While the health measurement landscape today consists of a great many high-quality measures, meaningful at some level for their intended purpose, the effectiveness of the health measurement enterprise as a whole is limited by a lack of organizing focus, interrelationship, and parsimony in the service of truly meaningful accountability and assessment for the health system. If the effectiveness and efficiency of health expenditures are to be brought into alignment on behalf of better health and lower costs, keen attention and decisive actions will be required of all stakeholders—health professionals, payers, policy makers, and all individuals as patients, family members, and citizens—on what matters most. That is the focus of this report. What matters most for health and health care? What are the most vital signs for the course of health and well-being in America?
To explore this issue and to propose a basic, minimum slate of measures for assessing and monitoring progress in the state of the nation’s health, the Institute of Medicine convened the Committee on Core Metrics for Better Health at Lower Cost. This report presents a parsimonious set of core measures for health and health care identified by the Committee, and describes how their focused implementation can contribute to reducing the burden of measurement on clinicians; enhancing transparency and comparability; and most critically, improving health outcomes nationwide.
The Committee identified a set of 15 core measures that together constitute the most vital signs for the nation’s health and health care: life expectancy, well-being, overweight and obesity, addictive behavior, unintended pregnancy, healthy communities, preventive services, care access, patient safety, evidence-based care, care match with patient goals, personal
spending burden, population spending burden, individual engagement, and community engagement. In addition to this core measure set, the Committee identified 39 related priority measures, which provide additional texture to the core measure set for stakeholder groups with focused interests in specific areas.
The core measure set is fundamentally a tool for enhancing the efficiency and effectiveness of measurement, efficiency through the potential to diminish the burden of unnecessary measurement and reporting, and effectiveness through the potential to concentrate attention and action on issues that matter most. Implementation of this measure set will depend on leadership at every level of the health system, particularly on the leadership of the Secretary of the U.S. Department of Health and Human Services, who is the natural mainstay of the coordinated, multi-stakeholder process for refining and implementing the core measures that the Committee envisions in its recommendations. There is some irony in the fact that an effort aimed ultimately at simplifying entails complex responsibilities. But the Committee is confident that the results of this effort will be real, vital—and measurable.