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Quality Improvement: Processes & Best Practices in Healthcare

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Written by Alex Ramirez, MHA

Addressing quality improvement in the healthcare industry may feel like a daunting task. Many practices face staffing shortages, limited resources, and an abundance of patients with complex chronic illnesses. Despite technological advancements in data collection and risk assessment, implementing quality improvement measures that encourage proactive, preventive care delivery may seem impossible for already overburdened healthcare practices. 

However, meaningful quality improvement is achievable. Through patient education and outreach, your practice can engage patients on positive care journeys that facilitate a proactive approach to health. Investing in quality improvement strategies promotes effective and efficient care, conserves resources, reduces costs, and increases patient satisfaction. 

Practices don’t need to undertake quality improvement measures alone. In this article, we’ll examine how Chronic Care Management (CCM) services assist healthcare providers in implementing quality improvement, raising quality improvement scores for MIPS or for your  ACO, and generating additional revenue through CMS reimbursements.* We will also explore the broader goals and tangible benefits of quality improvement endeavors. 

*Results may vary by provider. 

What is quality improvement in healthcare?

Quality improvement is a systematic, measurable approach to healthcare delivery that increases efficiency, effectiveness, and positive outcomes for patients, practices, and healthcare organizations. This healthcare strategy implements measures to reduce avoidable hospitalizations and emergency interventions, encourage financial efficiencies for patients and healthcare providers, and standardize procedures and processes that deliver high-quality care. 

Quality improvement emphasizes safe, equitable, and timely patient-centered care. When properly implemented, quality improvement helps patients achieve favorable clinical outcomes and a higher quality of life. By facilitating quality improvement as part of value-based care, healthcare providers can achieve consistency, reduce wasted resources, and earn additional revenue*. 

What is quality in healthcare?

In healthcare, ‘quality’ refers to the timeliness, effectiveness, and accuracy of care delivery. High-quality healthcare positions patients for optimal clinical outcomes, maximized longevity, and the highest quality of life. A practice-wide, committed investment in continuous quality improvement is critical to your enterprise's success.

Prioritize proactive interventions and preventive care over a reactive care delivery model. Care should improve patient engagement, encourage compliance with medication adherence and wellness plans, and result in more optimized, data-driven internal processes. 

Quality in healthcare is directly linked to patients’ quality of life as they manage chronic illnesses and post-operative care. Quality improvement measures seek to prolong patients’ lifespans and create the conditions for patients to live vibrant and rewarding lives. 

The 6 primary goals of healthcare quality

In 2001, The Institute of Medicine (IOM) proposed six primary healthcare quality domains to guide healthcare providers and organizations in standardizing the elevation of care delivery. This framework has been widely adopted across the healthcare industry to discuss and measure quality in healthcare. The six domains are: 

  1. Safety: The treatments, medications, and interventions administered to patients should never place them at risk of undue harm. All clinical care provided should, first and foremost, be to help the patient. 
  2. Effectiveness: Services should be provided based on scientific research to all who can benefit them. The service should be avoided if a treatment or medication is unlikely to help a patient. This domain ensures that treatments' underuse and misuse are mitigated wherever possible. 
  3. Timeliness: Patients and providers should not face extended and harmful wait times and delays. Timeliness includes reducing wait times for routine appointments, screenings, and emergency services.
  4. Efficiency: High-quality care should avoid waste and redundancy. This includes wasting medical resources and supplies, healthcare providers' time and energy, and patients' time and money. 
  5. Equity: Care should be distributed uniformly across all patients. Patient characteristics like race, gender, socioeconomic background, sexuality, and ethnicity should never impact the care delivered to a patient. 
  6. Patient-Centeredness: Care should be dynamic and responsive to each patient's unique preferences. Clinical decisions should be guided by patients and respectful to the worldview and values of every individual patient. 

CMS’s quality improvement programs and quality scores

The Centers for Medicare and Medicaid Services (CMS) devised programs and accompanying quality scores to encourage practices and hospital networks to engage in high-quality care delivery and continuous quality improvement measures. These are called Quality Payment Programs (QPP) and offer reimbursements to clinicians for administering Medicare Part B-covered services and improving quality and patient outcomes. 

These programs include the Traditional Merit-Based Incentive Payment System (MIPS) and the newly streamlined and enhanced MIPS Value Pathways (MVPs). These programs observe four categories of care delivery: quality, improvement activities, promotion of interoperability, and cost. MIPS and MVPs use a composite performance score to determine payment bonuses for practices based on these categories. 

