Dr. Christine Cassel, President and CEO of the National Quality Forum

Mark Masselli: This is Conversations on Healthcare, I'm Mark Masselli.

Margaret Flinter: And I'm Margaret Flinter.

Mark Masselli: Well Margaret we've reached an important milestone in the 18 month
long Ebola epidemic.

Margaret Flinter: Well more than 28,000 residence in that region were afflicted with
Ebola with many of the worse hit areas not having healthcare infrastructure in place and
it took months before the global health community could really ramp up to get
meaningful help to the region.

Mark M asselli: Ebola has claimed the lives of more than 11,000 people during the past
18 months. But it could have been a lot worse.

Margaret Flinter: Well it has been a disaster for the three West African countries Sierra
Leone, Guinea and Liberia. Global h ealth official suggest asked the G7 Summit
leadership to provide funds for an Ebola ready response team in the event of future
outbreaks.

Mark Masselli: They're hoping to put in place and organized and train rapid response
team if or when other epidemics emerge.

Margaret Flinter: Well global health experts were able to develop some pretty reliable
best practices in a short period of time how to contain those infected, protect healthcare
workers and educating the communities about how to stay safe. All th ese were key to
eventually containing the epidemic so, so many lesson learnt here Mark.

Mark Masselli: Learning from measurements is something our guest today is quite
passionate about Margaret. Dr. Christine Cassel is President and CEO of the National
Q uality Forum a nonprofit coalition of healthcare stakeholders seeking to improve
healthcare through better measurements.

Margaret Flinter: And Lori Robertson managing editor of FactCheck.org stops by and
she is always on the hunt for misstatements spoken about health policy in the public
domain.

Mark Masselli: But no matter what the topic you can hear all of our shows by going to
CHC Radio. If you have comments please email us at CHC [email protected] or find us
on Faceb ook or Twitter, we'd love hearing from you.

Margaret Flinter: Really get to our interview with Dr. Christine Cassel in just a moment.

Mark Masselli: But first here is our producer Marianne O'Hare with these week's
headline news.

(Music)

Marianne O'Hare: I'm Marianne O'Hare with these healthcare headlines. Healthcare is
three trillion dollar a year industry in this country and increasingly prescription drugs are
playing a big role. And the result of a recent Kaiser Family Foundation poll should come
as no surprise. 72% of Americans feel the federal government should step in and do
something to control the sometimes outrageous cost for prescription drugs. A vast
majority also believe it should be easier to purchase the cheaper drug equivalence in
Canada .

Parity in the bedroom the FDA has approved a new drug develop to target low libido in
women. The so called women's Viagra comes with some warnings though some of the
side effects include a severe drop in blood pressure especially when accompanied with
a lcohol. The pill is to be taken daily and is said to moderately increase desire in
women.

As if you needed another incentive to breast feed according to a 30 year study it
appears breast feeding offers another benefit improve cardiovascular health over a
lifetime. The study looked it over 800 women who breast fed for a month or less as
oppose to those who breast fed for 10 months or more longer participants had almost
20% less plague build up in their carotid artery. The study is the August issue of
obst etrician gynecology. I'm Marianne O'Hare with these healthcare lines.

(Music)

Mark Masselli: We're speaking today with Dr. Christine Cassel President and CEO of
the National Quality Forum a nonprofit membership organization that works to help
improve hea lth and healthcare quality through measurement. An internist and specialist
to geriatric medicine Dr. Cassel served as President and CEO of the American Board of
Internal Medicine. She serves on the President's Council of Advisors on science and
technolo gy. Dr. Cassel was a former President of the American College of Physicians
and has published extensively, her most recent book is Medicare Matters. She's
consistently named modern healthcare's 100 most influential list. Dr. Cassel welcome
to Conversati ons on Healthcare.

Dr. Christine Cassel: Thank you Mark it's a pleasure to be here.

Mark Masselli: Yeah and the Quality Forum now a 16 years old set out to create a best
in class standards and metrics that could be used to improve the nation's quality of
healthcare. Could you share with our listeners about how far we've actually come since
the National Quality Forum was established?

Dr. Christine Cassel: Well if you think back to 1999, it was a time where we had very
little open information for consumer s or frankly even for providers about the quality of
care. If you think about it even Google had just barely been created around that time so
---

Mark Masselli: Hard to believe.

Dr. Christine Cassel: Yeah it's hard to imagine that, that's how long ago. So we've
come a long way and NQF has been right in the center of helping to set standards for
what measures are actually accurate. But I would say we have a long way to go, I think
of it as kind of a airplane we've been texting down the runway and we've just gotten
liftoff but we aren't nearly at cruising altitude yet.

