September 12, 2019
Much of the focus in health policy circles and the media has been on the price transparency provisions of the recently released executive order on improving price and quality transparency. However, the executive order also calls for the establishment of a health quality roadmap that outlines a process for alignment of measures across all federal programs and care settings, adoption of common measures, and elimination of “low-value or counterproductive measures.”
The health quality roadmap will need to address several key questions including:
- What is the purpose of measurement?
- What do “high-value and productive” measures look like?
- What is a feasible pathway to evolving measurement?
In this post, we address these and other important questions and discuss the importance of developing patient-centered outcomes measures. We provide an overview of our approach, which is described in more detail in a just-released white paper and was developed through multistakeholder convenings and a review of existing measures and measurement frameworks. We argue that a confluence of factors makes this an ideal time to move forward with these next generation of measures.
Purpose Of Measurement
There have been many uses for measures, but the primary application for measures in any quality roadmap should be accountability. We use the term accountability to encompass two specific use cases: assessing and rewarding provider performance, and enabling informed provider selection by consumers.
With the growth in alternative payment models and the movement toward value, there has been an increasing recognition of the need for measures that are better suited for these models, which include accountable care organizations and episode-based payments. They address care across the continuum comprehensively and therefore require parsimonious and meaningful performance assessments, rather than assessments based on individual patient encounters such as receipt of a hemoglobin A1c test.
Similarly, these process measures have not been useful to consumers as they seek information to inform their choice of providers. In fact, the success of any transparency initiative aimed at patients and consumers will be dictated by our ability to provide useful price and quality performance information to individuals. We fully recognize the importance of more granular measures for use by providers in quality improvement but posit that clinicians and health systems should have the flexibility to choose such measures based upon their particular circumstances and quality improvement goals.
Authors’ Note
Mark B. McClellan, MD, PhD, is an independent board member for Alignment Health Care, Cigna, and Johnson & Johnson. He co-chairs the Accountable Care Learning Collaborative and the Guiding Committee for the Health Care Payment Learning and Action Network, and serves as an adviser for Cota and MITRE. He has received research grants from the American Heart Association, the Commonwealth Fund, and the Gary and Mary West Foundation and WestHealth Policy Center.