FACCT devises quality measures and broad care guidelines for chronic disease that seek to help practitioners ensure that they satisfy all aspects of good care.

The Foundation for Accountability (FACCT) has grown a great deal in recent months, in terms of both its philosophies and its impact on today’s health care system. Since it was founded 3 years ago, the Portland, Oregon-based organization has developed a set of broad patient care guidelines, established a rapport with the health care community, and started reaching out to patients as health care consumers. Ultimately, FACCT envisions a health system that not only includes patients in the care process, but emphasizes the importance of a “patient as consumer” approach to gathering and reporting information about health care quality. While this approach has started to take hold in the field of respiratory care and other forward-minded, patient-driven disciplines, FACCT has discovered that health care still largely leaves patients out of the loop in terms of sharing objective information about quality.

Fundamentally, FACCT and its core staff members realized that their approach to creating a consumer-focused system of quality measurement needed some fine-tuning in order to reach the broadest audience. “Getting information to consumers isn’t going to happen the way we thought it was going to happen,”says Doug Davidson, director of communications at FACCT. “As opposed to being an overall national process, which would take place through the actionof major national purchasers like the federal government or major corporate purchasers, it’s probably going to happen at more of a regional or state level.”

The death of broad-based calls for national health care reform, which had served as the impetus for FACCT, resulted in an organization with new-found focus. Rather than take a national view of health care quality and reporting, FACCT chose to emphasize individual health plans and provider groups. As a result, consumer-oriented quality measurement and reporting as envisioned by FACCT have started at health care’s very core: with the practitioner, the facility, and the patient.

Guidelines and Measures
On a broad level, FACCT emphasizes three phases: the process of health care–the steps to good care; the outcomes and objective quality of good care; and patient experience and satisfaction. “We think you have to have all three of those things to really get a good, comprehensive view of care,” Davidson says. The organization has devised quality measures and broad care guidelines for chronic disease that seek to help practitioners ensure that they satisfy all three aspects of good care, and furthermore that practitioners can communicate effectively with patients about all of these phases. “Beyond that, the measures really are not very prescriptive,” points out David Lansky, PhD, president of FACCT. “The goal is not to tell providers what they have to do to get good results. We just say, ‘These are the results we’re going to be watching for, do whatever you think makes the best sense for the patient.’ ”

FACCT stresses measurement for the purposes of public accountability rather than clinical measurement, although Lansky admits that those two types of measurements overlap a great deal. “Our guidelines for chronic disease care don’t report a care path; they don’t go through everything you need to do for a patient who has asthma, for instance. However, they include enough measures to really give patient and practitioner a good indication of the quality of care,” he says. FACCT’s chronic disease guidelines, including its asthma care guidelines, each pinpoint six to eight very broad areas that serve as indicators of quality, flags that verify whether a health plan or facility is doing a good job.

Defining Accountability
At FACCT, accountability exclusively encompasses consumer accountability–bringing the patient back into the health care mix. “We really think the health care system ought to be accountable to the people that it serves and who pay for its services. One way to be able to hold the health system accountable is to really know what you’re getting for your money,” Davidson explains. Since its inception, the organization has worked closely with consumers to learn just what they want and need from the individual health care practitioner, the facility, the health plan, and the system overall.

That focus on consumer understanding redefines, in part, the value equations for health care, adding quality-related expectations to existing goals such as maximizing resource use and allocation. “It comes down to saying, ‘We need a lot from, and in fact invest a lot in, our health care system. We really need to be able to tell that it’s providing positive results.’ ” Thus, in a consumer-based model providers must think of accountability in terms of outcomes and results rather than simply process and capacity, according to Davidson.

To facilitate the process, FACCT worked closely with consumers in creating a “talking points” framework. Facilities and individual providers can use the talking points to ensure that they pass along useful information to patients. In addition, Lansky says, the framework provides a structure to help providers speak in a simple, easy-to-follow language that patients can follow. “We’ve learned that this is what people really expect from their health care,” he notes. The framework encompasses five key points designed to help providers tailor their efforts in collecting and dispensing information about quality: The Basics–Access to necessary services, skilled care, communication with providers, and coordinated care; Staying Healthy–Helping people avoid illness and stay healthy via preventive care, reduction of health risks, education, and early illness detection; Getting Better–Helping patients recover from sickness or injury with appropriate treatments and follow-up care; Living with Illness–Helping patients with chronic conditions take care of themselves, control symptoms, avoid complications, and maintain their lifestyles; and Changing Needs–Caring for patients and families when disability or terminal illness results in dramatic need changes by emphasizing caregiver support, comprehensive services, and hospice care.

The framework has emerged as a viable standard for communicating with consumers, according to Davidson, and guides FACCT in its outreach efforts. More important, though, it gives providers a road map to the process of getting quality-based information to consumers. “The framework helps create categories of information and scores that people can actually understand,” Davidson says. “It helps us really look at where the gaps are and focus our measurement development, and instrumentation and reporting work, on trying to populate that framework–to get information out to consumers in those areas.”

