Measuring value-based care aspirations is becoming increasingly important as more healthcare providers transition to this care model. A framework has been identified that can be used to determine the key relevant metrics for this transition process. Similarly, several areas have been identified where it is essential to measure metrics to assess the value of healthcare. The CMS have developed several areas that they consider are essential metrics in value-based models of healthcare. These are in line with the incentives they are offering to encourage adoption. Despite extensively searching industry publications, there was no clear indication that commercial payers require different metrics from healthcare organizations. Finally, a breakdown of the value-based aspirational metrics of the five providers identified has been included. In the interests of commercial sensitivity, the information the providers make available publicly is limited.
Check out this other report to discover the U.S Value-Based Healthcare System.
VALUE-BASED CARE APIRATIONS
- Value-based care aspiration metrics relate to how a healthcare organization measures its journey to becoming a value-based healthcare organization. However, value-based care aspiration metrics are also the measure of the journey to ” achieving the aspirational goals of improving the patient experience of care, improving the health of populations, and reducing the per capita cost of health care—as well as improving clinician experience.” Both are essential as the value-based healthcare system sees the healthcare provider take on the burden financially of providing value-based care. There must be clear metrics in place to assess both.
- The systemic measurement of values is essential if value-based reimbursement is to be implemented in healthcare. The lack of outcome measures has slowed the implementation of this model of care and has meant healthcare providers are reluctant to become accountable for outcomes.
- When measuring value-based care, there has to be a move away from process-based metrics, which fail to differentiate between those providers that are adding value and those that are not.
ASSESSING VALUE-BASED CARE APIRATIONS
- There are a wide range of metrics used to assess value-based care in the US. There are several frameworks or sets of metrics that have been adopted by different healthcare providers. The choice of metrics is largely based on goals of the organization and the way they want to deliver healthcare.
Journey of Healthcare Organization
- The report “Second Curve of Healthcare” suggested four strategies need to be prioritized when moving to a value-based system. These four strategies are:
- A framework has been developed within each of these strategies that identifies the metrics that should be measured by aspirational value-based healthcare providers. This framework is set out below.
- The framework provides metrics and measures that should be considered by a healthcare organization when transitioning to a value-based model. Despite an extensive search of industry publications and best practice guides, few available resources detailed specific metrics relating to the transition. Most of the information focused on the metrics that the healthcare organization should be monitoring to measure the value being provided. By recording metrics illustrating success in delivering value, the organization, by default, demonstrates how it is progressing in its transition to value-based care.
- Patient-reported outcomes are critical to any value-based health system. Until patient-reported outcomes are consistently measured and used to develop healthcare systems, value-based healthcare will struggle to gain traction. A healthcare system should first and foremost deliver patient outcomes. Metrics for evaluating value-based healthcare systems must give weight to patient-reported outcomes.
- Patients can experience delays, chaos, confusion, and complications in their healthcare journey, but one-dimensional data fails to recognize this aspect of care. By measuring patient-reported outcomes, these issues are highlighted and addressed, which adds value to the patient experience. The relevant metrics depend on the role of the healthcare provider but could include non-medical metrics, including social, psychological, financial, and quality of life metrics.
- The Australian Commission on Safety and Quality in Healthcare has put together a comprehensive list of different tools that are used globally to identify the key value-based metrics.
- Work has been undertaken by International Consortium for Health Outcomes Measurement (ICHOM) to develop standardized and measurable outcomes for a range of conditions, representing approximately 45% of the global burden of disease. A list of metrics to evaluate the value of health care has been developed in relation to each of these conditions. A full list of the conditions and the suggested metrics are available here.
- The ICHOM measures both quantitative and qualitative have been implemented globally to evaluate the patient outcome aspect of value-based healthcare.
- Research from Harvard has also emphasized using standardized measures, developing a hierarchy of patient outcomes to assist healthcare providers in assessing the value they add from a patient perspective. The hierarchy is graphically illustrated below.
METRICS AND PAYER TYPE
Medicare and Medicaid Services
- The Center for Medicare and Medicaid Services (CMS) has developed a set of meaningful measures that can be used to assess value-based providers and their transition. The diagram below details these meaningful measures.
- Source The CMS offer two quality programs that health providers can choose from. Benchmark metrics have been developed across four categories which providers need to monitor and meet to qualify for incentive payments. The four categories are quality, cost, improvement activities and promoting interoperability. The 2020 benchmarks are available here.
