November 20, 2013
As a supporter of efforts to promote health and wellness by preventing and better managing chronic diseases, and accordingly, policy efforts to align financial incentives, the Partnership to Fight Chronic Disease (PFCD) believes that managing healthcare costs and improving quality are and should be pursued as complementary goals. Encouraged by increased discussion on quality measures among policymakers, the PFCD sees several issues critical to achieving patient-centered, value-driven care.
First, the quality dialogue should remain on identifying appropriate measures, recognizing the limitations of existing measures and gaps that exist, and working to address those limitations and bridge gaps. Stakeholders across the healthcare ecosystem should be a part of the process of identifying measures and their use on an ongoing basis. This representation and buy-in are critical to assure appropriate implementation of quality measures that will improve outcomes in clinical settings, assure a patient-centered approach to care delivery, and enable innovative payment models to move forward.
Without at least an equal emphasis on the quality of care provided and outcomes achieved, “value” devolves to “least expensive” and patient outcomes are pitted against cost-reduction targets. This reality especially applies with Accountable Care Organizations (ACOs) and bundled payment models. Policy discussions should include a close examination of the measurement of care quality, patient clinical outcomes, and quality of life improvements to ensure that new models are truly patient-centered to avoid sacrificing quality in the pursuit of cost containment.
The Medicare population is particularly vulnerable given that the vast majority of Medicare beneficiaries have multiple chronic conditions – over half has more than five chronic conditions. Yet, current quality metrics do not account for this reality. Instead, they follow disease-specific clinical guidelines for treatment and too often overlook the implications of multiple co-occurring conditions on those benchmarks. This oversight can put providers and patients at odds when trying to strategize care plans for patients struggling with more than one condition. The Patient-Centered Outcomes Research Institute could play a pivotal role in advancing the evidence base on caring for people with multiple chronic conditions and related quality metrics, but does not appear to have made multiple chronic conditions and related issues a research priority.
Care delivery models should also evaluate on important quality metrics that do not necessarily align with the generation of immediate cost savings but are important. For example, while a focus on preventive care may not generate immediate cost reductions, it does improve quality outcomes particularly over the long term and is an overarching goal of healthcare reforms. Quality metrics for evaluating performance should include measures that promote patient-centered care and better outcomes but do not necessarily generate immediate cost reductions.
Finally, unintentional disincentives to medical innovation are another concern. Cost savings is often evaluated based on historical costs of care. Similarly, quality measures are based on standards of care dated from the publication of the measure. The pace of medical innovation, however, moves much faster than either of these processes.
Careful consideration of patient-centered outcomes and their durability must be included in the analysis of quality to ensure that cost does not become the predominant factor in determining the course of treatment.
Transforming healthcare requires a meaningful discussion about quality. The PFCD commends efforts to move away from volume-based healthcare financing in pursuit of workable financing solutions that will improve the quality of care received and the health outcomes that result. Having a robust quality measurement system is critical to truly delivering patient-centered care and to efforts to enhance quality while managing costs.