CMS also offers MIPS Alternative Payment Models (APMs). These offer other pathways to receive CMS reimbursements, like providing care through Accountable Care Organizations (ACOs). ACOs are collections of doctors, hospitals, specialists, and other healthcare providers coordinating to deliver high-quality care to Medicare recipients. ACOs emphasize timely interventions, eliminating duplicated or extra services, and preventive care. ACOs are especially effective at managing the complex needs of chronically ill patients. They also receive reimbursements from Medicare for achieving savings and improving care quality.  

No matter which program you choose, maximizing your quality scores will allow your practice to receive recurring revenue* streams from CMS as you effectively implement quality improvement measures. 

What are quality improvement measures?

Quality improvement measures are actions taken by healthcare providers to facilitate high patient engagement and optimal clinical outcomes. CMS defines quality measures as tools that help healthcare providers measure or quantify the success of processes, outcomes, patient perceptions, and structures in achieving healthcare goals.

Closing gaps in care is a significant quality improvement measure. This includes facilitating blood work, diagnostic tests, preventive screenings, mental health evaluations, and Social Determinants of Health (SDOH) assessments for at-risk patients. 

Quality improvement measures also encompass refining care coordination between patients and their healthcare providers, and between practices and hospitals across healthcare networks. Data-driven patient risk analysis, effective patient communication and outreach, balanced workloads for hospital employees, and consistent, streamlined processes are all quality improvement measures implemented by healthcare systems and organizations.  

Examples of quality improvement in healthcare:

  1. Using data-driven analytics to discover and address outstanding gaps in care among patients
  2. Educating patients on their unique risk profile informed by their age, gender, and familial history 
  3. Facilitating preventive screenings to preemptively identify chronic illnesses like high blood pressure, diabetes, and heart disease 
  4. Standardizing protocols, guidelines, and best practices to ensure consistency and reliability in care delivery across different settings 
  5. Lowering the cost of care for patients through intentional, personalized wellness planning that reduces hospital readmission and redundant testing
  6. Creating seamless care coordination that ensures patient records are readily accessible across healthcare providers and networks 
  7. Optimizing clinical and administrative processes to reduce errors, delays, and inefficiencies that obstruct the timely delivery of care
  8. Adopting an interdisciplinary approach to healthcare that includes behavioral healthcare in addition to traditional physical healthcare 
  9. Prioritizing patient-centered care through actively involving patients in every step of the clinical decision-making process
  10. Removing barriers to access for patients by arranging for transportation to appointments and medication refills and improving patient health literacy
  11. Addressing the social and economic factors that contribute to a patient’s physical and mental wellbeing
  12. Promoting a culture of continuous improvement by regularly assessing performance and adjusting strategies and processes when needed

What are the benefits of quality improvement?

Standardizing and streamlining healthcare processes through quality improvement conserves the time, energy, and resources of healthcare networks, providers, and patients. Standardized processes ensure that consistent inputs achieve reliable outputs (accounting for some degree of chance beyond the control of the healthcare providers). 

When preventive care is administered effectively, patients experience brighter clinical outcomes, reduced hospital readmission rates, and milder symptom self-management. This alleviates pressure from the greater healthcare landscape, as these healthier, more engaged patients often utilize fewer resources and require fewer emergency interventions. 

Quality improvement benefits everyone interacting with the broader healthcare system, from the individual patient to the primary care provider to the hospital network administrator. 

Benefits of quality improvement for patients: 

  • Up-to-date and holistic patient health profiles through robust communication and enhanced care coordination 
  • Optimal clinical outcomes through preventive and personalized care
  • Improved access to primary care, specialists, and emergency services
  • Better quality and longevity of life by addressing illness and chronic health conditions in their early stages
  • Fewer readmissions to hospitals
  • Reduced healthcare costs
  • Lower healthcare resource utilization and waste

Benefits of quality improvement for the healthcare system:

  • Healthier patient populations through education and activation
  • Decreased burden on public healthcare systems through streamlined processes, healthier patients, increased access, and lower healthcare costs  
  • Better quality of care that encourages higher patient satisfaction and engagement
  • Lower waste, fraud, and abuse through standardization and accountability 
  • Recurring revenue* streams through CMS by maximizing quality improvement scores

Learn more: 5 Strategies to Improve the Quality of Healthcare

5 ways to incorporate quality improvement measures in your practice 

Your healthcare practice can integrate quality improvement measures into your everyday workflow by standardizing processes, leveraging patient data, closing gaps in care, and championing a culture committed to continuous quality improvement. Programs like Chronic Care Management (CCM) can also help you incorporate quality improvement measures and receive CMS reimbursements. 

1. Close gaps in care

Closing gaps in care is one of the most effective measures to improve care quality and bolster quality improvement scores. It requires shifting your focus from reactive care to preventive care. Use data-driven analytics to identify outstanding care gaps in patients and assist them in scheduling the appointments necessary to close them.