But NQF's role has been all along the one place that includes all the perspectives from
stakeholders public and private as well as a very strong voice of consumers and
purchasers. If you l ook at just the last four years we've seen a dramatic reduction
almost 20% reduction in hospital acquired conditions like infections 50,000 live saved in
12 billion dollars. So that would not have happened if we hadn't been able to measure
those things an d then report back to people and allow them to find ways to reduce those
kinds of events.

Same kinds of levels of improvements actually even more dramatic in maternity care
and reducing unnecessary hospitalizations and readmission. So I think the place to
really look for results in this area is within hospitals and community based institutions
where people now are able to look at the quality of care and the patient experience and
collaborating regionally or even nationally to figure out how to reduce probl ems and
improve quality.

Margaret Flinter: You know, Dr. Cassel let's talk a little bit about the membership today
that's at the core of the National Quality Forum. You've said to create a truly gold
standard for quality measures you got to have all stak eholders at the table, how do you
derive that quality measures in a way that satisfies all the stakeholders that are at the
table?

Dr. Christine Cassel: Well this actually what makes NQF so unique, there really isn't
another organization like this. The N QF is the really only place that comes together
around of open transparent process particularly having the strong consumer voices at
the table. So we have roughly 12 to 14 different ongoing standing committees, we have
850 plus volunteers on all these exp ert and multi stakeholder committee. So looking at
the different measures and the different issues and helping us come to consensus. You
know, we're seeing more and more controversial measures now because payment is so
strongly attached to so many of the m and that's not surprising. One of the things we're
able to do through our consensus process is get to the most practical dissolve.

Mark Masselli: You've talked about these tensions that weigh heavily on the industry
we had Dr. Steven Stack who is the President of the AMA describing that his
membership is drowning in reporting requirements. Could you talk to our listeners
about these industry challenges and the need for better science behind the
measurements?

Dr. Christine Cassel: First as a physician let me just say I'm very sympathetic with Dr.
Stack's point. And it is really true that the demand for better information is kind of hitting
the doctors with all these different requirements and there really is a need to align the
measures. To get all of the different people who are using similar measures but not
exactly the same together and try to reduce the redundancy and reduce the burden
what it cost to collect the data and report it.

It's interesting, you know, when I first came to NQF literally 50% of the people I talk to
said that just what you're hearing that were drowning in measures it's all noise and
nobody can make any sense of it. The other 50% are saying we don’t have enough
measure from the doctor's perspective if you're a neurosurgeon we actually don’t have
good measures that measure what you do. And if you're a patient and you have an
unusual condition or actually not an unusual like let's say multiple sclerosis you want to
know about that and we don’t have good measures for that. So I call this a Goldilocks
problem we have too many measures and not enough measures and we don’t have the
right measure so we need just the right measures and that's where measurement
science comes in.

Margaret Flinter: Well Dr. Cassel what kind of system ch anges have come about
because of having access to better data because of these quality measures. Give us
maybe some examples of the system changes within that led to the better outcomes
and also if you have examples of some health systems across the count ry that you
really think are getting this data sharing right.

Dr. Christine Cassel: I can point to Male Clinic, Cleveland Clinic, (inaudible 9:47 )
Denver Health, Kaiser Intermountain, Mass General and Partners and many, many
more and each of them they rep ort this national metrics to the federal government and
to state payers Medicaid and the private payers as well six north. And let's go find out
what they are doing differently. And a lot of people are just literally learning from one
another the science of quality improvement and that includes putting in place reminders
checklist for safety.

And every single time we go into the operating room because that's how you prevent
errors from happening. So recently a number of hospitals have done amazing things in
reducing readmission. By following up with their patients and some even giving your
patients an iPad to take home with them that reminds them to take their medication has

them able to communicate seamlessly with a nurse at the hospital. Lots of sort of
creative ideas like that.

Mark Masselli: We're speaking today with Dr. Christine Cassel President and CEO of
the National Quality Forum, national collaboration of stakeholders aimed at improving
health and healthcare quality through measurement. Dr. C assel also served as
President and CEO of the American Board of Internal Medicine. Dr. Cassel let's talk
about the incentive movement and we're seeing this shift from volume to value and HHS
and Secretary Burwell recently announce some very ambitious goal s for the coming
year including ensuring that 90% of Medicare outcomes are tied to quality. Is the
National Quality Forum engaged in conversations with them about this reach?

Dr. Christine Cassel: We are very definitely Mark engaged in conversations with them
and with the private payers as well because they are moving down this road too. They
all are part of national effort the learning and action network that's trying to align the
efforts of the private sector and the public sector much more accelerated push to paying
for value. NQF has been very clear in our measurement science work to say you're not
going to be able to just use cost alone and still have consumers know that they're
getting value because value is cost plus quality. It's really about ge tting rid of the waste
and extra cost, unnecessary cost in healthcare and paying for what really does benefit
the patient.

