HCA outlines quality‑measurement basics and federal changes in Senate Health work session

Kaley Dufresne, Special Assistant for Health Policy and Programs at the Health Care Authority, told the Senate Health & Long Term Care Committee on Jan. 24 that quality measurement is essential to know where the state’s health system is performing well and where it needs improvement.

Dufresne opened with a short primer: quality measures fall into three buckets — structural (infrastructure and accreditation), process (clinical actions such as screenings), and outcomes (patient‑level results such as mortality or remission). She said the most commonly used nationally is the HEDIS set developed by NCQA and that Washington also uses locally developed measures from the Department of Social and Health Services’ research team.

Dufresne described the trade‑offs of measuring quality: “We wanna improve. Quality measurement is the way that we know we have problems or where we’re doing well. It’s how we know if the value of the dollars that we’re spending are giving us a return,” she said, while also acknowledging that reporting hundreds of measures creates administrative burden for providers.

She summarized HCA’s current approaches: shared decision‑making tools, certifications of decision aids, and value‑based purchasing (VBP) that financially incentivizes insurers and plans to adopt payment models tied to quality outcomes. Dufresne said HCA publishes plan performance, conducts audits and evaluations, and uses incentives to target measures with statistically significant changes over time.

Looking ahead, Dufresne told the committee that new federal rules will require a Medicaid quality rating system and reporting of 18 standard measures for all Medicaid plans, including fee‑for‑service. She also described CMS network adequacy changes that will require “secret shopper” surveys — calls to provider offices to verify actual appointment availability — to better measure access. Finally, she discussed national efforts to automate outcome measurement and reduce manual chart review by leveraging electronic health record tools; HCA is exploring how to support providers in that transition.

Senators asked about existing patient‑reported surveys and specialized referral lines; Dufresne said the agency conducts annual CAHPS surveys for public‑employee and Medicaid populations and will follow up on how lines such as Partnership Access Lines (PALS) are measured.

The briefing framed measurement as a continuous process and positioned HCA to align state measure sets across payers to reduce provider burden and improve comparability.