Chartbook on Care Affordability

The report demonstrates that the Nation has made clear progress in improving the health care delivery system to achieve the three aims of better care, smarter spending, and healthier people, but there is still more work to do, specifically to address disparities in care.

• Access improved:
  • After years without improvement, the rate of uninsurance among adults ages 18-64 decreased substantially during the first half of 2014.
  • Through 2012, improvement was observed across a broad spectrum of access measures among children.
• Quality improved for most NQS priorities:
  • Patient Safety improved, led by a 17% reduction in rates of hospital-acquired conditions between 2010 and 2013, with 1.3 million fewer harms to patients, an estimated 50,000 lives saved, and $12 billion in cost savings.
  • Person-Centered Care improved, with large gains in provider-patient communication.
  • Many Effective Treatment measures, including several measures of pneumonia care in hospitals publicly reported by the Centers for Medicare & Medicaid Services (CMS), achieved such high levels of performance that continued reporting is unnecessary.
  • Healthy Living improved, led by doubling of selected adolescent immunization rates from 2008 to 2012.
• Few disparities were eliminated:
  • People in poor households generally experienced less access and poorer quality.
  • Parallel gains in access and quality across groups led to persistence of most disparities.
  • At the same time, several racial and ethnic disparities in rates of childhood immunization and rates of adverse events associated with procedures were eliminated, showing that elimination is possible.
• Many challenges in improving quality and reducing disparities remain:
  • Performance on many measures of quality remains far from optimal. For example, only half of people with high blood pressure have it controlled. On average, across a broad range of measures, recommended care is delivered only 70% of the time.
  • As noted above, disparities in quality and outcomes by income and race and ethnicity are large and persistent, and were not, through 2012, improving substantially.
  • Some disparities related to hospice care and chronic disease management grew larger.
  • Data and measures need to be improved to provide more complete assessments of two NQS priorities, Care Coordination and Care Affordability, and of disparities among smaller groups, such as Native Hawaiians, people of multiple races, and people who are lesbian, gay, bisexual, or transgender.

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2014 Chartbooks

The 2014 QDR is supported by a series of related chartbooks that:

• Present information on individual measures.
• Are updated annually.
• Are posted on the Web (https://archive.ahrq.gov/research/findings/nhqrdr/2014chartbooks/).

The order and topics of the chartbooks are:

• Access to care.
• Priorities of the National Quality Strategy.
• Access and quality of care for different priority populations.

The new QDR and supporting chartbooks are further integrated with the National Quality Strategy (NQS). The NQS has three overarching aims that build on the Institute for Healthcare Improvement’s Triple Aim^® and that support HHS’s delivery system reform initiatives to achieve better care, smarter spending, and healthier people through incentives, information, and the way care is delivered. These aims are used to guide and assess local, State, and national efforts to improve health and the quality of health care.

To advance these aims, the NQS focuses on six priorities that address the most common health concerns that Americans face. Quality measures tracked in the QDR have been reorganized around these priorities, and a chartbook will be released marking progress for each NQS priority. Care affordability is one of these NQS priorities and the topic of this chartbook.

Priority populations are noted in the legislation that requires AHRQ to report on health care disparities (42 U.S.C. 299a-1(a)(6)). These populations consist of groups with unique health care needs or issues that require special focus, such as racial and ethnic minorities, low-income populations, and people with special health care needs.

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