Mind the Gap: Improving Quality Measurement in Accountable Care Systems

Our society is obsessed with quality, from the cars that we buy to the food that we eat, and the schools to which we send our children. One glaring exception is in health care.

It’s very difficult to be an informed, quality conscious consumer of health care in this country. Until we have appropriate quality measures in place and open and transparent platforms to communicate this information, patients won’t know the best centers of excellence, the best providers, or the best treatments for their individual situation.

That’s not to say that health care quality measures don’t exist. Quality measurement, tied to financial incentives, is one of many approaches accountable care programs are using to promote system-wide improvement. Measures can help payers to reward better care, providers to take action to improve care, and patients to make informed decisions about where to seek care.

In fact, there are many quality measures outlined by the Centers for Medicare and Medicaid Services (CMS) and quality organizations, but the measures vary greatly by condition. 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, both of which have significant consequences for patients and health outcomes. Yet, it is neither feasible nor desirable to measure everything in health care, so balanced solutions are required.

What can we do to improve what we measure? To begin with, we need to examine where there are gaps in care and where we can do better. That’s why, working with Discern Health, we 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.

What did we find? Some conditions requiring specialty care and innovative treatments have a number of quality measures—mostly process, and not outcome measures—while others have none.

To address the identified measure gaps, accountable care program implementers would benefit from innovative ways of enhancing accountable care measure sets to support the goal of better results for the broad populations covered by their programs, including patients who require specialty care and innovative treatment. Applying patient-focused measures to existing health care systems could also help assess whether accountable care or other reforms are achieving the desired improvements in care.

As a starting point, those who are implementing accountable care programs can apply utilization statistics and analytics from disease management programs as early warning indicators to detect problems in care. They also can review their data to identify improvement opportunities and whether they need to add measures to their sets. To be sure, “minding” this gap doesn’t necessarily mean adding more measures and placing a greater burden on providers; it can mean carefully designing those measures so they can account for the broadest set of patients and outcomes. Additionally, program implementers can take different approaches to balancing the burden of data collection and measurement with the benefit of meaningful quality measurement information for accountability and improvement.

When it comes to reviewing their measures to determine gaps and consider solutions, there are several steps that program implementers can take to improve accountable care measurement, including:

  • 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.

We’ll be exploring these challenges and potential solutions in greater detail on October 30, when we’ll bring together health care experts and thought leaders for a conference, “Mind the Gap: Improving Quality Measurement in Accountable Care Systems.” We encourage you to join us as we take a closer look at how we can do a better job to balance quality patient care and financial incentives for providers.