Government, private insurers find common ground on quality health care

The Obama administration on Tuesday trumpeted an “historic” effort to standardize how private insurers and government programs like Medicare determine if a patient is getting quality care, saying doctors had been overwhelmed by a dizzying array of yardsticks.

The Centers for Medicare and Medicaid Services teamed with private insurers to settle on clinical measures in seven key areas of medicine — from primary care, cardiology, gastrointestinal care, HIV and hepatitis C, oncology, orthopedics and obstetrics/gynecology.

Dubbed the Core Measures Collaborative, the effort is part of a broad push to reward good outcomes for patients instead of encouraging doctors to wrack up bills with additional services, while making sure everyone is using the same standards.

“This is a major step forward for alignment of quality measures,” said Carmella Bocchino, executive vice president for America’s Health Insurance Plans, the industry’s main lobbying group.

Government programs like Medicare will begin to adopt the new standards by next year, officials said. Private insurers will phase them in around the same time, as they update or renew contracts with doctors and other health care providers.

Officials said the collaborative will keep tabs on how the measures work and update them as needed.

The American Medical Association characterized the standards Tuesday as a “work in progress,” but said they should be beneficial to doctors and patients alike.

“Everywhere you go in health care, people ask universally for one thing — simplify, simplify, simplify,” Acting CMS Administrator Andy Slavitt said.

Shifting the health care industry’s focus from “quantity” to “quality” of care has been a major theme for policymakers in recent years.

The administration has set a goal of linking half of all Medicare payments to patient results by 2018, and Congress last year scrapped the program’s outdated payment formula to make way for an incentive-based system.