardiovascular disease. The lessons from this effort will feed into efforts addressing conditions such as HIV/AIDS and other chronic illnesses. Future initiatives will address a broad range of diseases and age ranges.

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15: Priority 4 (continued): Promoting the Most Effective Prevention and Treatment Practices For the Leading Causes of Mortality, Starting With Cardiovascular Disease

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National Tracking Measures

Measure Focus
Measure Name/Description Most Recent Rate Aspirational Target
Aspirin Use

Outpatient visits at which adults with cardiovascular disease are prescribed/maintained on aspirin

53%* Increase to 65% by 2017
Blood Pressure Control Adults with hypertension who have adequately controlled blood pressure. 53%** Increase to 65% by 2017
Cholesterol Management Adults with high cholesterol who have adequate control 32%** Increase to 65% by 2017
Smoking Cessation

Outpatient visits at which current tobacco users received tobacco cessation counseling or cessation medications

22%* Increase to 65% by 2017

*Source: CDC, National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS), 2009-2010
**Source: CDC, National Health and Nutrition Examination Survey (NHANES), 2009-10

Note: Quantitative targets for prevention and treatment practices for the leading causes of mortality include Aspirin Use, Blood Pressure Control, Cholesterol Management, and Smoking Cessation.

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16: Priority 5: Working With Communities to Promote Wide Use of Best Practices to Enable Healthy Living

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Long-Term Goals

  1. Promote healthy living and well-being through community interventions that result in improvement of social, economic, and environmental factors.
  2. Promote healthy living and well-being through interventions that result in adoption of the most important healthy lifestyle behaviors across the lifespan.
  3. Promote healthy living and well-being through receipt of effective clinical preventive services across the lifespan in clinical and community settings.

Note: The broad goal of promoting better health is one that is shared across the country, whether it's promoting healthy behaviors, such as not using tobacco, or fostering healthy environments that make it easier to exercise and get access to healthy foods. For that reason, successful efforts to improve these health factors rely on deploying evidence-based interventions through strong partnerships between local health care providers, public health professionals, and individuals.

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17: Priority 5 (continued): Working With Communities to Promote Wide Use of Best Practices to Enable Healthy Living

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National Tracking Measures

Measure Focus
Measure Name/Description Most Recent Rate Aspirational Target
Depression Percentage of adults who reported symptoms of a major depressive episode in the last 12 months who received treatment for depression in the last 12 months 68.1%*

Increase to 78.2% by 2020

Obesity Proportion of adults who are obese 35.7%**

Reduce to 30.5% by 2020

*Source: Substance Abuse and Mental Health Services Administration (SAMHSA), Office of Applied Studies, National Survey on Drug Use and Health, 2010.
** Source: CDC, National Health and Nutrition Examination Survey (NHANES), 2010.

Note: Incidents of Depression and Obesity are key indicators of overall health within a community, and as such, are used as the national tracking measures for Priority 5.

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18: Priority 6: Making Quality Care More Affordable for Individuals, Families, Employers, and Governments by Developing and Spreading New Health Care Delivery Models

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Long-Term Goals

  1. Ensure affordable and accessible high quality health care for people, families, employers, and governments.
  2. Support and enable communities to ensure accessible, high quality care while reducing waste and fraud.

Notes: The National Quality Strategy recognizes that while this will be a challenge, the goal of reducing health care costs is important to everyone because of the impact of rising costs on families, employers, and State and Federal governments. Reducing costs must be considered hand-in-hand with the aims of better care, healthier people and communities, and affordable care.

The National Quality Strategy will foster strategies that reduce waste from undue administrative burdens and make health care costs and quality more transparent to consumers and providers, so they can make better choices and decisions.

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19: Priority 6 (continued): Making Quality Care More Affordable for Individuals, Families, Employers, and Governments by Developing and Spreading New Health Care Delivery Models

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National Tracking Measures

Measure Focus
Measure Name/Description Most Recent Rate Aspirational Target
Out-of-Pocket Expenses Percentage of people under 65 with out-of-pocket medical and premium expenses greater than 10% of income 18.5%* See footnote
Health Spending Per Capita Annual all-payer health care spending per person $8,680 per person** See footnote

See the HHS Budget in Brief for a discussion of investments and proposals to reduce health care spending.
U.S. Department of Health and Human Services. Fiscal Year 2014: Budget in Brief. April 2013. http://www.hhs.gov/budget/fy2014/fy-2014-budget-in-brief.pdf

* Source: Agency for Healthcare Research and Quality, Center for Financing, Access, and Cost Trends, Medical Expenditure Panel Survey, 2010.
** Source: Available at CMS Office of the Actuary Web site.
www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html

Note: Out-of-Pocket expenses and Health Spending per Capita are two quantitative measures that help the National Quality Strategy track national progress toward making care more affordable.

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20: Highlighted Initiatives

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NQS Priority Highlighted Initiative Web Site
1. Making care safer by reducing the harm caused in the delivery of care Partnership for Patients http://partnershipforpatients.cms.gov/
2. Ensuring that each person and family members are engaged in their care Consumer Assessment of Healthcare Providers and Systems (CAHPS) http://www.cms.gov/Hospital-Value-Based-Purchasing
3. Promoting effective communication and coordination of care Multi-payer Advanced Primary Care Practice Demonstration (MAPCP) http://innovation.cms.gov/initiatives/Multi-Payer-Advanced-Primary-Care-Practice/
4. Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease Million Hearts http://www.millionhearts.hhs.gov

Notes:

  • Partnership for Patients: a national campaign to reduce preventable hospital-acquired conditions and 30-day hospital readmissions
  • Consumer Assessment of Healthcare Providers and Systems (CAHPS): a survey that asks consumers and patients to report on and evaluate their experiences with health care
  • The Multi-Payer Advance Primary Care Practice Demonstration (MAPCP): a multi-payer collaboration to transform primary care practices around quality outcomes
  • The Million Hearts Campaign: a national effort to prevent 1 million heart attacks and strokes by 2017.

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21: Highlighted Initiatives (continued)

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NQS Priority

Highlighted Initiative

Web Site
5. Working with communities to promote best practices for healthy living Community Transformation Grants (CTG) http://www.cdc.gov/ communitytransformation/
6. Making quality care more affordable by developing and spreading new health care delivery models CMS Innovation Center http://www.innovations.cms.gov
  • Community Transformation Grants (CTG): these grants support community-level efforts to reduce chronic diseases such as heart disease, cancer, stroke, and diabetes.
  • The CMS Innovation Center: this center supports new models of care and innovative practices for Medicare, Medicaid, and CHIP beneficiaries, with the goal of improving the quality of health care while maintaining or reducing costs.

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22: Questions/Comments?

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For More Information:

Note: Thank you.

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