Value-based care has already started to transform the healthcare system and its management. The adoption of a new model requires medical providers to improve the measuring criteria and reporting outcomes. The challenge they can face here is how to define and choose the most informative outcomes for assessing and reporting.
The United States outspends other developed nations on healthcare, and improving health outcomes is believed to bring down the industry costs by reducing expenditures per patient. Measuring, reporting, and analyzing healthcare outcomes is aimed to make the population health better by improving individual patient experience and reducing unnecessary regulatory or administrative complexities the clinical staff may face.
Patient Outcomes
With the ongoing healthcare system shift toward patient-centered care, defining right care measurements and their analysis is a critical part of changes implementation. They reveal areas where interventions could improve the results, provide evidence about what works best, identify care variations, and compare various procedures and treatments in terms of the effectiveness. Right measures can also help a team to assess whether adopted changes are effective in a certain situation under certain conditions.
There is a significant gap between conventional measures medical providers use to analyze the effectiveness of the treatment and the outcomes that actually matter to patients. Most medical providers limit outcomes tracking to several measures groups, not focussing enough on what really concerns the patient. The groups include metrics of the initial patient condition, health indicators, structure (such as state of providers facilities, staff competencies), treatment protocols, and patient satisfaction with the care. However, nearly all patients look for the same health outcomes based on basic human needs, such as being self-sufficient and capable of doing activities they want without interference by their medical condition. It is important to recognize that addressing only conventional measures may be misleading and prevent providers from focusing on what is really important to the patient and how the treatment affects his quality of life.
Improving Patient Outcomes
Improvement starts with effective measurement and choosing the right metrics. But before addressing this, medical providers need to arrange data flow and availability. All data should be recorded in electronic form and be transparent so that patients can make the proper choice and educated decision relying on outcomes data. Data also should be interoperable and available for other parties engaged to ensure integrated care and its consistency. Effective data management will also allow medical providers to compare outcomes between various teams rather than procedures, which is fundamental for the value-based care model.
Finding an efficient solution that will ensure data security, availability, and interoperability is often a challenge for medical providers, who are concerned with the high costs and increased administration load. However, innovations have been already made in this field, and any provider can implement these solutions considering his circumstances and possibilities.
One of the most prominent examples of such innovations is the Diabetes Care Administration Network that was launched in 2019 on the Solve.Care platform by collaboration between Solve.Care and Boehringer Ingelheim Pharmaceuticals, Inc. Commenting on the collaboration, Pradeep Goel, CEO of Solve.Care, said: “The Diabetes Care Administration Network will help bridge a knowledge gap by providing a platform which offers vital information on diabetes and cardiovascular diseases in an easily accessible manner. This is invaluable in the healthcare ecosystem as it allows patients to gain a better understanding of their disease while also coordinating their care needs”.
Outcomes should be measured for strictly defined groups regardless of the protocol of care (as was stated above, in the value-based model, to compare results of different teams is more important than results of different procedures). Measures should be monitored across the full care cycle, including follow-up after recovery and long term wellbeing.
It is essential to track patient outcomes along with conventional metrics. For this purpose, many providers use PROMs, or patient-reported outcomes metrics, which helps to assess treatment outcomes from the perspective of the patient.
As there are hundreds of metrics, providers need to choose only those which are reliable, informative, and easy to track. For this reason, Centers for Medicare & Medicaid Services (CMS) classified essential outcome measures in healthcare and grouped them into seven categories to assess the service quality. Four largest groups cover 88% of the quality score and include mortality measures, care safety (likelihood of medical mistakes), readmissions (which are often costly and avoidable), and patient experience. Three groups – treatment effectiveness, patients’ access to care, and effective use of medical imaging – constitute the remaining 12%.
Healthcare Outcomes
Health outcomes are defined and classified by governmental organizations, such as the abovementioned CMS, National Association for Healthcare Quality (NAHQ), and the Joint Commission. Outcomes are targeted based on mandates, incentives, accreditation requirements. In some cases, more aggressive targets might be set. There are also market competition and contracting efforts among healthcare organizations that encourage them to meet and constantly search for ways to exceed the national targets. All these benefits care quality, reduces prices, and enhances innovations in the industry.
