Grand Rounds Blog

The early signs of trouble appeared more than a decade ago, when the Institute of Medicine published “Crossing the Quality Chasm” and drew attention to tens of thousands of lives impacted by high-variation, low-quality healthcare in the United States. Since then, a steady stream of evidence has shown a massive healthcare quality management problem in this country that is impossible to ignore.

Though awareness of the problem has increased markedly, we are still a long way from solving it. The recent IOM report on misdiagnosis shows that the quality problem persists unabated, profoundly impacting the lives and livelihoods of both consumers and purchasers of healthcare.

Efforts to address low-quality care

Though the variation and opacity in quality persists, it is not due to a lack of effort. Multiple approaches have been attempted to address the problem, with varying degrees of success. Payers have begun to knit together “high performance” networks, carving out low-quality (or low-value) physician groups. Though, their hands are often tied by powerful provider groups that prohibit differentiation of doctors within the same institution.

Employers have tried to work around these issues by contracting directly with centers of excellence, using additional data to select top practitioners for high impact procedures. The government is also playing a role, offering incentives for reporting quality indicators and reducing obvious sources of waste like readmissions. Health systems are beginning to respond to this changing landscape, adopting new documentation, tracking and measurement tools to identify and improve behavior and outcomes.

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