As the future of health care moves forward, patients, providers and policymakers have converged on the shared goal of creating value in the U.S. health care system — high quality health care that contributes to favorable patient-centered outcomes and lower costs. Although these various stakeholders may define value in slightly different ways, all views are important and interrelated.
Since the Affordable Care Act was passed four years ago, the government has made efforts to identify innovative models of care tied to quality and reimbursement. However, it remains difficult to define and measure the value of care provided by individual providers or health care organizations. Current measures of clinical performance may not be producing better quality or reducing costs. For example, emerging data suggest that measuring individual provider performance (i.e. achieving optimal blood hemoglobin A1C levels) bears little relation to the health of patients with diabetes mellitus.
Recently, the Kern Center for the Science of Health Care Delivery at Mayo Clinic hosted the symposium "Measuring Value: From Theory to Practice” in conjunction with Optum Labs. Nearly 20 national experts, including seven members of the Institute of Medicine, collectively participated in discussions about how to create more meaningful measures that will reward high-value care. Specific goals were 1) to determine how to operationalize the measurement of value in health care and 2) to recommend ways to measure value for complex tertiary and quaternary care. Through in-depth discussion, a number of consensus themes emerged:
- While value must be defined from multiple perspectives, the patient perspective is of primary importance.
- Measurement is not an end in itself, but a means to address important quality problems. Specifically, a key focus needs to be on understanding the impacts of implemented policies.
- Current approaches are not measuring what is needed. Measurement must be reoriented to align with patient function and goals.
- Payment reform mechanisms are not the only way to encourage high-value care. Enhancing consumer engagement and developing care coordination strategies are just as important.
- The term “value” is not well understood by providers, policy makers or the public. The concept of value must be translated into language that consumers understand.
Our goal within the Kern Center for the Science of Health Care Delivery is to continue to engage with these national experts and to disseminate information from this meeting through the following publication and research activities:
- Create a white paper summarizing the policy discussion and recommendations.
- Identify three themes “upstream” of value constructs including care for multiple conditions, diagnostic accuracy and patient-reported outcomes.
- Identify “tracer” conditions of high-value care and use data to measure outcomes and costs for patients with these conditions.
- Examine the extent and impact of low-value health care services (i.e. Choosing Wisely) using large-scale data.
- Engage with IOM’s Diagnostic Accuracy Committee to define quality around this topic.
Editor's note: Jayant Talwalkar, M.D., M.P.H., is co-director of the Value Analysis program within the Kern Center for the Science of Health Care Delivery and a gastroenterologist at Mayo Clinic. Follow Dr. Talwalkar on Twitter at @JayTalw.