Quality Measures: How do you know if you are paying for quality if you can’t properly measure it?

Value-Based Payment (VBP) arrangements allow health care purchasers to align financial outcomes to quality clinical outcomes. Such arrangements are designed to drive improvements in health outcomes at multiple levels (i.e., individual, community, within a risk pool) and reduce the cost burden associated with treatment and prevention. Quality measurement is a central component to these arrangements—how do you know if you are paying for quality if you can’t properly measure it?

There are generally five categories of quality measurement: structure, process, outcomes, satisfaction, and efficiency. Each category has its place, including strengths and weaknesses that should be evaluated prior to consideration. For example, clinical outcomes measures alone are not sufficient, and there are variations within them, such as the difference between clinical endpoints and functional outcomes. Process measures can be useful in assessing the degree to which care adheres to evidence-based guidelines and process that are proven to eliminate variation in care. However, where there isn’t a strong link between process and outcome, then the process measure can break down. Additionally, process measures allow providers to measure outcomes within the sphere of their control and mitigate against downside risk associated with factors beyond their direct influence (such as patient compliance or behaviors).

There are many associations, agencies, private, and public entities that have published on quality, adding to the general body of knowledge, and perhaps confusion. Notwithstanding the provider responsibility, the industry has had to start somewhere, encouraged by the Centers for Medicare & Medicaid Services (CMS) in its effort to simplify regulations. In our view, there is room to mature our thinking and implementation of quality measures through simplification and standardization that is appropriate to the clinical needs and to alleviate the burdensome nature of useless measurement documentation in clinical practice that can frustrate physicians.

Written by Chase Titensor, Director, Leavitt Partners Solutions