Quality initiatives in healthcare refer to official measures by government or industry organizations that aim to improve the quality of care. The most well-known are those introduced and managed by the Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS), including the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs).
Quality initiatives are part of an industry-wide transition to a value-based care model. Essentially, they exist to facilitate and incentivize all healthcare industry stakeholders to transform their practices in a way that improves patient outcomes, healthcare equity, and cost efficiency. By participating in quality initiatives, healthcare organizations can receive greater financial support from the government.
Many quality initiatives focus on reporting performance according to various metrics, called quality measures. Different types of practice will engage with different quality initiatives and target different measures. Still, broadly, they should all demonstrate an improvement in value-based care (e.g., a reduction in ED admissions or end-of-life expenses). Let’s take a closer look at how quality initiatives work in cancer care.
Quality Initiatives in Oncology
Quality initiatives are especially important in oncology. The current trend in best practices for cancer care is based on precision medicine. In precision medicine, the treatment of patients is informed by factors particular to that individual, such as their genetic makeup and socioeconomic background. This data-driven approach is naturally aligned with value-based care, which supports informed, cost-effective treatment that delivers the best results rather than the highest number of billed procedures.
Several quality initiatives are effective in precision oncology, especially:
- Enhancing Oncology Model (EOM) - This voluntary CMS initiative is the successor to the previous Oncology Care Model (OCM). The OCM successfully reduced ED admissions, end-of-life hospice care, and hospitalizations. The new EOM builds on this by tracking and incentivizing equity of cancer care, with special attention to underserved populations.
- Merit-based Incentive Payment System (MIPS) - This quality initiative is used throughout the healthcare sector as the framework for reimbursing healthcare organizations according to quality measures. By submitting performance data to MIPS, oncology practitioners qualify for financial rewards.
How to Get Started With Quality Initiatives
Getting the most out of quality initiatives requires a practice overhaul in two areas: aligning your organization’s leadership and company culture with the value-based care approach such as Practice Transformation and implementing IT solutions to facilitate and streamline the process.
Here’s what you should look for in a technological solution for precision oncology:
- Advanced Data Analytics: Demonstrating performance in quality initiatives involves gathering, reporting, and translating all relevant data into actionable steps toward improvement. This includes EHR, admissions, population data, end-of-life expenses, claims, and much more.
- Intuitive Operational Platform: Along with comprehensive data analytics, a good IT solution should provide a feature-rich platform for viewing, sharing, and securing this data among all relevant stakeholders
- Oncology-Specialized: The most effective way to improve performance is to partner with a technology vendor with proven expertise in your specialty, as its processes will already be optimized for cancer care.
By keeping these factors in mind, you should easily find a technology solution for quality initiatives in cancer care that works well for your practice.
References:
https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo
https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/Value-Based-Programs
https://innovation.cms.gov/innovation-models/enhancing-oncology-model
https://www.ajmc.com/view/new-enhancing-oncology-model-builds-on-knowledge-from-the-ocm
https://www.advisory.com/blog/2022/07/enhancing-onc
