Getting To The Root Of Performance Measurement
By Frank Mazza, Chief Medical Officer, Quantros
The U.S. healthcare system is quickly shifting care focus away from volume and toward value. In this new and challenging environment, the means used to define, deliver, and measure quality will characterize the essential elements that power the collective performance of every stakeholder.
Providers who demonstrate positive clinical outcomes across episodes of care, while at the same time lowering expenditures, will prevail. Likewise, data analytics designed to help organizations to monitor, manage, and report errors and adverse events will play a major role in the delivery of safer, higher quality care.
Vendors that provide useful and usable solutions for this purpose will best position themselves to effectively meet the expectations of both providers and payers if they can deliver a unique blend of functionality that centers on these fundamental areas: Safety Risk Management and Surveillance, Pay-for-Value Reporting, and Performance Analytics. A key aspect of this offering entails the combination of SaaS-based solutions and information services — which should be made available either on a standalone or fully integrated basis — to more effectively monitor and measure clinical and financial performance with precision and conviction.
All of these elements in combination will be integral to helping the U.S. healthcare system deliver value-driven care and be compensated for it, while paving the way for meaningful improvements in patient safety and clinical quality.
Measuring What Matters Most
With the new emphasis on outcomes achieved relative to costs, healthcare payments are becoming increasingly and explicitly linked to a complex myriad of performance measurements. In turn, non-performing providers will begin to face greater financial risk.
Accountable Care Organizations (ACOs) and other alternative payment models that aim to deliver better care at lower cost must focus on and optimize their day-to-day operations. It’s about unlocking value in healthcare and seeing improvements in quality and safety, which demands a commitment to a standardized approach to the treatment of major medical conditions and measuring outcomes.
Information technology vendors must take the lead in embedding standardized order sets and clinical processes into electronic medical records, and in creating software solutions that automate and aggregate outcomes-data collection. A data platform that allows provider benchmarking based upon resource utilization and condition-by-condition clinical outcomes should be included as a critical component.
In the absence of a consensus on measurement, but with finances remaining in great risk, the adoption of a continuous quality improvement process that measures what matters and holds providers accountable is essential. As more employers, health plans and government purchasers implement value-based payment models, quality and safety risk management solutions will play a fundamental role in helping to align physician and hospital incentives for measured outcomes. Healthcare organizations that commit to developing their capabilities and adopting robust processes that support and continually improve them will gain competitive advantages as they strive for higher quality care and increased market share.
Finding The Most Optimal Solution
Healthcare information technology (HIT) data that providers need to track patient care is critical for success, especially given that episode-of-care analysis — where the complexity of measurement is most evident — requires a sophisticated system for tracking and measuring data. Fortunately, episode evaluation systems exist that can span the entire continuum of patient care.
In contrast to traditional encounter-based systems, these systems have the ability to capture all clinically related encounters and assign them to a single episode of illness, regardless of care setting. This allows providers and purchasers to accurately compare the total cost and utilization of medical services against local peer groups, national norms and generally accepted best practices. This also gives providers the power to measure what matters using meaningful and reliable information for assessing the integrated delivery of cost-effective care.
About The Author
Frank Mazza, M.D., chief medical officer, Quantros, is a physician by training (pulmonary, critical care and sleep disorders), and still practices medicine part-time. Prior to joining Quantros, he held several executive positions within the Seton Healthcare Family in Austin, Texas, including system-level chief Patient Safety officer and associate chief medical officer, as well as vice president of Medical Affairs at Seton Medical Center, Austin.