What are the most effective ways to use managed care quality measures to improve healthcare safety?

1 Why healthcare safety matters

Healthcare safety is a vital aspect of quality care, as it affects the outcomes, experiences, and costs of health care for patients and providers. According to the World Health Organization, unsafe care is one of the leading causes of avoidable harm and death in health systems, and it can also result in medical errors, infections, injuries, and lawsuits. Improving healthcare safety can reduce the burden of harm, enhance patient satisfaction and trust, and save resources and lives.

2 What are managed care quality measures

Managed care quality measures are standardized indicators that assess how well health plans, providers, and other entities deliver health care services according to evidence-based guidelines, best practices, and patient preferences. These measures can cover various aspects of health care, such as clinical quality, patient experience, access, utilization, efficiency, and equity. For example, the Healthcare Effectiveness Data and Information Set (HEDIS) measures the performance of health plans on over 90 metrics related to preventive care, chronic disease management, behavioral health, and more. Additionally, the Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys patients about their experiences with health plans, providers, and facilities. Lastly, the National Quality Forum (NQF) endorses and maintains a set of national consensus standards for measuring and reporting on health care quality.

4 How to collect and analyze managed care quality data

Once you have selected your managed care quality measures, you need to collect and analyze the data that will inform your performance and improvement. To do this, you must first define your data sources and methods, such as electronic health records, claims, surveys, or audits. Additionally, you should plan when and how often you will collect and analyze the data, who will be responsible for each task, and what tools and techniques you will use to process and interpret the data. Lastly, you must decide how and to whom you will report and share the data and the results of your analysis. Consider the format, frequency, and channels of your communication such as reports, newsletters, or websites.

5 How to use managed care quality data to improve healthcare safety

The ultimate goal of using managed care quality measures is to improve healthcare safety and quality for patients and providers. To achieve this, you should identify and prioritize improvement opportunities by using data and analysis to identify gaps in performance. Additionally, you need to implement and monitor improvement actions, which should include goals, objectives, actions, resources, and timelines. Furthermore, recognize and reward improvement achievements by acknowledging successes, celebrating improvements, rewarding efforts, sharing best practices, and fostering a culture of continuous learning.

6 Here’s what else to consider

This is a space to share examples, stories, or insights that don’t fit into any of the previous sections. What else would you like to add?