Shantanu Agrawal, MD, is President and CEO of the National Quality Forum (NQF). Dr. Agrawal, a board-certified emergency medicine physician, is the former director for the Centers for Medicare & Medicaid Services’ Center for Program Integrity. He spoke with us about how NQF is advancing quality and patient safety.


The National Quality Forum brings together diverse experts — from purchasers to providers — to address the most pressing issues in health care safety and quality. What is the value of having those differing perspectives?

We strive every day to make sure that we are genuinely multi-stakeholder.  And so, for us, that means making sure that all of our work — whether it’s measurement work, or quality improvement work, or work in social determinants of health — that all of that work is informed by expert input from every major stakeholder group in the health care ecosystem. So, that definitely includes payers, providers, hospitals, clinicians, and also — very importantly — consumers, patients, and purchasers. This has been at the core of NQF literally since we were founded. I think that’s one of the reasons people trust NQF.


After you determine how quality issues should be measured, what are the next steps to make sure you have impact?

We try to show where there are good measures already in place, and our endorsement helps to identify the most scientifically valid, the most useful, and most supported measures set by the stakeholders that we were just talking about. Recently, we have started to connect our measurement work to quality improvement activities, which I think is really critical so that we are not only establishing the right measures; but we are also supporting delivery systems and helping patients get the care that everyone wants and needs. It’s a new area for us, and one that I think holds a lot of promise.

And beyond measurement, we try to identify areas that really need improvement in the quality ecosystem overall. So, years ago, for example, we got very involved in risk adjustment for various types of clinical risk in measurement and in other areas. Now, we have really started to work on social risk, on the social determinants of health. And that’s an area where we have definitely prioritized as a strategic goal.


Can you tell us what the National Quality Forum is doing in the area of opioid use and abuse?

So, we are trying to bring every major capability that we have to the opioid issue. Measurement in the opioid space, or the substance use space, generally is really lacking. And we have been talking to a number of stakeholders about how to get the right measures put into the field. We have worked with CMS and also provided technical assistance to Capitol Hill on a bill that ultimately included a provision to identify gaps and promote measure development to drastically increase the number of measures in the opioid space. And we’ll be launching an opioid technical expert panel later this year to help identify the priority gaps in measurement. Addressing the opioid crisis was an NQF priority last year and we produced, through a multi-stakeholder approach, an opioid stewardship playbook that delivery systems can use to better manage their opioid prescribing and utilization.


Linda Schwimmer, President and CEO of the Quality Institute, serves as chair of NQF’s Consensus Standards Approval Committee (CSAC), representing the purchaser/consumer voice. How do organizations such as the Quality Institute make an impact in your organization?

The purchaser and consumer voice has been critical to us from the very beginning and is one of the foundational reasons NQF was created. We’ve never lost sight of that as we’ve evolved as an organization. Consumers and patients sit on all of our committees. CSAC has a special role in our process. It helps to ensure that individual endorsement committees are being consistent with each other as they make their endorsement recommendations. We have a chair, vice-chair model that oscillates between a consumer or purchaser organization and another kind of stakeholder organization. Linda has been absolutely great in that role and really pulls people into the conversation. She’s gone from vice-chair to chair, which also means that she’ll hold a seat on the NQF board, which I think is really exciting. Consumers and purchasers are not just at the table but also serve in leadership positions.


You are nearly 20 years old as an organization. How do you envision NQF’s role in the next 20 years?

I think we need to do a better job in quality. Measurement is not an end onto itself. We certainly recognize that. We have to do a better job as a community of connecting measurement to population health approaches so that we are actually producing the change that we want to see. And so, one of the things that we’re doing this year, partly to mark our 20th anniversary, but also, frankly, because there are a number of challenges that I think we need to talk through, is that we’re launching a task force to help address exactly this type of question. That’ll be comprised of quality leaders and will help to create the future vision for the overall quality enterprise, which I think will be really compelling and help take us into the next 20 years.