Q: Under your visionary leadership, the National Committee for Quality Assurance (NCQA) has established and enforced quality standards for much of American medicine for >25 years. What is the current major role of NCQA in caring for patients with advanced cancer?
A: We at NCQA (National Committee for Quality Assurance) are proud of our role in helping drive better performance in health care. Since 1993, when HEDIS (Healthcare Effectiveness Data and Information Set) measures were first publicly reported, we have seen substantial improvement in colon cancer screening rates, diabetes and blood pressure control. This comes as a result of HEDIS measures driving pay for performance Medicare stars and a variety of rating and reward systems. These gains translate into better quality of life—and even longer life—for the people to whom the measures apply.
In NCQA’s Accreditation and Recognition programs, plans and practices are rated on whether they are organized for quality through structure and process measures. In patient-centered medical homes and specialty practices, we look at whether access is adequate, whether there are systems to follow up on abnormal test results and whether practices “talk to each other” to ensure that patients benefit from an unbroken chain of coordinated care. Study after study has shown that practices “organized for quality” do better on quality and patient experience and have lower rates of hospital and emergency department use.
We have been working on cancer care from a number of different angles. For me, this is personal: I lost my father to cancer and a number of my family members have struggled with it. NCQA is partnering with Dr. Ezekiel Emanuel and the Center for American Progress to focus on two issues: adherence to treatment guidelines and management of patient symptoms. There will be needless deaths unless life-saving knowledge is disseminated to patients as it is generated, so adherence to guidelines matters. If patients’ symptoms are managed carefully, suffering, needless emergency room visits and hospitalizations can be avoided—along with the attendant risk of infection and avoidable costs.
Parallel to those efforts, we have worked for a number of years with forward-looking oncology practices to certify that they are organized for quality. Dr. John Sprandio, for example, brought his oncology practice through our PCMH (Patient-Centered Medical Home) Recognition program before we had a specialty practice program. Work has continued on a project involving a number of oncology practices in Pennsylvania, with funding from the Patient-Centered Outcomes Research Institute. So far, 35 oncology practices have earned Patient-Centered Specialty Practice Recognition. And we are evolving that program to be more cancer-specific, with the collaboration of Dr. Barbara L. McAneny, who has made groundbreaking efforts on the organization of cancer practices.
In addition, we were recently awarded a grant by the Gordon and Betty Moore Foundation to focus on patients who are at the end of life from illnesses such as cancer. Watching a loved one suffer is never easy, and when there is unnecessary suffering due to defects in the system of care, it is particularly difficult. Cancer treatment is often very difficult, particularly in advanced stages, where the rigors of treatment can actually cause harm. We must learn to engage with patients more effectively—to give them information about a treatment’s potential risks and harms and, when treatment is futile, to give them emotional and personal support.
NCQA is proud of the course we have charted to improve the quality and outcomes of cancer care. Much remains to be done, and much good remains to be achieved.