NQF Must Transform Along With Healthcare, Group's New President Says

Shantanu Agrawal, MD, MPhil, comes to the quality measurement organization as Congress weighs whether to continue a relationship with HHS to develop measures used in federal health programs.

Quality measurement makes healthcare better for patients, but like healthcare itself, the process of creating good measures can’t stand still, said Shantanu Agrawal, MD, MPhil, the former CMS official who is now president and CEO of the National Quality Forum (NQF).

Tapped in January to lead the 17-year-old organization, Agrawal opened NQF’s annual conference on Tuesday outside the nation’s capital with a road map for making NQF more relevant to patient needs and more responsive to providers that rely on its measures.

“NQF must demonstrate why it is relevant and up to the critical task of defining safe and effective healthcare for the nation,” he said.

Agrawal’s arrival from CMS, where he led anti-fraud efforts through the Center Program Integrity, comes a critical time. Congress is weighing the fate of the Affordable Care Act (ACA), which has led to the historic shift toward reimbursement based on the measures NQF develops. Alongside that debate, Congress will also have to decide by September 2017 whether to renew NQF’s Measure Applications Partnership, a relationship with HHS outlined in the law that gives NQF input into measures used in federal health programs. An assessment in Health Affairs pegged the value of funding for MAP, as well as measure review, endorsement and maintenance, at $100 million over a 2-year period.

The abundance of measures—NQF has endorsed more than 650 of them—and the time it takes to create them are on Agrawal’s radar screen, according to his prepared remarks. Going forward, he said NQF will have 4 priorities as it creates measures, even as it starts to weed out those that aren’t serving their purpose. Measures, Agrawal said, must be outcome-focused, improvable and actionable, and meaningful to patients, and they must support an “integrated view of care,” meaning they work across practice settings, providers, and time.

At the same time, Agrawal said NQF must trim the time it takes to get measures up and running, and it must improve its system for getting feedback on how well measures are working. He would like to reduce the time to endorsement to 5 months, and the work cannot stop once a measure is created.

“We need to hear much more to have a more complete understanding of the impact of measures,” Agrawal said. “Are they working as intended? Are they driving quality improvement without unintended consequences, and while minimizing cost?”

The maturing of measurement comes with proof that NQF’s efforts have changed healthcare for the better. Agrawal said between 2008 and 2014, there’s been a 50% reduction in hospital-acquired infections, a 17% drop in surgical site infections, and an 8% drop in hospital readmissions. “For patients, these results mean better, less or not complicated hospital stays, and increased opportunity to heal at home,” he said.

NQF has also worked to address the special needs of rural doctors and hospitals, and to support the growth of telehealth, Agrawal said.

But he’s convinced that NQF can do its job more efficiently—and get results to doctors and hospitals quickly. “With the pace and cost of measure development, waiting until a measure is mature and then evaluating its impact is often quite late,” he said. “We are missing opportunities to provide important early input while a measure is still in development.” Earlier review can ensure that only the most valuable, necessary measures are produced.

“Building these new pathways holds the potential to result in on-point measures the nation needs that enter the market faster and with greater certainty of effectiveness,” he said.