Core Measurement Needs for Better Care, Better Health, and Lower Costs Counting What Counts: Workshop Summary (2013) / Chapter Skim
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2 Vision
2 Vision
Pages 9-20
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From page 9... ...
• Setting specific targets could stimulate innovation and trigger efforts to identify what is and what is not working to optimize health and health care. • Families of measures are useful for assessing the same concept at multiple levels of aggregation in the health system.
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From page 10... ...
, focused her presentation on some of the lessons that have been learned from several initial efforts at creating health care systems based around the three-part aim. George Isham, senior advisor at HealthPartners and senior fellow at the HealthPartners Research Foundation, discussed the need to consider the overall structure of the health system, and not just its subsystems, when designing metrics for measuring improvements in the system.
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To focus attention on quality instead of volume, physician pay is based on satisfaction and clinical outcomes, and relevant metrics are enabled by a data system that tracks the system's entire patient population. From its inception, QuadMed achieved improved clinical outcomes and rapid cost reductions -- today, costs are 32 percent less than the Midwest average -- and its focus on evidence-based medicine has led to gains in overall outcomes that outpace national benchmarks for conditions such as acute lower back pain, diabetes, hypertension, and hyperlipidemia.
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In the case of Memphis and Shelby County, IHI and its partners started small by activating a virtual faith-based network and focused on two goals: reducing untreated and unmanaged hypertension among low-income African American men and reducing the risk and incidence of uncontrolled chronic disease for vulnerable women. The Memphis Congregational Health Network, formed by integrating three existing church networks, influenced
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Efficiency, she said, is measured by combining the per capita costs and care experience aspects, as this would describe the level of resources required to achieve a given quality of care. Effectiveness can be derived from the combination of the population health and care experience dimensions, as this shows how health care delivery affected health outcomes for a local population.
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Rather, a better approach for managing a complex adaptive system such as the health system is to specify a small number of simple rules with minimum specifications, which will allow organizations and individuals to develop and adapt solutions suited for their specific circumstances and needs. In this spirit, Isham presented five simple rules that could provide a starting point for the discussion of core metrics (Kottke et al., 2012)
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Creating a national challenge for improving life expectancy would trigger efforts to identify on a state-by-state and locality-by-locality basis what is not working in terms of optimizing health and health care. Isham then discussed an idea that David Kindig, emeritus vice chancellor for health sciences at the University of Wisconsin School of Medicine and Public Health, has put forward about how the components of the three-part aim measure the broader determinants of health.
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participation) FIGURE 2-3 Conceptual framework depicting measurement domains of a "system within a system" approach and the drivers of health determinants.
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In this regard, a concept developed by the National Quality Forum could prove useful when it comes to developing families of measures and core measures. This concept defines families of measures as "related available measures and measure gaps that span programs, care settings, levels of analysis, and populations" (MAP, 2012, p.
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Isham agreed that this would be an appropriate metric to help set national targets and enable the scale of re-engineering that is needed to improve the nation's competitiveness. As an example of how this could work, Leslie Mikkelsen, managing director of the Prevention Institute, cited the Accountable Care Community of Akron, Ohio, which brings together seven health care partners and 70 community organizations with the Austen BioInnovation Institute playing the role of integrator.
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Addressing the issue of population heterogeneity, Bruce Ferguson, Jr., inaugural chairman of the Department of Cardiovascular Sciences at East Carolina University, asked if there was some theoretical level of heterogeneity in a population beyond which it becomes difficult to integrate data into one metric. In particular, he cited his own personal experience as a cardiac surgeon in which he observed that patients who are referred to his clinic from the southeastern United States have double the mortality of local patients whom he treats using the same level of care.
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2012. A Guide to Measuring the Triple Aim: Population Health, Experience of Care, and Per Capita Cost.
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