Reflections on the Session: Advancing Value in Healthcare through Measurement

On February 17, 2021, the Zetema Project convened to discuss the role performance measurement may play in advancing value in the healthcare system. As speakers discussed the opportunities and limitations of measurement from the perspective of a provider, an employer, and a healthcare quality and transformation leader, consensus emerged on several key points:

Value is equal parts quality, patient experience, and affordability

While the definition of value may seem straightforward, panelists stressed that each element - quality, patient experience, and affordability - are critically important and interconnected, and therefore one element cannot falter at expense of the others. Measurement is one tool for advancing value as it can provide data that enables quality improvement, provider accountability, and incentives. However, measurement is not sufficient to be the sole driver of value; indeed, there are few measurement initiatives that have improved quality, experience, and affordability.

Measurement should be actionable and specific

Panelists agreed that measurement should enable quality improvement by focusing on specific conditions, episodes of care, and populations in order to provide actionable insights. However, there is no silver bullet to measurement that advances value, and what is specific and actionable to a provider practice is likely to vary from what is valuable to a payer or purchaser. For example, providers may find condition-specific dashboards and patient drill downs helpful in managing workflows and patient encounters, while payers and purchasers will benefit from higher level insights about performance of providers and health systems in their networks.

Quality incentives are not a sufficient motivator for advancing value, but every stakeholder has a lever to pull

Panelists questioned if financial incentives (e.g., pay for performance) correlate with improvements in quality and affordability. However, it was clear that payers, providers, and purchasers can use measurement to advance value from their position within the healthcare system. Different tools emerged as successful for different stakeholders - a provider saw significant quality improvement from process-oriented tools like action lists and patient follow ups, while purchasers were more successful in influencing consumer and provider behavior through plan design and driving volume to providers who demonstrate high value care. These strategies can complement each other when provider improvements in quality result in financial and market-driven incentives from payers and purchasers to create feedback loops for improvement.

There are many strategies, innovative ideas, and priorities for optimizing the value of measurement: from reducing measures used to those that are outcomes focused, stratification of measure data by demographic indicators to support addressing social determinants of health, to a host of potential policy interventions possible under the Biden administration in a post-COVID world. However, we cannot overestimate the power of measurement, as it is only one of many tools available to advance value in the healthcare system.