The National Committee for Quality Assurance (NCQA) began hosting its annual Quality Talks event in 2015 in order to highlight innovation in the healthcare industry that has the potential to improve quality care and change the status quo going forward. This year’s talks were no exception, from discussions on what’s in the technology pipeline to a movement to make sure that innovation does not drown out personalization for patients.
In the introductory talk by NCQA founder and President, Margaret O’Kane, she discussed the goal to align measures across each of the different platforms, and additionally for these measures to be reported directly in a system to system format. Quality reporting is rapidly enabling the gathering of needed data, specifically with HEDIS measures gaining momentum: 57% of the population is now represented in the data, which equals 184 million lives. Despite the obvious use of data and technology, and the evidence on how its use improves patient care, many of the speakers focused their comments on the patients themselves. Surgeon and Johns Hopkins professor of health policy, Dr. Martin Makary, emphasized the fact that what matters to the patient is not usually what matters to the physician. In his talk Measure What Matters: Asking the Tough Questions, Dr. Makary stated that patients are hungry for honesty in healthcare, and that a recent study found that 21% of procedures may be unnecessary. Patients want to know if they actually need the procedure or medication being prescribed, and that a good doctor is not defined by the outcome measures, but in part by their honesty—being able to tell a patient “I don’t know,” and by giving consideration to the making appropriateness of certain types of care in healthcare a focus for the benefit of each individual patient benefit.
One of the speakers to highlight making a push towards a more human connection was Lynn Baneszak, executive director of the Disruptive Health Technology Institute (DHTI) at Carnegie Mellon University (CMU). For an institute with the title ‘disruptive’, Ms. Baneszak’s comments during her talk Building Health Care’s Future: A Prognosis were refreshingly down to earth, or should we say, at the patient level. With a call to action to remember the human connection in healthcare, Ms. Baneszak stressed that 87% of patients feel that kindness is an important consideration in choosing a provider, and three quarters of study respondents said they would pay more for a provider who emphasized kindness in care. She encouraged this aspect of care by highlighting how providers must apply the technologies that are coming next, while finding a way to make and maintain the personal connection in the era of checking boxes next to pre-determined questions.
After dropping that CMU was responsible for developing the first emoticon – the smiley face – she explained that at the institute, disruption using innovation means “a big leap in a shorter time to get it off the bench and into the field.” With the goal of increasing affordability, accessibility and effectiveness of healthcare, DHTI is using technology such as artificial intelligence and 3D printing, along with models such as behavioral economics and human computer interaction to determine what’s next and what works in healthcare. Once such use of a technology not typically found in healthcare, is the use of the same algorithm that recognizes faces in a crowd. Applying this to colonoscopies has helped to find polyps more quickly, and decrease the resulting blurriness when the camera is moving back and forth. Not limiting themselves to technology, they have also spearheaded the research and use of bioactive raspberry extract to reduce permeability in the GI tract–leading to an inexpensive therapy that lacks the side effects of conventional medicine.
Also heavy on technology innovation is IBM Watson Health. Dr. Kyu Rhee, Watson’s Chief Health Officer and President of the IBM Health Services, discussed some of the ideas they are exploring to improve quality of care, but also quality and efficiency in practice. During the discussion The Future of Health Is Cognitive: Beyond Jeopardy, IBM’s Watson Provides Health Care Answers, he discussed the potential for an automated accreditation process — rather than have practices and facilities allot a large amount of staff time for compiling paperwork and completing recertification and accreditation applications, having the appropriate technology in place would allow for continuous and automated accreditations.
On the patient front, IBM is exploring how utilizing devices and instruments in the home can predict and prevent frailty conditions in the ever-growing aging population. IBM calls their intended use of technology Augmented Intelligence. The quality comes from not just the stores of data but a system that can support providers in identifying patterns, and complementing the people who focus on the actual relationships with patients. According to Dr. Rhee, the three principles of AI are to:
- Support humans, not replace them,
- Provide essential transparency: this is “not a black box, it’s a glass box.” There must be transparency in how these systems are trained and the information that is used to make recommendations,
- Create a new model of human plus AI to deliver outcomes.
Evidence, Ethics and Value
Providing the right care where and when the patients need it continued to be a focus in the discussion on Toward More Complete Health & Wellbeing, by Kyle Hill, Co-Founder & CEO of Harvey, a leading telehealth provider of personalized and integrative medicine. With four out of five deaths in the US being due to lifestyle diseases, Mr. Hill explained that they decided to go for the “lowest hanging fruit” in healthcare — the patients who fall through the cracks of the conventional medical system and are misdiagnosed or not diagnosed at all. Using a telehealth platform, Harvey brings integrative medicine to the patients via video consults in home with a number of integrative health providers, with the intention of complementing conventional medicine and creating more of a focus on personalized prevention. Mr. Hill challenged the medical community to build more whole-body health measures into their quality metrics, and to welcome integrative health professionals into patient care. Reducing the $400 million prescriptions written annually is a main goal of preventative integrative healthcare, and the industry is starting to warm up to this care — the University of California at Irvine just received a $200 million grant to start an Integrative Medicine department.
Perhaps the most impactful talk of the event was focused around ensuring quality in end of life care for all patients. Nneka Mokwunye Sederstrom, Director of Ethics for the Children’s Hospitals & Clinics of Minnesota, gave the stirring address Ethics Is Quality, Quality Is Ethics: Improving Care at the End of Life. According to Ms. Sederstrom, approximately 80% of patients want to die at home, but 60% of patients die in hospital, 20% in nursing homes, and only 20% die at home. “We know that dying is a thing, so why don’t we work toward the goals of dying patients?” Patients desire to be free of pain and to die peacefully at home — the medical community needs to adjust and have death be embraced as a natural end of life, not a situation in which technology goes from being curative to organ substituting, with a “no one gets out of life alive” attitude. Enhancing the quality of end of life care challenges providers and facilities to develop quality indicators that measure how they are doing with end of life care, and to create dashboards that measure successes, applying the same tools that are used to measure quality and improvement in chronic and preventative care.
Ms. Sederstrom ended with a challenge for participants to take a hard look at their institutions, with a list of 10 suggested questions to start:
- How many patients received a palliative care consult in the last 6 months?
- How many patients were offered hospice?
- How many had advanced directives or other durable power of attorney forms?
- How many with terminal disease were given death preference?
- How many received end of life care counseling?
- What are the demographics of those who received that counseling?
- Where did your patients die? Was that where they wanted to die?
- What are the barriers for your patients at the end of life?
- How many had an ICU admission in the last year of life?
- How many had an ethics consult last year of life?
The 2017 NCQA Quality Talks provided attendees with a glimpse into how technology and other innovations are continuing to push quality in healthcare forward. While pushing at these boundaries, the talks also provided the very timely reminder that patient care should always be focused on the most important measure of quality: the patient.