Sharing Humana’s learnings about clinical quality

In September, Misty Roberts, Associate Vice President at Humana and Clinical Quality Officer, and Faith Green, Director of Enterprise Clinical Quality, took the story of Humana’s mission to improve quality on the road. They presented their work on building a culture of clinical quality to 1,400 peers at the National Association of Healthcare Quality’s annual conference in Phoenix.

“Clinical quality is about improving health outcomes,” Roberts said. It has always been important, of course, but never more than now, as health care transitions from a fee-based system to a value-based system, where payments are based on health outcomes.

Roberts has been at Humana since 2010 and moved into the Office of the Chief Medical Officer in 2014, where she was asked to form a new department focused on clinical quality. Her role was to lead Humana’s internal response to a new national challenge to identify a set of meaningful and efficient quality standards.

“At that time, the number of quality measures was overwhelming, and reporting requirements were inconsistent,” Roberts said. She and her new team set out to transform Humana’s quality measurement process.   

They discovered that 46 groups around the organization were setting and measuring standards. The quality team knew they had to simplify.

After six months of meeting with representatives from all those groups, the team found they could pare down their combined list of 1,116 quality measures to 208 meaningful ones. That was an 80 percent reduction. “Because of company silos, associates in one area had been unaware of quality measurements in other groups,” Roberts said. “That had resulted in duplication and inconsistencies across Humana.”

Last year, Roberts and Green told the story of that process of aligning measurements in an article published in the American Journal of Medical Quality (“A Health Plan’s Journey to Identifying Meaningful Quality Measures”). They told the story again at the meeting in Phoenix but added another dimension.

The title of their new presentation was “Infuse, Empower, Lead,” and the subject was the bigger lesson they learned about creating a culture of clinical quality. The advantage of being an organization with a culture of clinical quality, say Roberts and Green, is that it will keep the excitement about improving quality alive. It will push people to be proactive. It also will lead to a holistic view of what quality is.

Here are the steps they recommend:

  • Infuse your organization’s culture with the mindset of continuous quality improvement and collaboration (communicate; spark team conversations)
  • Empower and motivate employees to make decisions and act with purpose (get them engaged; unleash their courage)
  • Lead your organization and industry in making a cultural shift (have a vision; offer guidance; inspire)

The primary measure of success, however, will always be “the impact on patient health and clinical outcomes,” Roberts said.

“Everything we do has the potential to impact patient outcomes,” she said. “Building a culture, creating a mindset – that’s how we continue to improve quality across the enterprise.”

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