The Alliance’s New Quality Composite Score: How Quality Reporting Can Drive Regional Improvement in Health and Health Care
I’m sure you agree that the measurement of health care quality is an important mechanism to help us understand how to achieve better health and health care for all Washingtonians. The reporting that the Alliance has produced over the last 15 years has enabled us to understand where care quality is strong and where there are opportunities for improvement. Such is the case with the first release of the Quality Composite Score report for Washington counties and Accountable Communities of Health.
Regional comparisons, such as at the county and ACH-level, invite a larger conversation that we all must be a party to. For many years, research has confirmed that health status and the quality of the care one receives (or the needed care not received) are functions of more than the quality of the healthcare delivery system. There are many other important factors that must be taken into consideration that are largely associated with where one lives, such as the availability of healthy food options, access to safe places to exercise, reliable transportation and affordable housing.
Robert Wood Johnson Foundation’s County Health Rankings Model breaks these factors down and recognizes that social and economic factors, health behaviors, and the physical environment all play important roles in supporting the positive health outcomes we want to see. While the social determinants of health have long been acknowledged and frequently addressed in public health and policy discussions, the conversation has become much more mainstream in recent years and is especially relevant given how COVID-19 has disproportionally affected communities of color. In some ways, COVID-19 is shining a bright light on the importance of addressing inequities. The degree to which communities have policies and programs in place to address these inequities is no longer a conversation that can be limited to public health and policy leaders. It has to involve all of us.
At the Alliance, we believe it is important to highlight variation in care quality across geographies as we have done for many years. We also believe that it is increasingly important to recognize the variation in the other factors that influence health care in a way that we can all begin to understand root causes and work collectively to seek improvements. For example, whether an individual receives a recommended preventive screening in a timely manner (an important measure of primary care included in the Quality Composite Score) is a function of much more than whether that person’s provider recommends the service. Lack of trust in the healthcare delivery system, the inability to miss work to receive the service, unreliable transportation, or lack of child care can all be factors that influence one’s ability to receive recommended services – regardless of the nature of the service or the underlying need.
Obstacles that get in the way of receiving care are often associated with income. Across Washington counties, there is more than a two-fold difference in the 2019 median income level between the richest county at $94,800 to the lowest at $40,500. When we look at the county rankings produced by the Alliance’s new Quality Composite Score, we generally see what we would expect – the higher performing counties are also generally at the higher end of the income distribution and vice versa. However, there are exceptions worth noting. Yakima County, with a median income level of $51,400 (25th overall), was among the top ten counties in performance on the Quality Composite Score for both its commercial and Medicaid populations. Conversely, two counties (Island and Clark) are among the top ten in median income, but are among the lower-performing counties across both the commercial and Medicaid populations. These examples underscore that measurement is complex and represents the starting point for the real work of improvement.
We hope that all leaders, those in government, health care, and business, take a close look at their county’s results. At the Alliance, we believe that these results are not the end of the story, but the beginning of a meaningful dialogue that leads to needed action.
We look forward to taking those next steps with you.
Nancy