What are quality measures?
According to the Centers for Medicare and Medicaid Services, quality measures are:
... tools that help measure or quantify health care processes, outcomes, patient perceptions and organizational structure and/or systems that are associated with the ability to provide high-quality health care and/or that relate to one or more quality goals for health care. These goals include: effective, safe, efficient, patient-centered, equitable, and timely care.
Quality measurement plays an essential role in value-based payment models and accountable care structures. Quality measures, when tied to financial incentives, can help payers to reward better care, encourage providers to take action to improve care, and guide patients to make informed decisions about where to seek care.
Overall, rigorous quality measures can:
- help to achieve the delivery of higher quality care
- serve as a monitoring function to detect problems within an accountable care system, such as inappropriate use of services (e.g., underuse or overuse of care)
- align financial incentives in accountable care models that reward providers for achieving savings
- help to evaluate if care delivery aligns with clinical guidelines and standards
- promote patient-centered care and meaningful patient access through patient-reported outcomes and patient-reported performance measures
Gaps in health care quality measurement
Early accountable care measure sets prioritized common health care conditions (i.e., diabetes and heart disease) but left out several prevalent and costly conditions. Gaps in quality measurement can lead to the delivery of inefficient care and undermine value-based payment models. A 2014 NPC analysis conducted with Discern Health examined gaps in early accountable care quality measures and made recommendations to inform future measure sets. The analysis included five recommendations for stakeholders implementing accountable care programs:
- identify and prioritize measure gaps
- use alternative measurement approaches
- use the most meaningful measure types
- address barriers to measurement
- assess opportunities to continuously improve
Although the field of quality measurement is evolving, key gaps in measurement persist. Quality measurement in oncology is particularly challenging because patients have complex and individualized needs, and often require targeted diagnostics and therapeutics as part of their treatment. In 2016, NPC, Discern Health, the Duke-Margolis Center for Health Policy, and the American Society of Clinical Oncology (ASCO), analyzed gaps in accountable care measure sets across 10 high-priority types of cancer.
This analysis identified significant measure gaps across all 10 cancer types, including areas where available measures are not being used in accountable care measure sets and new measures need to be developed. A roundtable of patient advocates, providers, payers, employers/purchasers, policy makers, and quality organization representatives identified recommendations to improve oncology quality measures. The roundtable suggested refining oncology core measure sets with existing and new cross-cutting measures that address important quality issues across types of cancer and recommended additional research to better understand cancer-specific patient-reported outcome (PRO) data collection tools and PRO performance measures for accountable care through research and measure development. Additional roundtable findings can be found here.
How do we make quality measurement more patient-centered?
Patient-reported performance measures should be incorporated into accountable care measure sets to better reflect patient priorities and meaningfully measure quality of care.
In NPC’s analysis of gaps in oncology measures, health care stakeholders from across the health system emphasized the need for PROs that reflect patients’ individualized needs or preferences, understanding, and experience of care. As a follow-on to this analysis, NPC partnered with Discern Health to explore the landscape of available patient-reported measures (PRMs) and patient-reported performance measures (PR-PMs) and identify recommendations for closing existing gaps.
The researchers identified five key recommendations:
- Involve patients and caregivers throughout all aspects of the measures’ life cycle to ensure measures capture value
- Fill care phase and domain gaps in PRMs and PR-PMs
- Address methodological challenges
- Reduce provider and patient burden by standardizing and aligning use of PRMs and PR-PMs
- Support providers in PRM and PR-PM implementation
- Improving patient access to medications through quality measurement
Quality measurement also plays an integral role in ensuring meaningful patient access to necessary medications. Barriers to medication access and compliance pose a serious problem for the U.S. health care system, costing billions of dollars in lost productivity, additional doctor visits, preventable hospitalizations and nursing home admissions, and even premature death.
To inform future quality measures pertaining to medication access, the Pharmacy Quality Alliance (PQA) and NPC developed a conceptual framework that holistically defines the patient’s medication access journey and identifies gaps in quality measurement that could address the financial and non-financial barriers that stand between patients and the medications they need. This conceptual framework can serve as a foundation for future efforts by measure developers, researchers, and other health care stakeholders to advance quality measurement for medication access.