Quality Talk

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Chisara N. Asomugha, M.D., MSPH, FAAP 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 and population health. Prior to joining CMS, she served as Deputy Mayor/​Community Services Administrator for New Haven, Conn. where 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. In addition to being a pediatrician and government leader, Dr. Asomugha is a minister, public speaker and philanthropist. She is a graduate of Stanford University, Duke University School of Medicine and an alumnus of the Robert Wood Johnson Foundation Clinical Scholars Program at Yale University. She is also a Commissioner on the U.S. Commission to the United Nations Educational, Scientific and Cultural Organization.

Explain your role at CCSQ and what motivated you to accept this responsibility after serving in community health for several years.

As the Senior Technical Advisor and the Medical Officer for CCSQ, I support activities related to value-based purchasing, population health and our quality strategy. Additionally, I’m working with other government agencies and coalitions on issues such as 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. What motivated me to accept this position at CMS was my overwhelming belief that federal government needs people who have insight into what’s taking place on the ground and within communities. Moreover, I’ve always been interested in challenging the status quo. At CMS, I get to play an active role in the transformation of our health care system into something that works better for all.

How have your life and prior career experiences impacted your work at CMS?

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.

Since becoming a part of CCSQ, you have engaged QIO medical directors; what contributions do they make in shaping the Program?

Engaging medical directors was one of the first things I began doing when I joined CMS. We started having regular conversations which led to meaningful activities not only for CMS, but for the new Leadership Network that was created. This past summer, the Leadership Network participated in a series of webinars to learn about important topics impacting beneficiaries such as value-based purchasing, patient safety and adverse drug events. It was really great to see it all unfold. It is important to realize just how far the QIO Program has come and that a large part of that is because of the network of providers that QIOs continue to engage and support in providing the best care to beneficiaries. Medical directors, working with QIO staff, serve as our boots on the ground” professionals, informing us of the best ways to improve quality of care for beneficiaries.

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?

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 community 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 with an us vs. them” mentality. The implications impact us all; we all must work together, proactively and persistently, to target the underlying issues to this problem.

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?

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 engagement is the right now that will get us to the goal we’re striving for. Another thing 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 the Three-Part Aim. Remember, no matter who is at the table, everyone comes in with their own agenda based on their experiences and mission. 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.

What role do physicians play in helping patients become full participants in their health care?

Physicians play a big role in supporting patient self-activation, but working long hours and having to face a lot of constraints within the larger health care system 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 better coordination of care for our patients and continue to work with community or social service organizations to achieve this. 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 towards high quality care at a lower cost and better health for our patients. 

Anything else you’d like QIO News readers to know? 

This is a really exciting time in our health care system due to all of the transition and expansion that is going on. 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. Think about 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; and how we can create sustainability and spread for programs that work.