But in terms of what -- how to bring providers along because some physicians and
some healthcare systems and hospitals are way far al ong this way, they've been doing
this for a long time and they know how to think about patient centered care in a way that
doesn’t ask every time is this going to get paid for or not. But for many providers there's
a whole new way of thinking about how yo u collect information, how you organize your
teams and how you interact with your patients through email or telephone or other kinds
of ways. Providing really good quality data that both providers and their own patients
can understand and that they really believe in is dramatically motivational. If they are
using data that they believe they will say oh I never realize that I wasn't checking
(inaudible 13:11 ) diabetics because we didn’t have the data systems to make that
visible to folks before. So I thin k that's what's going to really be the key here.

Margaret Flinter: Well Dr. Cassel let's maybe take a moment to look at some areas of
interest to you personally prior to heading the National Quality Forum you are the CEO
of the American Board of Internal Medicine and the ABIM Foundation. And three years
ago ABIM launch the Choosing Wisely campaign that call for providers as well as
patients to curtail the overuse of dozens of costly often unnecessary and sometimes
even dangerous common procedures and medi cations. Share with us what kind of
impact has the Choosing Wisely campaign had been -- how do you see that movement
evolving in this era of both consumer driven and also value driven healthcare?

Dr. Christine Cassel: I am so proud of having been involve d in that at the very
beginning. And, you know, it was in a way something that came from the profession
itself who are beginning to look at all of the concern about the rising cost of care and
say, you know, we own a piece of this and we can be helpful by identifying areas in our
own practice that are overused. Often because patients have those expectations too, I
think the insight that we had at ABIM Foundation was we need to get the doctors and
the patients together to talk about this message because so often when you being
talking about cost of caring, reducing overuse people are worried about rationing.

And so let's just the medical experts and patient (inaudible 14:53 ) we were so fortunate
to have a robust partnership with consumer reports and I think that was the magic of
choosing wisely. And now as you've seen it's kind of entered the vernacular, this is
coincided in interesting way with the rise of more high deductable insurance programs.
So I think it came just at a time when consumers needed thi s because often that first
dollar payment is actually something that comes out of their pocket.

Mark Masselli: You know, let me give a quick shout out to one of our staff physicians
Dr. Steven Smith he's one of the founders of the Choosing Wisely movement and ---

Dr. Christine Cassel: Oh yes, well Steve was there right at the very beginning and
actually brought the idea initially to us along with the National Physician Alliance.

Mark Masselli: And speaking of great physicians you're certainly a world ren own expert
th
in geriatric medicine and Medicare as we know celebrated its 50 anniversary. Your
book Medicare Matters what geriatric medicine can teach American healthcare, you
know that Medicare is perhaps the most important healthcare program of our time and I
wonder if you can share with our listeners a little bit about what we learned about the
evolution of Medicare as well as the evolving disappointment for geriatric medicine.

Dr. Christine Cassel: I first would point out that those 10,000 people a da y who are
turning 65 are by and large not what we think of as a geriatric patient. And between the
ages of 65 to 75 probably even up to 80, people are living longer and staying healthier
as they age. But part of the price of getting old is that you do de velop a number of age
related conditions.

The specialty of geriatrics is unique because it understands the science behind ageing
the distinction between treating a disease and treating a patient who has multiple,
multiple chronic conditions and all of it i s patient focus which is of course something we
want all healthcare to be now. And that's why geriatric medicine can teach American
healthcare because looking at what are our patient's values but let's have a partnership
between the patient and their fami ly and organize the care around that set of values
which frankly might sometimes be putting different priorities in place than a standard
medical guidelines would have.

So that's where I think the specialty of geriatrics could add a lot, it's also totally
committed to coordination of care so having multiple specialist very interactive with one
another so none of them are interacting at a bad way and everybody knows what
everybody else is doing. And trying to keep people out of nursing homes, out of
hospita ls but when they are in nursing homes in hospitals being able to communicate
and organize the care to be the best care it can be.

So geriatricians work very closely with nurses and social workers and physical therapist
and others, but I think the innovatio ns, you know, Medicare's also been an innovator in
terms of data for reporting and in terms of now all of the advances of the ACA. So I
think that all of the creative approaches to driving care that's more coordinated in some
way it's come from those with in the early days of Medicare and the specialty of geriatric
medicine.

Margaret Flinter: Well Dr. Cassel I was glad to hear you're allude to some other
members of the healthcare team there a moment ago. And I know that in your role at
the National Qualit y Forum the issue of interprofessional practice must arise. But also
that among the stakeholders although we've primarily focused in the conversations on
physicians, you must have represented the other clinical professions in particular that
play an impor tant role in the healthcare delivery system the PAs and the nurse
practitioners and the health psychologist and others. Tell us maybe just a little bit about
how the National Quality Forum has, you know, since it was founded, you know, back in
the late 90 s really transform who's at the table in terms of interprofessional perspective
on how from -- in clinical practice we achieve these transformations in the direction of
better quality?

