Questions for the future

RON DAVIS: Now that we have heard from each of the speakers, we will offer you some “questions for the future”. Those questions will set the stage for the question-and-answer session.

Here are my questions:

• Is the HEDIS advice-to-quit measure, determined by patient self-report, a valid performance indicator?

• Would it make more sense to evaluate screening and intervention (for example, advice to quit) through the traditional HEDIS method of assessing computerised medical records and medical charts? (Would this be affordable?)

• Should our goal be the development and use of moreoutcome-oriented measures, such as quitting and prevalence?

• Will purchasers and the public discriminate among health plans, at least in part, on the basis of this measure?

• Will health plans build quality improvement initiatives around a tobacco measure?

• Can we include a tobacco measure in other “report cards”, such as those in development for medical group practices and individual physicians (American Medical Accreditation Program (AMAP))?

I would like to show you two charts that were put together by Rick Ward, a former colleague of mine at the Henry Ford Health System. Figure 1 depicts what he describes as the current reality of the complex accountabilities in the American healthcare system. There are multiple and complex accountabilities. HEDIS only addresses the accountability from the health plan to the employer. All of the other accountabilities shown in the figure can be described by other performance indicators or “report cards”, some of which are currently under development. For example, AMAP, a program sponsored by the American Medical Association to accredit individual physicians, can address the accountability of physicians to hospitals, medical group practices, and health plans.

Figure 2 …