Practitioners and Accountability
“One of the things we’re interested in looking at is how to measure quality beyond the managed care model and beyond the HMO level,” Lansky points out. “We know the consumer is really interested in measuring quality at the provider level.”

To meet that patient interest, FACCT has shifted its focus at least in part to an adaptation of measurements culled from managed care delivery approaches to provider level measurements. It also stresses consumer education as a primary mode of increasing demand for consumer-oriented reporting at the practitioner level. “We hope to increase consumer education and activation, to get consumers to recognize that this is something that matters to them,” Davidson says. Patients, as health care consumers, need to understand that their interests are best served when they expect and demand quality-related information, he adds, because it can make a difference in how they experience the health care system, the kind of health care they get, and the help they receive. In fact, individual health care practitioners and facilities can play a role by working proactively to help patients become partners in their own care.

Davidson points out that many of the most willing recipients of FACCT’s techniques and approaches in fact are individual providers or health plans. “These tools give them a way to focus their quality improvement on things of importance to consumers, which in turn enables providers to begin to get comfortable with those data and what it’s going to take to use them as a basis for quality improvement.” Furthermore, the measures and “talking point” framework emphasize the importance of the provider-patient relationship, Lansky says. “The guidelines are very education-, self-management-, prevention-oriented.” In designing them, FACCT focused on broad health care goals that would reduce the cost of care and keep people healthier by strengthening the connection between patient and provider. “They’re very pro-provider measures,” Lansky stresses.

While many practitioners work hard to communicate on an individual level with patients, the health system as a whole still has difficulty with the leap from measuring and understanding performance internally to communicating those results to consumers, according to Davidson. “The health system is very involved in lots of measurement for quality improvement. But we’re actually talking about measurement for public accountability, where you not only measure yourself but you compare yourself to others, you support the sharing of that information with the public. That’s where the interest starts to wane.”

FACCT sees measurement as a method that will help people make better choices as health care consumers, which in turn will lead to a more efficient, focused health care delivery system. In the organization’s view, many current measurement strategies do not lead to the type of quality reporting that is important to consumers. “For example, structure and capacity measures such as how many certified physicians you have don’t really tell people much about the quality of care you’re providing–it tells them about your capacity to provide care,” Lansky says. “Rather than merely ask, ‘How much did the doctor do for me,’ consumers would prefer to hear an answer to ‘How am I actually doing? How did the doctor help me?’ ”

FACCT offers several broad guidelines to practitioners who wish to facilitate patient understanding of health care quality. Following the broad guidelines and framework, the successful provider or facility will “measure the right things, be open and eager to share the results with consumers, and share them in a way that consumers will understand,” Davidson says. “But most important, the provider will communicate those things in a language that people will understand.”

The FACCT Role
FACCT recently has combined its “talking points” framework and care guidelines with a new perspective about how the organization itself can best facilitate the shift to consumer-focused quality information. In working with interested groups on all sides of the health care discussion, the organization has found that it has an important role as a “convener and encourager” of collaboration, according to Davidson. “These projects require that a lot of people come to the table,” he says. “You’ll have a state government or a local government, you’ll have health plans, purchaser coalitions, you may have a district of a federal agency.”

Originally, FACCT sought to provide the tools to facilitate collaboration, and counted on interested parties to work together in developing a consumer-based measurement program that worked for local health care systems. Davidson says that strategy left room for improvement. “Now we’re finding there’s a very beneficial role that we can play in actually helping those people get together, collaborate, and build the consensus to get these projects going,” he explains.

At least for the foreseeable future, as long as consumer-oriented quality information remains a comparatively new approach in information gathering and reporting mechanisms, FACCT plans to stay involved on the ground floor. “In the long-term, we hope that enough momentum develops so that eventually things will happen on their own,” Lansky notes, “but in the meantime, we recognize that it’s just not enough to build good measurement tools and reporting tools and then simply throw them out there.” Follow-through occupies a crucial spot in FACCT’s vision for its own future, as well as that of the health system overall. “You’ve got to be there to help with the implementation, help with the evaluation and demonstrate the value, and help people understand and use them.”

For the short-term at least, this revised strategy places FACCT in a role similar to that of adviser or consultant. “We build a set of tools and we bring to this arena a certain set of approaches and tools–for example, our measurement principles regarding outcomes and patient experience. We have a certain way of looking at measurement and reporting to consumers,” Davidson says. The organization discovered that combining the tools it creates with implementation support bridges the gap between lofty ideas and project success. Today, FACCT works hard to ensure that every group, regardless of size or scope, interested in devising a consumer-focused quality measurement plan has the support it needs to put that plan into action.

“We have some perspectives about health care, and some perspectives about quality and empowering consumers,” Lansky explains. “In terms of standards, though, we’re not trying to be a standard-setter, we’re trying to be an informer and an educator about what standards ought to look like and what concepts we believe are important.”

Kathryn Olson is a contributing writer for RT.