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Accountable Care Measures for High-Cost Specialty Care and Innovative Treatment

You Get What You Pay For—Improving Measures for Accountable Care

Background:

  • 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.

  • Measure sets need breadth, depth, and new approaches to promote appropriate care across the relevant population.

Research Goals:

  • Examine gaps in accountable care measure sets and available measures to fill gaps for certain conditions.

  • Focus on gaps for high-priority—prevalent and costly—health conditions:
    • Asthma
    • ADHD
    • Breast Cancer
    • Chronic Low Back Pain
    • Chronic Kidney Disease
    • COPD
    • Diabetes
    • Glaucoma
    • Hepatitis C
    • HIV
    • Hypertension
    • Influenza
    • Ischemic Heart Disease
    • Major Depression
    • Multiple Sclerosis
    • Osteoarthritis
    • Osteoporosis
    • Prostate Cancer
    • Rheumatoid Arthritis
    • Stroke

  • Understand the implications of the measure gaps to inform recommendations for improving accountable care measurement.

Research Highlights:

  • Gaps in accountable care measure sets cannot be completely addressed with more of the same measure types and measurement strategies currently in use.

  • Strategic approaches to measurement do not necessarily require more measures.

  • Measurement enhancements could include the increased use of outcome, cross-cutting, and patient-reported measures in measure sets, and new approaches to measurement including layered and modular models.

    • 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.

  • A framework that could help those who are developing accountable care measure sets to analyze their own sets and strategies 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 measurement through feedback loops, input from patients, and evaluation of measure impact. 
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