Core Measurement Needs for Better Care, Better Health, and Lower Costs Counting What Counts: Workshop Summary (2013) / Chapter Skim
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5 Specifying the Shape of a Core Metrics Set
5 Specifying the Shape of a Core Metrics Set
Pages 39-54
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From page 39... ...
• The six domains of quality from the Quality Chasm report provide an important starting point, with one new potential concept being overall modifiable risk. Population Health • Population health metrics can be divided into two categories: current health, such as length of life and quality of life, and future health, including factors that are both intrinsic and ex trinsic to individuals.
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From page 40... ...
An important component of this workshop was the 2-hour working group session, during which participants engaged in discussion to identify potential sets of core metrics for tracking progress toward better care, better health, and lower costs at national, state, community, organizational, and individual levels. Participants were assigned to one of three breakout groups, with each breakout group considering one dimension of the threepart aim.
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From page 41... ...
services screening Community Safety, healthy food, health walkability/places to exercise, pollutants, healthy workplaces Social and Educational attainment, economic factors literacy, poverty, unemployment, health insurance status Effective Adherence to guidelines, Promote the most effective disease-specific prevention, treatment, and treatment targets (e.g., intervention practices for the cardiovascular disease: leading causes of mortality, control of high blood starting with cardiovascular pressure, cholesterol, disease. (National Priority 2)
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From page 42... ...
health care team members, (National Priority 5) Health including patient, family, Care and caregivers; appropriate continued sharing of health records; care consistent with preferences, particularly for end-of-life care Equitable Support of vulnerable Elements captured in National populations, Priorities 1, 3 and 5 communication appropriate to individual and community health literacy Efficiency and Access to needed care, Elements captured in National timeliness consistent insurance, Priorities 5 and 6 (includes achievement of meaningful operations)
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From page 43... ...
, utilization of services Indirect costs Absenteeism, productivity Waste Unnecessary services (includes costs due to unwarranted variation/ overuse) , fraud, excessive administrative costs, inefficiently delivered services, prices that are too high, missed prevention HEALTH CARE BREAKOUT GROUP Key points from the breakout group discussion chaired by David S tevens, associate chief medical officer and director of the Quality Center at the National Association of Community Health Centers and research professor at the George Washington University School of Public Health and Health Services, are summarized here.
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From page 44... ...
Reviewing Potential Metric Categories Several members of the breakout group indicated their comfort with the initial set of measurement categories contained in the background material, which were largely drawn from the Quality Chasm definition of quality (IOM, 2001)
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From page 45... ...
POPULATION HEALTH BREAKOUT GROUP Participants in this group, chaired by Patrick Remington, associate dean for public health at the University of Wisconsin School of Medicine and Public Health, focused on three topics: defining populations, selecting metrics, and measuring community health. Before discussing these topics, Steven Teutsch, chief science officer of the Los Angeles County Health Department, gave a brief overview of the current state of population health measurement.
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From page 46... ...
The group also discussed the idea that the three-part aim requires measures for population health that are outside the traditional purview of the health care system and that it would be the responsibility of those communities to address those metrics. The group also explored the concept of community health.
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From page 47... ...
Core metrics need to be related to the aim of lowering cost in general -- and to lowering per capita costs specifically -- and they should help explain variations in trends. Cost metrics are also needed to understand the drivers of cost and waste; to inform choices for plans, patients, and administrators; to inform value-based payments; and to fuel transparency.
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That discussion is summarized here. Population Health Multiple attendees voiced support for creating two major metric categories for current and future health.
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From page 49... ...
There were several comments about how to conceptualize population health as it moves from the entire population to subpopulations. One participant remarked that population health at the level of a 5,000-person accountable care organization serving Medicare patients is not going to look the same as a subpopulation of Medicaid patients or a subpopulation in the hundreds of thousands and wondered how those differences will be
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From page 50... ...
Participants also asked how measures of population health across subpopulations should reflect the concepts of equity, health disparities, insurance status, and access to care. Health Care When the breakout group reported its discussion to all workshop attendees, Marcus Thygeson, vice president for medical services at Blue Shield of California, remarked that it would be useful to have metrics that measure how patients do over time.
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From page 51... ...
Affordability Percent of household • egal L spending on health • osts C Percent of national GDP and/or federal government health Cost care spending as percent of total federal government spending Percent of economy, governmental budgets, organizational budgets, or individual budgets devoted to specific programs or sources of payment, including employer based health benefits, Medicaid, Medicare, and spending by the uninsured. Premiums
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From page 52... ...
However, one participant noted that this may lead to conceptual issues, as utilization can sometimes be considered in the health care quality domain of the three-part aim as opposed to the cost domain. For example, one participant noted that good health care services can directly reduce utilization, but their impact on cost may be unclear because of the multiple business layers between utilization and cost.
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From page 53... ...
Other participants noted that similar metrics could be included that illustrate the level of spending devoted to multiple programs and sources of payment, such as Medicare, Medicaid, employer-sponsored health programs, and health spending by the uninsured, with this spending normalized by the size of the economy, governmental budgets, organizational budgets, or individual budgets. One speaker suggested that premiums be included in the percentage of household spending on health and not listed separately, and another participant suggested there should be a metric involving value; while the members of this workshop all understand that value is included throughout these metrics, the participant noted, it would be useful to make this explicit for the general public.
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