Dr. Christine Cassel: Well we have a large number of medical specialty societies who
are members of the NQF but we also have a very large number of nursing organizations
pharmacy is huge I mean when we think about how the world of pharmacy use this data
and to make sure that they deliver the accurate medication to the right patient at the
right time. What's interesting to me about this transition and what I called measurement
science is that we've tended to focus on the doctor measures because that's who gets
paid. But in fact more and more everybody is recognizing that the quality of the care
that is given is can be attributed to a team either a small team or a larger system and in
a group practice. And frankly my perspective as a physician and as a geriatrician is that
more and more I think we should be reporting team out comes and system outcomes
rather than the individual. And that's going to of course depend on changing a payment
and models and things like that.

Mark Masselli: We've been speaking with Dr. Christine Cassel President and CEO of
the National Quality Forum , you can learn more about their work by going to

Qualityforum.org or you can follow them on Twitter at NAT Quality Forum. Dr. Cassel
thank you so much for joining us on Conversations on Healthcare today.

Dr. Christine Cassel: You're most welcome, I've e njoyed it.

(Music)

Mark Masselli: At Conversations on Healthcare we want our audience to be truly in the
know when it comes to the facts about healthcare reform and policy. Lori Robertson is
an award - winning journalist and managing editor of FactCheck.org a nonpartisan,
nonprofit consumer advocate for voters that aim to reduce the level of deception in US
politics, Lori what have you got for us this week?

Lori Robertson: We often hear about the high price tag of healthcare in United State,
but does the US spend almost twice as much per captia on healthcare as any other
country? That's what Senator Bernie Sanders said in a speech at the Iowa State Fare.
But Sanders who is running for the democratic presidential nomination is wrong. The
US does spend more than twice as much per capita at the average amount spent by
other developed nation but it doesn’t spend twice as much as everyone of them.

We consulted the most recent data from the organization for economic cooperation and
development which shows the US spent $8713 per capita in 2013 on healthcare. That's
more than double the OECD average of $3453 per capita. After the US, Switzerland at
$6325 per capita and Norway 5862 per capita spent the most on healthcare. But the
US didn’t spend twice as much as e ither country nor that the US spend double the per
capita amount of The Netherlands, Sweden or Germany.

Barack Obama made a similar claim in 2008 when he was running for president.
Obama was wrong back then and Sanders is wrong to make the claim now. And that's
my fact check for this week, I am Lori Robertson Managing Editor of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country's
major political players and is a project of the Annenberg Public Policy Center at the
University of Pennsylvania. If you have a fact, that you would like checked, email us at
www.chcradio.com. We will have FactCheck.org's Lori Robertson check it out for you
here on Conversations on Health c are.

Each week Conversations highlights a b right idea about how to make wellness a part of
our communities and to everyday lives. One in six people in the world lacks access to
drinking water or basic sanitation. And statistic show that diarrhea is the leading cause
of death for these populations . But access to clean and potable water continues to
present a real challenge, in Africa the number are staggering with 46% of the
residences of Sub - Saharan Africa having no direct access to clean water. In 2005 artist

Tracy Hawkins went to Tanzania to s ee what she could do about it. Clay pot water
filtration has been around for several hundred years where simple clay pots lined in the
bottom with silver oxide can remove up to 99% of the impurities for most water sources.
But no one had undertaken a ded icated program to produce and distribute these pots.

Tracy founded that the Sing'isi Pottery Project with a local activist and began making the
pots with local artisans in this region of Tanzania. By 2008 she and her team were able
to get a factory built so that they could increase production. The project has served
multiple communities and continues to expand. Independent researchers have
determine the system to be safe, effective and the best part the health of entire
communities has been improve signi ficantly once each village resident is provided with
a clay filtration system. The pots are inexpensive to produce, easy to handle and the
factory has also created jobs for local residences. They have since change the name of
the organization to Safe Wat er Ceramics of East Africa and have continued plans to
replicate the successful model across the region. A simple easily manufactured solution
that improves access to potable water for a community that previously has few options,
one that improves health, wellbeing and economic conditions at the same time, now
that's a bright idea.

(Music)

Margaret Flinter: This is Conversations on Healthcare, I'm Margaret Flinter.

Mark Masselli: And I'm Mark Masselli, peace and health.

Conversations on Healthcare, broadcast from the campus of WESU at Wesleyan
University, streaming live at www.wesufm.org and brought to you by the Community
Health Center.