February 2019
Quality Improvement Priorities for 2019: Focus on the HMO Model
By: Dr. Derek J. Robinson, M.D., MBA, FACEP, CHCQM, Vice President and Chief Medical Officer, Blue Cross and Blue Shield of Illinois (BCBSIL)
Together, we are answering the call for improved value in health care delivery for Illinois. In 2018, BCBSIL’s HMO was recognized by the National Committee for Quality Assurance (NCQA) as one of the highest ranked health plans in the state. Thank you for your commitment to sustaining our long record of success. One of the ways that we quantify our performance and accountability for the health of those we serve is through quality measurement, which continues to evolve. While there are several new quality measures introduced for 2019, we have worked to reduce the number of measures and refine our clinical focus. Below, we highlight several priorities in the areas of cardiovascular care, cancer screening, chronic obstructive pulmonary disease (COPD) management and health equity.
Cardiovascular Care
Despite reduction in the prevalence of heart disease, it remains the leading cause of the death in the U.S. In Illinois alone, more than 25,000 deaths were attributed to heart disease in 2017.1 Given the potential burden of illness and related health care costs for our members, we decided to place greater emphasis on improving cardiovascular health in our Quality Fund. In addition to the current measure encouraging beta blockers after heart attacks, we will now be actively monitoring statin adherence for members with atherosclerotic disease.
Cervical Cancer Screening
Cancer screening and prevention remain a continued focus of our quality program, and we have reintroduced a cervical cancer screening measure to help ensure that numbers of screenings remain high. As you may be aware, 2018 brought some changes to cervical cancer screening guidelines. Last August, the U.S. Preventive Services Task Force (USPSTF) issued new guidelines for women ages 30 to 65, outlining three options: a new option of DNA testing only for human papillomavirus (HPV) every five years, or the earlier options of a Pap test every three years, or co-testing with both the HPV and Pap test every five years.2 BCBSIL supports these recommendations; however, the new guidelines were not issued in time for inclusion into industry-wide specifications led by NCQA. Thus, specifications for assessment of cervical cancer screening for the purposes of our Quality Fund do not include this option yet, but we anticipate this new option will be fully incorporated by 2020.
COPD Exacerbation Management
We also wanted to draw attention to the management of patients hospitalized for an exacerbation of COPD, as network performance in this area has shown some decline recently, according to claims data. Research has demonstrated that the use of systemic steroids in acute exacerbations improves the odds of treatment success,3,4 and that use of short-acting and long-acting bronchodilators relieves acute symptoms and reduces the risk of long-term exacerbations, respectively.5 While both interventions should be pursued with hospitalized COPD patients, since the systemic steroid rate of use is lower than that of bronchodilators for HMO members, we have decided to add a measure for steroid use post-discharge to our Quality Fund.
Health Equity
BCBSIL recognizes that understanding how to address social determinants of health and reducing racial and ethnic health care disparities is a long-term initiative that will take concentrated effort working in close coordination with provider partners, community-based organizations and our members. That effort includes an incentive for providers to receive health equity training to ensure that HMO providers are aware of cultural and structural biases that may be impacting the care they deliver to our members. Over time, we will invest in more robust methods to assess and understand health disparities and their implications on health care outcomes, and we will look forward to transitioning our efforts to work with providers to develop more creative interventions to address health care disparities more directly.
For more information on specific measures, annual HEDIS reports, site visits and more, refer to the Quality Improvement page in the Clinical Resources section of our Provider website.
Thank you for your partnership as we work to promote improved health outcomes and access to quality care and services for our members and their communities across Illinois.
Learn more about Dr. Derek J. Robinson
1 Illinois Department of Public Health. http://www.dph.illinois.gov/sites/default/files/Leading%20Causes%20of%20Death%20by%20Age%20Group%202017.pdf
2 USPSTF. Screening for Cervical Cancer: U.S. Preventive Services Task Force Recommendation Statement. JAMA. 2018;320(7):674-686.
3 Aaron SD, Vandemheen KL, Hebert P et al. Outpatient oral prednisone after emergency treatment of chronic
obstructive pulmonary disease, New Engl J Med 2003; 348:2618-25.
4 Abroug F, Ouanes I, Abroug S, et al. Systemic corticosteroids in acute exacerbation of COPD: a meta-analysis of controlled studies with emphasis on ICU patients. Ann Intensive Care. 2014;4:32.
5 Hanania NA, Donohue JF. Pharmacologic interventions in chronic obstructive pulmonary disease: bronchodilators. Proc Am Thorac Soc. 2007 Oct. 1;4(7):526-34.
The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. References to third party sources or organizations are not a representation, warranty or endorsement of such organizations. Any questions regarding those organizations should be addressed to them directly. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.