Q&A: Lauren Niles

In the fight against opioids in America, it’s all hands on deck. And Bloomberg Fellow Lauren Niles is one of the people working behind the scenes to try to reverse the tide of the epidemic. She’s worked for seven years as a senior health care analyst at the nonprofit National Committee for Quality Assurance, which aims to improve the quality of health care in America. Her job there: find ways to measure and standardize the quality of care provided to people with behavioral health problems, substance use disorders and pain management needs, including people on opioid therapy. 

The quality measures Lauren and her colleagues develop give health plans, providers and others the tools to improve — and even save — the lives of patients. As she studies for her doctorate in public health at Johns Hopkins Bloomberg School of Public Health, Lauren hopes to learn from professors, peers and guest speakers about what works in the field and what doesn’t.  

We talked to Lauren about what goes into developing new quality measures, a measure she’s currently working on and how the national conversation about America’s opioid epidemic is changing. 

Talk us through the process of developing a new quality measure.

As measure developers, one of the first things we do is familiarize ourselves with an issue. We identify a gap in care or treatment, explore existing literature and current efforts in the field to address that gap, and then begin thinking about ways to measure it — all the while talking to experts and our various panels with specific expertise. For example, with substance-use measures, we might consult our panels on behavioral health, pain management, geriatrics and technical issues, such as billing codes and payment. By doing that, we’re better able to wrap our heads around why this gap exists, what the field is doing to address it, what evidence and guidelines to recommend, and how we might measure all of that.

Then we determine if the measure concept we have identified is scientifically-sound, evidence-based and positioned to address a gap in quality. If that’s the case, we move forward and try to understand how the concept performs in the real world and if it is feasible for health plans to collect necessary data and report such a measure. We field-test the measure and work to flesh out what it will look like, as well as determine if the measure is a valid and reliable way to measure care for its target population. 

One of the things we want to consider is which populations we will include and exclude. For example, if we’re looking at substance-abuse disorder, are we only looking at opioid use, or are we also including alcohol-use disorder? Does it make sense to exclude cancer patients or another group from this particular measure? Our measure development process is very rooted in science and methodology, but also relies heavily on talking to experts and end-users to problem-solve and think through real-world feasibility. 

Can you tell us about a measure you’re developing right now? 

This year, we are working on a measure that assesses adherence to pharmacotherapy for people with opioid-use disorder. Data from an existing NCQA measure tells us that only around one-third of people diagnosed with opioid-use disorder are beginning treatment. We know that pharmacotherapy is an important, evidence-based treatment, but patients’ adherence is very low. We just completed our field testing of this new measure, and although I cannot publicly discuss results just yet, what we found suggests that this measure would help to fill this gap in care. 

The opioid epidemic in America keeps getting worse. Has the national conversation around the issue been changing?  

We’re definitely seeing increased interest in how to effectively measure opioid prescribing practices. We now have three measures that assess high-risk opioid prescribing practices in our set of performance measures that is widely used in the healthcare industry. We are also exploring how to measure alternative methods of pain management. On the addiction side, there are ongoing conversations about the effectiveness of existing measures and about what new outcomes to measure. When we think about good outcome metrics, is it important to measure overdoses, high-intensity service usage, or hepatitis-C or HIV infections? Or is it something patient-reported, like the ability to hold a job, have positive interactions with family and friends, or be able to do things that are important to them in life? I think these are really important things to continue to think about as we move forward.