New Health System Scorecard: States Made Little Progress in Years Prior to ACA

The Commonwealth Fund’s Scorecard on State Health System Performance, 2014, assesses states on 42 indicators of health care access, quality, costs, and outcomes over the 2007–2012 period, which includes the Great Recession and precedes the major coverage expansions of the Affordable Care Act. Changes in health system performance were mixed overall, with states making progress on some indicators while losing ground on others.

“This state scorecard underscores the importance of national and state actions to ensure that no matter where a person lives, they have access to an affordable, high-quality health system,” said Commonwealth Fund Senior Vice President Cathy Schoen.  Radley_aiming_higher_2014_state_scorecard

The Journey Towards the Patient-Centered Medical Home: The Kansas City Experience

This report was prepared by Qualis Health to share insights and lessons learned about PCMH development in the safety net setting.  From the report summary:

This white paper was prepared to disseminate the learnings from the REACH Healthcare Foundation Medical Home Initiative to the broader health community as primary care practice is redesigned to adopt the patient-centered medical home (PCMH) model of care. It examines the journey of nine safety net primary care clinics in Kansas City as they strive to integrate components of patient-centered care into their daily work.

The results are instructive for safety net clinics, collaboratives, and funders.  Click here to read the report (in pdf format) from the Qualis Health website.


New Report: Integration of Oral Health and Primary Care Practice

We are pleased to pass along this email message received today from the Virginia Oral Health Coalition:

In response to the need for improved access to oral health care, the Health Resources and Services Administration (HRSA) developed the Integration of Oral Health and Primary Care Practice (IOHPCP) initiative. Coalition staff and board members were invited participants in the stakeholder group which helped develop these recommendations.

The resulting IOHPCP report reaffirms the Coalition’s message that oral health is a necessary component of primary care and outlines simple steps for integration, including:

  • Apply oral health core clinical competencies, such as oral health assessments, within primary care practices;
  • Develop an infrastructure that enhances adoption of the oral health core clinical competencies and acts as a conduit for interprofessional care; and
  • Modify payment policies to efficiently address the costs of implementing oral health competencies and provide incentives to health care systems and practitioners.

If you’re interested in more information about oral health and primary care integration (academic or clinical settings), please contact Sarah Bedard Holland at 804.269.8721 or The Coalition has a menu of resources for large- or small-scale integration.

Read the full report

Structuring Payment to Medical Homes After the Affordable Care Act

This research brief from the Commonwealth Fund summarizes findings and recommendations from a recent study by Harvard Medical School’s Samuel T. Edwards and colleagues as published in the Journal of General Internal Medicine.  Edwards et. al. conclude that patient centered medical homes (PCMHs) and accountable care organizations (ACOs) are complimentary approaches, and the authors recommend specific payment approaches for integrating PCMHs with ACOs.

Read the full Brief at the Commonwealth Fund website.

Marketplace Virginia Proposal

The document at this link presents a report from the Senate Finance Subcommittee on Health and Human Resources dated February 16, 2014.  This document contains a description of the Marketplace Virginia proposal.  Please note that this proposal is subject to change as the General Assembly continues its work.


Three Main Types of Quality Measures

When developing a quality strategy it is helpful to remember that there are three main types of quality measures that should be considered: process measures, outcome measures, and structure measures.  The following definitions are based on information provided by the AHRQ National Quality Measures Clearinghouse.

  • Process Measures.  A process of care is a health care related activity performed for, or on behalf of, a patient.  Process measures are supported by evidence that the clinical process – that is, the focus of the measure – has led to improved outcomes.  An example of a process measure would be the percent of patients with hypertension who received timely blood pressure screens.
  • Outcome Measures.  An outcome of care is a health state of a patient resulting from health care.  Outcome measures are supported by evidence that the measure has been used to detect the impact of one or more clinical interventions.  An example of an outcome measure would be the percent of patients with hypertension whose blood pressure is under control.
  • Structure Measures. Structure of care is a feature of a health care organization or clinician related to the capacity to provide high quality health care.  Structure measures are supported by evidence that an association exists between the measure and one of the other clinical quality measure domains.  An example of a structure measure would be whether the health care organization maintains a register of patients with established hypertension.

Some organizations recommend two additional categories of measures including patient experience measures and access measures.  However these types of measures are not as widely used, and they may also be included as appropriate under one of the three main categories outlined above.

Focusing on PCMH development, the PCMH model is based on recommended practices for the structure of health care.  In this context, implementation of the PCMH standards and elements can be viewed as structural indicators of quality.


The Quality Challenge: Getting a Handle on PCMH Performance Metrics

As the PCMH model spreads it is also receiving more scrutiny from stakeholders who want to be assured of PCMH performance. As a result various national organizations are publishing recommendations for PCMH performance metrics. We recently posted an inventory of PCMH Performance Metrics as a page under the PCMH Insight menu item. Please check it out and let us know what you think.