2. Emphasize education, engagement, and communication with patients 

Part of closing gaps in care involves patient education and ongoing communication. Engage patients in their journey by creating individualized wellness plans targeting their unique health risks based on age, gender, family history, and lifestyle. Emphasize patient education and engagement. Engaged patients are more motivated to receive screenings and other forms of preventive care. 

3. Leverage data-driven insights to improve processes and identify patient risks

Collecting and analyzing clean patient data allows you to make more effective evidence-based care decisions. Synergized clinical data can unlock insights into the success of medications and treatments and their impact on resource use and healthcare costs. Analytical risk assessments can also identify and categorize patient risks and unresolved care gaps, eliminating the added work of reading through individual patient profiles and health histories. 

You can also use data to observe the success of internal processes and benchmark performance after implementing quality improvement measures. As technology continues to accelerate, practices should capitalize on these advancements to serve their patients and providers.   

4. Champion a culture of continuous quality improvement  

Leadership within a healthcare organization should proudly champion a culture of quality improvement by celebrating the wins and highlighting the positive difference quality improvement measures make in patients' lives and the practice's operation. 

Quality improvement often requires an initial change in routines and processes for many employees. This can be daunting or frustrating if the changes are not adequately explained to all practice employees. Furthermore, the changes may seem like unnecessary complications if the positive results are not acknowledged,

Take the opportunity to create a culture committed to continuous improvement for healthcare professionals, patient populations, and the broader healthcare system. Quality improvement measures are most successful when there is complete buy-in from all parties involved.  

5. Implement a Chronic Care Management program for your Medicare patients 

Chronic Care Management (CCM) is a comprehensive, coordinated program that facilitates high-quality care delivery and brighter clinical outcomes for Medicare patients with multiple chronic conditions. Through ongoing patient outreach and education, care coordination, and emphasizing proactive engagement in healthcare services, CCM programs excel at integrating quality improvement measures into practice workflows. 

CCM programs can enhance the quality of care your practice provides with a wide range of services. These include medication refills and deliveries, arranging transportation and appointments, and assisting patients in closing gaps in care. A properly executed CCM program can elevate care quality across your practice.

Learn more: The Challenges of Delivering High-Quality Care to Patients with Chronic Conditions

How ChartSpan’s Chronic Care Management program enhances quality improvement measures 

ChartSpan is an industry-leading provider of fully managed Chronic Care Management (CCM) services. After asking patients if they would like to enroll in Chronic Care Management , we create analytics-driven risk assessments to locate CCM patients with unaddressed gaps in care. We emphasize data integrity, ensuring we accurately identify patients’ individual risk factors. This data-driven analysis saves practice staff time and energy and can mean the difference between a timely intervention or an emergency hospital visit for patients. 

Care providers at your practice have limited face-to-face interaction with patients. They may not notice that a patient is due for a cancer screening or vaccination until the patient visits for a scheduled appointment. ChartSpan can identify these care gaps, report them back to providers, and assist patients with scheduling appointments to close them. These preventive services  could include: 

  • Breast cancer screenings
  • Influenza immunizations
  • Colorectal cancer screenings
  • Diabetic eye exams
  • Hemoglobin A1C control for diabetes
  • Depression screenings
  • Pneumonia vaccinations
  • BMI screenings and follow-ups
  • High blood pressure control
  • And more

In addition, ChartSpan’s care managers maintain a monthly cadence of communication over the phone with every enrolled patient. This gives us an additional twelve annual touchpoints to discuss gaps in care and encourage patients to seek preventive services. Sometimes, engaging patients in their care journey proves difficult, but through CCM, care managers can provide education, self-management tips, and resources to patients every month. Investing in care quality and patient communication can help engage previously reluctant patients.

Finally, ChartSpan offers complimentary quality improvement services to all CCM clients who request them. Our quality team will meet with your practice to help you identify opportunities to address care gaps and improve the quality measures that are most significant to you. 

Learn more: Chronic Care Management: A Guide for Providers

Raise your quality scores with ChartSpan’s dedicated quality improvement services

Your MIPS scores, ACO compliance, and reimbursements will improve organically through ChartSpan’s data-driven identification, assistance, and patient outreach. We help patients with scheduling diagnostics, cancer screenings, lab work, and other proactive care. These preventive services are then billed to Medicare, so you can prove a closed gap in care and increase your practice’s quality scores and reimbursements for high-quality care delivery. Through billing CCM services, practices can open up a new and recurring stream of revenue* for their practice.

Our commitment to quality improvement and preventive care is foundational to our mission. To help ensure your practice maximizes opportunities, ChartSpan provides all of our healthcare partners with complimentary MIPS and quality improvement services to help them elevate their scores. Contact us to learn how a partnership with ChartSpan can support your practice in quality improvement endeavors. 

*Results may vary by provider. 

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