MEDICARE INCENTIVE PROGRAMS
- When dealing with Medicare, it is important to realize that various programs have been developed that provide incentives specific value-based health outcomes. The metrics used to evaluate these programs have been defined by the CMS. The metrics that are essential when dealing with Medicare are tied into the value-based programs they offer.
END-STAGE RENAL DISEASE QUALITY INCENTIVE PROGRAM
- The program links a portion of the medicare payment to the providers’ performance on quality care measures. There are four areas where metrics are evaluated to assess value:
- The metrics evaluated are Kt/V Dialysis Adequacy, standard transfusion ration, vascular access, hypercalcaemia, and ultra filtration rate.
- The metrics evaluated are standardized readmission ratio, standardized hospitalization ratio, percentage of prevalent patients wait listed, and clinical depression screening and follow-up.
- The metrics evaluated are NHSN bloodstream infection, NHSM dialysis event reporting, medication reconciliation for patients.
- This is evaluated using the ICH CAHPS survey.
HOSPITAL VALUE-BASED PURCHASING PROGRAM
- Incentive payments are made to providers who meet several key metrics including:
- Mortality and complications;
- Healthcare-associated infections;
- Patient safety;
- Patient experience; and
- Efficiency and cost reduction.
HOSPITAL READMISSION REDUCTION PROGRAM
- This program is assessed using the excess readmission ratio. The conditions and procedures monitored are acute myocardial infarction, COPD, heart failure, pneumonia, CABG Surgery, and elective hip and knee athroplasty.
HOSPITAL-ACQUIRED CONDITIONS PROGRAM
- This program rewards healthcare providers that minimize hospital-acquired conditions. The metrics monitored are pressure ulcers, iatrogenic pneumothorax rate, in-hospital fall with hip fracture rate, peri-operative hematoma rate, post-operative AKI requiring dialysis rate, post-operative respiratory failure rate, peri-operative DVT or PE rate; post-operative sepsis rate; and post-operative wound dehiscence rate.
SKILLED NURSING FACILITY VALUE-BASED PURCHASING PROGRAM
- This program provides incentives based on the quality of care. The metric used to measure the quality of care is the hospital readmission measure.
OTHER HEALTHCARE SYSTEMS ASPIRATIONS AROUND VALUE-BASED CARE
1. Intermountain Healthcare
- Intermountain Healthcare uses three key metrics to assess what it considers are the three cornerstones of its aspirational goals.
- The rate of serious safety events monitors safety.
- The quality of Intermountain Healthcare’s hospitals was assessed by the Vizent National Hospital Survey, with comparisons made to previous years.
- The overall patient experience was assessed using federal satisfaction scores with comparisons made to previous years.
- In addition, Intermountain Healthcare has launched a new company that will focus on elevating value-based care capabilities. This platform will assist other healthcare providers transition to a value-based model of care.
2. Providence St Joseph
- Providence St Joseph provides several of the key benchmarks it uses to assess its aspirations. Achieving key patient benchmarks at a lower level is fundamental to Providence St Joseph’s achieving its broader, more aspirational goals. The patient benchmarks disclosed include:
- Percentage of surgical patients treated within benchmark wait time;
- Percentage of admitted patients leaving ED within 10 hours of triage;
- Sick time as a percentage of productive hours;
- Overtime as a percentage of productive hours;
- Associated rate of CDI;
- Nursing sensitive adverse events rate per 1,000 discharges; and
- Composite score of senior’s quality leap initiative.
3. Cleveland Clinic
- Cleveland Clinic has developed a strategic plan relating to their value-based aspirations. The strategic plan is not available publicly. This is likely because it is commercially sensitive. However, Cleveland Clinic has identified in its annual report some of the metrics it uses to evaluate its progress. These include:
- The benchmarks used to evaluate overall performance include:
- Measures that HCA has disclosed that it uses to evaluate value-based aspirations include:
5. Baylor Scott & White
- Despite reviewing the literature and annual reports of Baylor Scott and White, no measures of value-based aspirations could be identified. Baylor Scott and White did identify several of its aspirational focuses, which include:
- Access to care for low and middle socioeconomic groups;
- Access to mental and behavioral healthcare;
- Preventable admissions;
- More dental providers;
- Teen births; and
- Drug addictions.