Humana Standardizes Healthcare Quality Measures for Physicians
The national payer Humana has focused its efforts on better regulating healthcare quality measures in order to reduce administrative burden among physicians.
By - Last week, Humana announced in a company press release the development of a Clinical Quality Metrics Alignment (CQMA) program meant to simplify and regulate healthcare quality measures. The new strategy will be used specifically among doctors who are participating with Humana in a value-based care payment arrangement.
The standardized healthcare quality measures will also benefit providers currently working with Humana in a fee-for-service structure but looking to transition into value-based care reimbursement.
“Measuring and managing quality is key in Iora Primary Care's work to continually improve the value of care delivered to our older adult patients,” said David Gellis, MD, Vice President of Clinical Performance and Development for Iora Health. “Humana's leadership in this area allows us to focus on measures that matter to patients and clinical outcomes, rather than the measurement system. Overall, this initiative recognizes the value of Iora’s relationship-based care model.”
Regulating healthcare quality measures within the private health insurance industry is a necessity for reducing administrative burden among clinicians. Standardized healthcare quality measures would allow providers to report identical data to multiple health plans instead of managing varying metrics among a multitude of payers.
A survey sponsored by Humana and completed by the American Academy of Family Physicians showed that more than six out of ten family physician practices are reimbursed by seven or more health plans, which brings different healthcare quality reporting requirements and excessive administrative burden among doctors.
With physician burnout continuing to be a major issue for the healthcare industry, steps to reduce administrative burden such as through standardized healthcare quality measures may go a long way to alleviating high levels of burnout. With more providers meeting the requirements of MACRA’s Quality Payment Program, commercial insurers may also need to align their quality reporting to that of CMS in order to reduce high levels of administrative burden and physician burnout.
Humana began its progress in creating the Clinical Quality Metrics Alignment (CQMA) program by collecting 1,116 quality metrics among 29 data sources. Then Humana looked at any inconsistent or repetitive measures and analyzed the clinical relevance of each metric. Out of more than 1,000 disparate healthcare quality measures, Humana was able to reduce the number down to only 208 quality metrics.
The new measures bring more focus to patient health outcomes and come soon after America’s Health Insurance Plans (AHIP) introduced core quality measures meant to standardize quality reporting among the nation’s physicians, the release states.
“At Humana, we are committed to helping physicians succeed in their transition from fee-for-service to value-based care,” said Roy Beveridge, MD, Chief Medical Officer at Humana. “Metrics that are not connected to patient health can serve as obstacles in their transition and distract from the intent of care tied to quality. Through our CQMA program, we hope to greatly simplify quality reporting and alleviate physician burdens.”
Humana’s Clinical Quality Metrics Alignment (CQMA) program is also expected to reduce the costs associated with quality reporting as well as improve the impact that quality metrics play in patient health outcomes.
While standardizing quality metrics can assist physicians by easing administrative burden, payers would be wise to provide education and resources to medical practices struggling with quality reporting and value-based care payments, said Amy Nguyen Howell, M.D., Chief Medical Officer at CAPG, in an interview last month.
“Some of the ways that stakeholders and partners like payers can help them is to provide them the education they need. We do a lot at CAPG in giving valuable resources like conferences, symposiums, hands on tools, and kits to really succeed in value-based care. We had a plethora of educational conferences this year,” Howell told HealthPayerIntelligence.com.
Through greater education and regulating quality measures, payers and stakeholders can help providers better navigate the ongoing challenges of quality reporting and value-based payment in a changing healthcare landscape.
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