Pacific Business Group on Health

Over the course of 12 years, the Blue Shield of California Foundation committed nearly $20 million to growing a pool of community health center leaders who were prepared to be effective agents of change in their organizations and in the safety net field. This signature investment, the Clinic Leadership Institute, was implemented in partnership with the Healthforce Center at University of California, San Francisco, in anticipation of a generation of California health center leaders beginning to transition into retirement. During the institute's 10 cohorts, access to community health centers dramatically increased with the Affordable Care Act, and this — coupled with rising costs of health care — continued to underscore how crucial community health centers were to accessible and quality care for poor and underserved populations. A study spanning 10 cohorts of alumni found that the institute served a critical role in supporting community health center leaders and their organizations in navigating these changes, while also building alumni networks advocating for community health centers in county- and state-level policy. The program equipped 258 individuals to lead and deliver care in a field marked by continuous change, complexity, and mounting demand. Drawing on these findings, we make the case that investment in leadership development is a critical philanthropic tool for field building and, ultimately, systems change. We explore how the foundation made the most of this investment through intentional funding, design, and strategic considerations.

BackgroundQuality measures are important because they can help improve and standardize the delivery of cancer care among healthcare providers and across tumor types. In an environment characterized by a rapidly shifting immunotherapeutic landscape and lack of associated long-term outcome data, defining quality measures for cancer immunotherapy is a high priority yet fraught with many challenges.MethodsThus, the Society for Immunotherapy of Cancer convened a multistakeholder expert panel to, first, identify the current gaps in measures of quality cancer care delivery as it relates to immunotherapy and to, second, advance priority concepts surrounding quality measures that could be developed and broadly adopted by the field.ResultsAfter reviewing the existing quality measure landscape employed for immunotherapeutic-based cancer care, the expert panel identified four relevant National Quality Strategy domains (patient safety, person and family-centered care, care coordination and communication, appropriate treatment selection) with significant gaps in immunotherapy-based quality cancer care delivery. Furthermore, these domains offer opportunities for the development of quality measures as they relate to cancer immunotherapy. These four quality measure concepts are presented in this consensus statement.ConclusionsThis work represents a first step toward defining and standardizing quality delivery of cancer immunotherapy in order to realize its optimal application and benefit for patients.

Research indicates that older adults receive only about half of their recommended care, with varying quality and limited attention to social issues impacting their health through the most commonly used quality measures. Additionally, many existing measures neglect to address nonclinical social determinants of health. Evidence of the need for more comprehensive measures for seniors is growing. The primary purpose of this article, which is supported by a limited review of literature, is to describe gaps among current quality measures in addressing certain nonclinical needs of older adults, including key social determinants of health. In doing so, the authors describe their position on the need for expanded measures to incorporate these factors to improve care and quality of life. The authors conducted a limited review of the literature to inform this article, focusing specifically on selected measures for older adults rather than a broader systematic review of all measures. Most research identified was related to clinical practice guidelines rather than quality measures of care as applied to older adults. Furthermore, the literature reviewed reflected limited evidence of efforts to tailor quality measures for the unique social needs of older adults, confirming a potential gap in this area. A growing need exists for improved quality measures specifically designed to help providers address the unique social needs of older adults. Filling this gap will improve overall understanding of seniors and help them to achieve optimal health and successful aging.

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The use of item screeners is viewed as an essential feature of quality survey design because only respondents who are 'qualified' to answer questions that apply to a subset of the sample are directed to answer. However, empirical evidence supporting this view is scant. This study compares data quality resulting from the administration of ambulatory care experience measures that use item screeners versus tailored 'not applicable' options in response scales. Patients from the practices of 367 primary care physicians in 65 medical groups were randomly assigned to receive one of two versions of a well validated ambulatory care experience survey. Respondents (n = 2240) represent random samples of active established patients from participating physicians' panels.The 'screener' survey version included item screeners for five test items and the 'no screener' version included tailored 'not applicable' options in response scales instead of using screeners.The main outcomes measures were data quality resulting from the two item versions, including the mean item scores, the level of missing values, outgoing patient sample sizes needed to achieve adequate medical group-level reliability, and the relative ranking of medical groups. Mean survey item scores generally did not differ by version. There were consistently fewer respondents to the 'screener' versions than 'no screener' versions. However, because the 'screener' versions improved measurement precision, smaller outgoing patient samples were needed to achieve adequate medical group-level reliability for four of the five items than for the 'no screener' version. The relative ranking of medical groups did not differ by item version. Screeners appear to reduce noise by ensuring that respondents who are not 'qualified' to answer a question are screened out instead of providing unreliable responses. The increased precision resulting from 'screener' versions appears to more than offset the higher item non-response rates compared with 'no screener' versions.

Unless President-elect Barack Obama-America's CEO-and the CEOs who run large businesses work together, health care changes will not occur. The government and private sector must abandon business as usual to reduce costs, reward outcomes, and stimulate innovative ways to achieve those outcomes. President-elect Obama will find a willing partner in corporate America if he reaches out in ways that recognize that solutions must put the patient at the center of our health care system and also drive efficiencies to allow U.S. companies to compete globally. It is past time for the nation's elected and appointed CEOs to take action to transform U.S. health care.

"Disruptive innovation" will only stimulate the transformation of health care when the regulatory and payment environment allows consumers to set our society's priorities for value. Legislators need to put patients' interests before those of the powerful lobbies that are in front of them every day. Purchasers must hold their health plans to higher, more patient-centered standards. Both government and private payers need to reset the rules to allow into their networks "disrupters" that will deliver more cost-effective care for patients.

Over the past decade, public reporting on health care performance has become increasingly common. But whereas most reporting has concentrated on the quality of care in health maintenance organizations, hospitals, or large medical practices, health care purchasers are now focusing on identifying which individual physicians deliver good care most efficiently. The appropriate way to measure physicians' efficiency — and the proper uses for such measurements — is a matter of disagreement between those who pay for health care and those who provide it.Knowledge about physicians' efficiency could be helpful to patients who increasingly struggle to afford premiums, deductibles, and . . .