Measuring the quality and cost of health care is an integral part of accountable care, but new research from the National Pharmaceutical Council and Discern Health sheds light on gaps in measurement and missed opportunities to promote improvement in patient care and health systems. The research also offers solutions for addressing measure gaps, particularly for specialty care and innovative treatment.
“We are moving toward health care payment systems, benefit designs, and public reports that could help achieve much better care at a lower cost, but these efforts are a work in progress today,” said Mark McClellan, MD, PhD, director of the Health Care Innovation and Value Initiative at the Brookings Institution and co-chair of the expert advisory group for the project. “Better measures can give clinicians more flexibility in reforming care through new personalized services, care teams, and other care innovations, and they can provide better evidence that we are making real progress for all patients in closing gaps in quality and improving outcomes.”
Quality measurement, tied to financial incentives, is one of many approaches accountable care programs are using to promote system-wide improvement. The focus of measure sets is typically limited to the clinical conditions of a few at-risk populations. Measurement influences priorities and care delivery to the potential detriment of patients with conditions outside the scope of measure sets. This could result in inappropriate care, which includes both overuse and underuse of services. Yet, it is neither feasible nor desirable to measure everything in health care, so balanced solutions are required.
“Gaps in accountable care measure sets cannot be completely addressed with more of the same measure types and measurement strategies currently in use,” said Tom Valuck, MD, JD, MHSA, who is a partner at Discern Health and co-author of the research. “Measure sets need breadth, depth, and new approaches to promote appropriate care across the relevant population.”
The research, “Accountable Care Measures for High-Cost Specialty Care and Innovative Treatment: You Get What You Pay For – Improving Measures for Accountable Care,” examined gaps in accountable care measures as compared with evidence-based guidelines for 20 prevalent and costly conditions, such as breast cancer, diabetes, HIV, and heart disease. The findings were reviewed via a roundtable discussion with national thought leaders. Some conditions have a number of quality measures, while others have none.
“Although there are gaps, we may not need more measures for certain conditions if we take strategic approaches to measurement, such as layered and modular models,” said Robert W. Dubois, MD, PhD, chief science officer, NPC, and research co-author. “Where additional measures are needed, measure set enhancements could include the increased use of outcome, cross-cutting, and patient-reported measures.”
- Outcome measures, which are meaningful to patients and providers, allow for flexibility and innovation in improving care, and can efficiently replace multiple process measures.
- Cross-cutting measures assess care across conditions, settings and time.
- Patient-reported measures emphasize the outcomes that matter most to patients, such as functional status and quality of life.
- The layered and modular approaches are meant to optimize measurement efforts by focusing the measures on specific purposes, such as external accountability or internal improvement for the layered approach or a specific subpopulation for the modular approach.
The research also outlined a framework that could help accountable care measure set developers to analyze their own sets and strategies. The framework includes the following steps:
- Prioritizing measure gaps for the most prevalent and costly conditions, identifying unmeasured aspects of care, and using early monitoring indicators such as readmissions to indicate problems.
- Using alternative measurement approaches, such as layered and modular models.
- Using the most meaningful measure types, such as outcome, cross-cutting, and patient-reported measures.
- Addressing barriers to measurement by enhancing data sources and overcoming measure methodological issues such as small numbers, risk adjustment, and attribution.
- Assessing opportunities to continuously improve through feedback loops, input from patients, and evaluation of measure impact.
“Accountable care offers great potential for improving health and health care delivery while lowering costs; however, the transformation to higher value care must be balanced by measures to ensure the provision of appropriate care,” the report explained.
Source: National Pharmaceutical Council