Chisara N. Asomugha, M.D., MSPH, FAAP is a highly experienced physician and government official who serves as the Senior Technical Advisor/Medical Officer at the Centers for Medicare & Medicaid Services’ (CMS) Center for Clinical Standards and Quality (CCSQ). Dr. Asomugha is a recognized thought leader in community health, stakeholder engagement, advocacy and gender equity. Her portfolio of work at CMS includes activities related to value-based purchasing, quality improvement, clinical practice transformation and population health. Prior to joining CCSQ, she served as Deputy Mayor/Community Services Administrator for New Haven, Connecticut. In that position she oversaw the operations of the city government’s health and social services arm, and spearheaded a number of multidisciplinary projects focused on low-income, minority and youth populations. She is a graduate of Stanford University and an alumna of the Robert Wood Johnson Foundation Clinical Scholars Program at Yale University. In addition to being a pediatrician and government leader, Dr. Asomugha is a public speaker and Commissioner on the U.S. Commission to United Nations Educational Scientific and Cultural Organization.
Q. Explain your role at CCSQ and what motivated you to accept this responsibility after serving in community health for several years.
A. As the Senior Technical Advisor and the Medical Officer for CCSQ, I support the activities of the CCSQ Director and CCSQ’s Group Directors, especially as it relates to value-based purchasing, our new Transforming Clinical Practice Initiative, population health and our Quality Strategy. Additionally, I’m working with other government agencies and coalitions on issues related to coordinated care, integrated care models and health disparities. I especially enjoy these collaborative efforts because they mirror my belief that within communities, we have to be collaborative, communicate with each other and always put the patient first. At CMS, I get to play an active role in the transformation of our health care system into something that works better for all on a national level.
Q. How have your life and prior career experiences impacted your work at CMS?
A. My prior life and career experiences have had a positive impact on my work at CMS. When you’ve worked “on the ground” within a community, you hear stories and witness challenges that help inform your thinking about policy. Keeping those in mind when making policy recommendations can help patients and the providers who serve them, as well as the communities in which they live. The QIO Program conveys a similar message through its activities: people first. My prior experiences have always entailed keeping people (beneficiaries, caregivers, communities) at the center of the equation, which is the cornerstone of the QIO Program.
Q. For the next five years, Quality Innovation Network QIOs (QIN-QIOs) will work to improve the health status of communities in alignment with the CMS Quality Strategy goals of chronic disease prevention and healthy living promotion. What challenges do you foresee in this endeavor, and how can QIOs overcome them?
A. I believe that QIOs and all partners (including patients) can overcome the challenges of our health care system by working together more effectively. What does that mean? Strengthening and developing new partnerships; making the case that healthy living and disease prevention require all parties to be actively engaged; and being persistent and consistent about our goals to achieve them.
Q. Health disparities continue to be a problem among certain demographic groups and in certain geographical regions. What are your perspectives on the issue, and how can we continue to eliminate disparities, so that we reduce their financial burden on the Medicare program.
A. First, our goal should be to eliminate disparities, not just because of the cost, but because it’s simply the right thing to do. Everyone should be able to live a long healthy life and receive high quality care in the communities where they live. To achieve this goal of health equity, we need to keep this issue at the forefront of every conversation on health and health care. We need to operate systematically and collaboratively. Every demographic group and geographic region in this nation is part of the discourse on disparity. If one region is doing well, and the region right next to it is not, there are implications for both. Within any demographic group, disparities exist. So we have to stop engaging on this issue as an “us vs. them.” The implications impact us all. Secondly, and equally as important, is data. We don’t know how we are doing unless we are collecting meaningful data. From quality to cost to prevalence, data must allow us to see differences across demographic groups so that they can be addressed systematically and consistently.
Q. Community engagement plays an important role in the QIO Program’s attempts to reduce disparities at the community level. Can you share some of your own best practices with us?
A. Community engagement does play a significant role in helping eliminate disparities, and a lot of QIOs are already doing the right things – listening to the beneficiaries and stakeholders they’re trying to engage, taking actionable and measurable steps to address disparities, and recognizing that progress takes time. I know from my previous experiences that such activities can take years. The length of time required can’t be underestimated. One of my favorite quotes is from personal trainer Jillian Michaels who said that “Transformation is not a future event; it’s a present activity.” In other words, you can’t get to your goal without doing something about it right now. Community and patient and family engagement is the right now that will get us to the goal we’re striving for. Another thing that QIOs do very well and should continue to focus on is helping provide unifying language across stakeholder groups, so that everyone understands their role in achieving better health and better care, all while spending our dollars wisely. While those who are at the table may have their own agendas informed by their experiences and goals, QIOs are in a uniquely qualified position to help find the common thread among competing agendas and to establish a mutually agreeable goal. In the end, we all want to provide patients with better, safer and more affordable care, and these are some of the important ways we can ensure that happens.
Q. What role do physicians play in helping patients to become full participants in their health care?
A. Physicians play a big role in supporting patient self-activation, but with the caveat that they work long hours and face a lot of constraints within the larger system that can make practicing medicine today more challenging. The bottom line is that we all want to keep patients healthy. All of us – doctors, nurses, health care professionals – must keep patients the top priority and listen to their needs. Physicians need to be prepared to ask and answer the questions that patients are afraid to ask. We must emphasize patient and family engagement, and continue to work with community or social service organizations to achieve this. And most importantly, as we all strive to improve the quality of care provided, we – as a workforce – must utilize the tools available to measure our progress in improving the patient experience, the care delivered and the health status of our patients. Whether through PDSA cycles, rapid cycle evaluations or other quality improvement tools, knowing where we are gives us a starting point on our journey toward high quality care at a lower cost, and better health for our patients.
Q. Anything else you’d like QIO News readers to know?
A. This is a really exciting time in our health care system. Those who joined us at QualityNet in December 2014 know that there is a lot of enthusiasm, passion and action taking place that will get us toward our health care system goals. QIOs and their partners are doing incredible work, and I would like to thank all of those involved for the work they do every day on behalf of beneficiaries and the health care system. That being said, we can still do better. Quality improvement is not a destination – it’s a journey. I would challenge you to think more broadly about what a community-wide health and health care system should look like in order to improve the health of beneficiaries. What is working and what isn’t working toward a more coordinated system. How we can develop strong learning networks for providers and get non-traditional partners to the table. Lastly, how to create sustainability and spread for programs that work.