Webinar recap: Diving into quality

Healthcare quality is a topic that’s frequently discussed, yet its definition remains vague and can vary significantly, depending on who you talk to.

In our recent webinar, The Science of Surgical Quality: How to Define Provider Excellence, speakers from the Chicago Institute of Advanced Bariatrics, Mercer, and Carrum discussed what they believe healthcare quality really means, emphasizing patient-centered outcomes, fairness in evaluation through risk adjustment, and the importance of ongoing accountability. They also explored Carrum’s rigorous quality approach.

What is healthcare quality? Experts weigh in

According to the National Academy of Medicine (formerly the Institute of Medicine), there are six important dimensions to healthcare quality. It must be safe, timely, effective, efficient, equitable, and patient-centered (STEEEP).

However, as Mercer’s Mason Shea noted, “I think it’s really nice to be grounded in STEEEP. But the reason we got into this business of measuring provider quality is because not everyone in the market is using STEEEP as their north star. And even for companies that are, not everyone’s doing it the same way or putting the same emphasis on the different parts.”

That’s why, Shea says, “it’s important to have these types of conversations across the market.” He notes that, besides the basic definition, there are a few specific things he’s looking at when evaluating quality, including:

• What type of data are you using? Is it at scale and appropriate for the use case?
• What type of metrics or standards are you holding providers accountable to?
• What type of adjustments are you making?

Both Shea and Sam Harris, Senior Director of Business Intelligence and Provider Quality at Carrum, made sure to note that, when they’re evaluating quality, they like to take cost out of the equation. “I like to think mainly about clinical outcomes—what we can see about patient care—and then have a cost conversation after that,” Shea says.

“Costs are irrelevant to this part of the process,” Harris says. “They are highly relevant to other elements of navigating the care ecosystem—we do want to make sure we’re saving our customers and their members money—but we have other teams at Carrum focusing on that. On  my team, we look at quality completely agnostic of costs.”

Dr. Rami Lutfi, bariatric surgeon, President of Chicago Institute of Advanced Bariatrics, and medical director for Bariatric and General Surgery at Carrum Health, describes quality as “a set of standards that, together, will determine the health outcome. The outcome,” he says, “used to be just surgical outcomes—you know, infection, leakage, readmission, things we don’t like. But now, the outcome is truly patient-centered. We look at medical outcome and the patient-perceived outcome (e.g., satisfaction scores), and this is how we tend to see quality.”
 

Carrum’s approach to quality

Carrum Health has built a quality evaluation model that helps employers connect their employees with the highest standard of specialty care (e.g., surgical care, cancer treatment, and substance use treatment). Our framework is grounded in four key pillars:

• Professional experience: Providers must demonstrate advanced training, certifications, and consistent procedure or treatment volume.
• Outcomes: Avoidance of complications, readmissions, infections, and so forth.
• Appropriateness: The procedure or treatment must be deemed necessary, with demonstrated improvements in pain reduction, mobility, or other related measures.
• Patient experience: Satisfaction scores and qualitative feedback via interviews and questionnaires confirm whether care is meeting patient needs and expectations.

There are two other very important points Harris made about Carrum’s approach. First, we go well beyond the facility level, evaluating each provider within a facility and each procedure a provider can perform.

“We [approach quality] at a very granular level,” Harris says. “A lot of other solutions will identify facilities or systems or practices as a whole. At Carrum, we evaluate at the facility, provider, and procedure level. That means we may include a physician for minor MSK procedures, but not for joint replacements, even if they traditionally do both. Or, we may include two spine surgeons at a facility, but not the other three spine surgeons, for example.”

Second, our quality evaluations are ongoing. They are not a “once-and-done” thing. As Harris notes, “just because someone is an excellent surgeon for five years doesn’t mean they’re performing at the same level 10 years later,” so we commit to constant reevaluations, recertifications, monitoring complications as they come in, and so forth.”

Dr. Lutfi admits that, as a provider in Carrum’s Centers of Excellence network, going through our evaluation process and consistent check-ins isn’t the most fun process, but this is also the part about Carrum that’s special to him. “They keep nagging me, but it’s nagging done with love to make sure that we’re driving the right accountability, the right partnership, and at the end of the day we’re keeping the patient at the center of everything we do.”

To learn more about these experts’ views on healthcare quality and to dive deeper into the details Carrum’s approach, watch the webinar here.