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Galina Priloutskaya, PhD, MBA, CHCA is a Corporate Director of Analytics at HealthInsight. She has more than 20 years of sustained experience using standardized statistical methods to perform high-level analyses linking outcomes to improved health, health care and lower costs, and calculating quality measures from claims data, including competencies related to establishing physician attribution, evaluating statistical validity and reliability, calculating risk adjustment, and assessing result stratification. Professional experience with SQL, VBA, and SAS augments her statistical and quality capabilities to efficiently and effectively access, manage, and analyze data -- including large datasets with millions of records.

She has expertise is in managing projects involving the design of health care cost and quality reports for employers groups and consumers, national public reporting initiatives for nursing homes and home health agencies, and the development and implementation ambulatory community public reporting. She is widely recognized and trusted throughout the health care system in New Mexico and nationwide, serving on multiple technical expert panels from the Centers for Medicare & Medicaid Services (CMS) and the National Committee for Quality Assurance (NCQA), often serving on committees at the national level on such topics as contract evaluation and measurement methodologies.

She holds a doctorate in economics and master’s degree in business administration. She is an NCQA certified HEDIS Compliance auditor and a CMS certified data validation auditor. She graduated from the Institute for Healthcare Improvement Breakthrough College covering the use of the Chronic Care Model in Collaborative settings, and was trained as a Quality Improvement Advisor. Galina has published more 70 articles and monographs.

A Rallying Call for Value-Based Health Care

stethoscope with money

As a part of my professional development, I was certified by the National Committee for Quality Assurance (NCQA) as a Healthcare Effectiveness Data and Information Set (HEDIS) auditor in 2001. I have kept this certification while expanding my skills to include data validation and Pay for Performance Value-Based Program (P4PVBP) certification as I began to recognize the changing environment and the potential shift to VBP.

With today's uncertainties in health care, the NCQA has joined several health care organizations in a call for a new model of care. In a letter to Congress and the administration, these groups have endorsed a shift from the fee-for-service health care system to value-based care. NCQA and its allies (doctors and specialty societies that represent physicians, health plans and payers) have developed a set of recommendations on how to move our health care system toward innovative, patient-centered care. These recommendations include:

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Is Good “Old-Style Public Reporting” the Means of Transparency that Aims to Maximize the Quality and Cost of Care?

Doctor typing on laptop

I was always curious about finding the best and most efficient ways of using and disseminating quality and cost data, and this has been the focus of my work for the last 10 years. We first started public reporting efforts in New Mexico 12 years ago with our statewide Takes on Diabetes coalition with health plans. In 2010 we received funding from the Robert Wood Johnson Foundation to expand our public reporting efforts to ambulatory setting and involved our stakeholders and providers in the collection, analysis, and reporting of health care data to patients, providers, insurers, hospitals and policymakers. The question I always have is how we make this data useful for all of our stakeholders.

As a health care analyst, I've seen both the advantages and disadvantages to traditional public reporting. Properly done, public reporting offers several potential benefits: it could reduce information asymmetry between both patients and providers, and payers, promote competition between providers in the health care marketplace, apply pressure to reduce costs and improve quality, empower patients to be more active participants in their own care, and foster a culture of accountability, transparency and efficiency.1 However, to be successful, public reporting must use a framework that has credibility for both those being evaluated and those using the data. In any public reporting schema there are trade-offs between the transparency required for success, and confidentiality required to protect physicians from litigation and from unfair and invalid characterizations of their clinical practices. If public reporting data may be used in litigation, physicians are far less likely to comply, which may undercut public reporting initiatives. Ultimately, patients may be on the losing side of this situation due to the lack of potential quality improvement with traditional public reporting.

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A New Year's Wish List for U.S. Health Care

Stethoscope and Candy

In the spirit of the holidays, here is my wish list for the changes I would like to see the health care system in the United States make in the coming year.

For Consumers: Improve health care data transparency and to be engaged

I wish that we all will become educated consumers and have access to all the data needed to make the right decision, at the right time, at the point of care. If consumers had access to quality, price and cost information, we all would make better decisions and have access to better quality care at the lowest cost.

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