Federal Agency Measures Health Care Quality

Among the Patient Protection and Affordable Care Act’s provisions are additions to the Public Health Service Act that focus on improving health care quality. As discussed in a previous post PHSA Secs. 2715 and 2717 require the federal government to develop uniform standards for plans' benefit summaries and explanations of coverage and guidelines for health insurers to report on their quality of care initiatives and programs.

The Agency for Healthcare Research and Quality, in the U.S. Department of Health and Human Services, has been addressing health care and health insurer quality issues since 1995 with its Consumer Assessment of Healthcare Providers and Systems (CAHPS) program, a public-private initiative to develop standardized surveys of patients' experiences. The AHRQ’s stated mission is to “foster health care research that helps the American health care system provide access to high-quality, cost effective services; be accountable and responsive to consumers and purchasers; and improve health status and quality of life.”

Most recently, the AHRQ published a Notice of Request for Measures to determine how well health plans and health providers address health plan enrollees' health literacy needs and how well they communicate with health plan enrollees.

The intent of the planned survey, the AHRQ says, is “to gain patients' perspective on how well health and health plan information is communicated to them by healthcare professionals and health plans.” Health plans, medical providers, and others may use the results of the survey to determine the quality of the health information they provide and the best methods to deliver that information to plan enrollees and to patients.

The issues that the measures would assess could include, for example, clarity and simplicity of provided health information related to preventive services (for example, risks and benefits of the service, explanation of screening results); health problems/concerns (such as information on how to stay healthy or prevent illness); treatment choices, instructions, or goals including pros and cons of each option; medications (for example, reason to take the prescribed medications, instructions on how to take the medications, and possible side effects); and care management/disease management.

Another subject that may be assessed is the quality of services that support delivery of health information, such as language access, including availability in other languages and timeliness of customer service and interpreter services and of forms and patient education materials, the quality and accessibility of member services, nurse advice lines, and health plan information on coverage, benefits, and billing information, health plan system navigation and health plan environment (language access and assistance in completing medical paperwork or forms, signage).

Since the CAHPS program started in 1995 it has expanded to include surveys and reports on individual medical services providers, group medical practices, kidney dialysis centers, nursing homes and hospitals. Most recently, AHRQ determined that the CAHPS should develop a survey to obtain the consumers' perspective on the quality of health information (another element of health reform).

Federal law gives the AHRQ the power to conduct and support research and distribute information on health care and on delivery systems including on the following elements: quality, effectiveness, efficiency, appropriateness and value of health care services; quality measurement and improvement; outcomes, cost, cost-effectiveness, use of health care services and access to such services; and health statistics, surveys, and database development.

So, in terms of health care quality assessment and improvement, one federal agency at least already is well established and moving forward to aid in health reform. Check out the AHRQ’s Website