The National Quality Strategy continues to serve as a catalyst and a compass for stakeholders to provide better, more affordable care for the individual and the community. The National Healthcare Quality and Disparities Report continues to track the performance of the nation on health care access, quality, and disparities. The National Healthcare Quality and Disparities Report data demonstrate significant progress in some areas and identify other areas that merit more attention based on the priorities of the National Quality Strategy.
Improving the health of the population can only occur if Americans can access health care services, and the 2015 Quality and Disparities Report demonstrates that access to care continues to improve as a result of the Affordable Care Act. As of March 2016, more than 12.7 million people selected or were automatically re-enrolled for health care coverage through the Health Insurance Marketplaces in all 50 states and the District of Columbia.23 Moreover, while racial, ethnic, and income-related disparities in access persist, many are getting smaller.
Five years after the National Quality Strategy identified six priorities to focus efforts on quality improvement, progress has been made in many priority areas, but wide variations persist. The number of measures in each priority area varies, and some measures carry more significance than others as they affect more people or have more significant consequences. The numbers below are just one way of illustrating progress against the National Quality Strategy priorities.
- Effective Treatment has a high percentage (57%) of measures that are improving and fewer disparities than other priorities have. When disparities are present, a higher percentage of disparities are getting smaller.
- Care Coordination has a lower percentage of measures that are improving. Data that track Care Coordination are limited, due to challenges in measuring this priority area. Stakeholders might seek to improve care coordination for all patients and develop tools that measure care coordination.
- Patient Safety, Person-Centered Care, and Healthy Living have a high percentage of measures that are improving but few disparities that are getting smaller. Stakeholders might seek to improve these priorities by focusing on specific populations whose care is worse than care received by others.
- Patient Safety had gains, with 60% of safety measures improving, led by a 17% reduction in hospital-acquired conditions.
- Person- and Family-Centered Care had 80% of measures improve.
- Healthy Living had 60% of measures improve.
- Data regarding Care Affordability are limited, but several measures have improved since the Affordable Care Act made health insurance accessible to many Americans with limited financial resources. Improvement should begin with the development of reliable metrics.
Federal and state quality initiatives have used the National Quality Strategy to establish frameworks centered on the aims and priorities for improving health and health care quality and achieving cost savings. Together, these initiatives touch the lives of millions of Americans. CMS used the National Quality Strategy aims and priorities as a foundation to develop the CMS Quality Strategy, which guides the activities of all agency components. At the state level, the California Department of Health Care Services adopted the National Quality Strategy's framework to develop its Strategy for Quality Improvement in Health Care.
Other promising programs hold hope for future improvement in the priority areas:
- For patient safety, national efforts saved 87,000 lives and nearly $20 billion in health care costs between 2010 and 2014.24
- For care coordination and person- and family-centered care, the recently announced Accountable Health Communities Model is the CMS Innovation Center model to focus on the health-related social needs of Medicare and Medicaid beneficiaries, by coordinating services between clinical and community-based services at the local level.
- For effective treatment, the Centers for Disease Control and Prevention continues to work toward the goal of preventing 1 million heart attacks and strokes by 2017.
- For healthy living, the Centers for Disease Control and Prevention Community Health Improvement Navigator program provides tools and resources for collaborative approaches to community health improvement, establishes and maintains effective collaborations, and finds interventions that work for the greatest impact on health and well-being.25
- For affordability, the Affordable Care Act provides tools, such as Accountable Care Organizations, to move our health care system toward one that rewards doctors based on the quality, not just the quantity, of care they give patients. As of January 2016, there are 121 new participants in Medicare Accountable Care Organization initiatives designed to improve the care patients receive in the health care system while lowering costs.26
As health care delivery continues to evolve, the framework of the National Quality Strategy and the tracking of the National Healthcare Quality and Disparities Report can help identify system successes that should be celebrated as well as opportunities for improvement.