Mind the Gap (and Engage Patients in the Quality Measure Conversation)

When it comes to quality measures, we don’t often talk about them in simple terms, instead using phrases and language that are understandable only to those who are working in the field or are truly steeped in health care policy.

It doesn’t have to be that way. In fact, when we do that, we often exclude audiences who should be more actively engaged in the conversation—patients and their caregivers.

There are many, many patients and caregivers who are engaged and well versed in quality measures and health policy; I’m not suggesting otherwise. But what I am suggesting is that we look for ways to broaden the conversation, to include more patients, caregivers and other stakeholders so that we don’t miss opportunities to seek their feedback and learn from their experiences.

To their credit, organizations such as the Centers for Medicare and Medicaid Services (CMS) and the National Quality Forum are developing patient advisory councils to ensure the patient voice is included in the development of quality measures. Specifically, CMS is working to consolidate, align and use data to focus quality measures, emphasizing patient-reported and other outcomes while coordinating with private payers.

This is a step in the right direction. Today, many quality measures are based on what we can readily measure—whether certain processes were followed or whether specific outcomes were reached, like lower HBA1c levels for diabetes. And while those are helpful measures because they can provide us with clear steps to follow when providing care to patients, especially those with complex conditions, patient-reported outcomes can help us to fill some of the gaps we see in quality measurement.

Last month, during a conference hosted by the National Pharmaceutical Council, the National Health Council, the Pharmacy Quality Alliance and 17 patient groups, the need to include patients in the conversation was reiterated across speakers and panels. There was a strong sense of optimism about being able to do better: with the right balance of financial incentives, coupled with evidence and quality measures, we can realize improved health outcomes and lower costs.

Another step forward in this effort includes the work by NPC with Discern Health and a roundtable of health care experts, such as Mark McClellan, MD, MPA, PhD, director, Health Care Innovation and Value Initiative, Brookings Institution, and Jerry Penso, MD, MBA, chief medical and quality officer, American Medical Group Association, to identify gaps in quality measures that need to be addressed. Filling the measure gaps is not a simple fix; it will require creative approaches to measurement. In particular, we need to consider:

  • 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.

There also are several steps that we can take to broaden the conversation about quality measures and ensure that patients and other stakeholders can become more engaged in the process:

  • Patient groups: Join together to focus on new measures, and push adoption.
  • Providers: Engage! Be a part of the process.
  • Quality Groups: Prioritize and fill gaps.
  • Industry: Include quality measures in studies and demonstrate improvement. Include measures in trials or post market studies to show that what you produce makes a difference.

It was encouraging to see the level of enthusiasm among stakeholders at the conference for working together. There’s a lot of progress already being made to improve quality measures and engage patients in these efforts, but we recognize there’s still a lot of work to be done.