Healthcare leaders discuss what key metrics their organizations use under value-based care.
This article first appeared in the January/February 2017 issue of HealthLeaders magazine.
There are several metrics we prioritize. Our highest priorities are outcomes of quality, and metrics that reduce cost. The most important metric, therefore, is readmissions. We are cognizant of readmissions in our bundled payment programs. Another metric we are also cognizant of is surgical-site infections. Both of those are issues that we work on and look at regularly.
The third most important metric for us would be complications; in other words, do we have to go back and do some manipulation where there's a dislocation or some other kind of possible postoperative problem that requires additional care and, therefore, additional cost?
These metrics are always weighed against less objective but still important metrics such as patient satisfaction, and our ability to provide an experience to our patients that's acceptable.
We have two sources for metrics. The first is through professional societies our physicians belong to. They are regularly identifying new metrics and making suggestions. They're generally not mandates, just suggestions, about the kinds of things they consider important.
Our mother source of metrics is a group of orthopedic practices called the OrthoForum, which we were a founder of and are regularly involved with. We have an outcomes committee initiative that identifies measures that are important to us, and we as practices have all agreed that we will use those metrics, which include patient-centric outcomes.
Director, Innovation and Collaborative Care
University of Arizona Health Plans
We are a Medicaid health plan in the state of Arizona offering Medicaid managed care, and we started our value-based contracting in 2015. That was the first time we used quality metrics in this space. We developed them first in primary care with our high-volume and safety-net providers, and we designed them to have an incentive component and a shared savings component with a gateway of quality measures. We targeted the triple aim, and we were looking at finding things focused on experience of care, access to care, utilization measures, and health outcome.
We offer 10 measures, and most providers only had to have between two and four measures to qualify that first year. The measures we chose were a set of four child's measures that were largely preventive in nature. Those measures were well-baby visits, six or more visits before six months of age, an annual well-child visit between age 3 and 6, an annual adolescent well visit, and, from ages 2 to 20, an annual dental visit.
We chose those measures because they were in line with what our state Medicaid objectives are. We wanted to choose targets that both aligned with state goals and our health plan's goals, and were also measureable. Those child measures were all about prevention. We added some other measures about utilization—readmission rates and adult and child emergency department utilization. We also wanted to address the triple aim. In our provider-centric approach, we selected measures that would be helpful, acceptable, and doable for everybody involved.
Chet Johnson, MD
Developing value-based performance metrics is a big one for us. We have those metrics both with our physicians and with our payers. I think that with every major payer in our market we have some kind of collaborative relationship. For example, a common quality metric would be the completion of an annual Medicare wellness visit.
All of our physicians have performance metrics, which include patient satisfaction. In primary care, we choose two more—this year, we decided to go with management of hypertension and management of diabetic nephropathy. We change those metrics every couple years in order to keep them fresh.
We have about 120 employed physicians, and we look to encourage alignment in a couple of ways. We have a physician executive council, which helps to set policy and communicate with other physicians. We also have a primary care leadership committee. We run our primary care policy by it, which can be anywhere from things like changing our walk-in policy to one that's more inclusive, to how we manage no-shows, to how we reset the performance metrics for the next year. For example, we recently started using smoking cessation as a metric. We chose it because it's a patient-centered medical home metric, and it's going to be an important part of the quality performance program. And we wanted to find something that would help us reach those goals but would also help our physicians to increase their compensation for quality.
Texas Health Resources
I would say that there are standards and metrics associated with the standards in a number of groups or areas. One area would be operational; one would be member experience. One would be physician quality and efficiency.
Under the operational standards, those are along the line of how available the provider organization is, whether that's a physician or hospital, to patients. We are looking for electronic health record participation and adoption. I would say member experience indicators are kind of obvious—things like member satisfaction, engagement in clinical programs, but also a measure of what I'd call network efficiency and using the network that has agreed to cooperate and provide value-based care. Also, on the clinical efficiency side, the standard set of utilization outcomes—hospital admits per thousand, readmits per thousand, those kinds of things.
On the importance of standardization. This is one of the great challenges right now. Different organizations define the details of measurement in some of these metrics differently. There's an effort underway to adopt a standard across the country so everybody's measuring things the same way. We're supportive of that, because we occasionally find ourselves measuring the same metric three different ways, depending on how a certain organization might want to define certain values.
Lena J. Weiner is an associate editor at HealthLeaders Media.