Streamlining Performance Measures for More Effective Value-Based Care

Evaluating clinical quality measures as a cohesive set rather than as individual measures will foster more effective, efficient, and accountable value-based care programs, write Mathematica experts in a new article for Health Affairs Forefront.

“While measures play a central role in paying for care, developing valid measures of providers’ quality of care has proven to be something of a Gordian knot,” write Mathematica’s Sam Simon, Jeff Ballou, Anita Somplasky, and Jennifer Starling. The authors say that the focus on individual measures has overlooked the need for a cohesive set of those measures that makes sense to providers and encourages them to truly improve quality. “We maintain that for payers to understand provider quality, measures must demonstrate utility independently and, when used together as a set, infer quality.”

The growth of pay-for-performance and value-based care programs has increased demand for clinical quality measures (that is, measures of processes, experiences, and outcomes of patient care) to assess and incentivize healthcare. Healthcare payers, including the Centers for Medicare & Medicaid Services, depend on these metrics to reward providers and gauge innovations in healthcare delivery. Despite the critical role that these measures play in determining financial performance, a cohesive set of measures has yet to emerge that makes sense to providers and drives real improvements in care quality. In the article, Mathematica’s experts explain how payers can build a set of quality measures that work together to assess performance.

The authors write that measure sets can be selected through a combination of expert review, such as CMS’s consensus-based entity, and analysis to determine whether the measures are reliable and work together. Artificial intelligence may further enhance an assessment of which metrics are most predictive of high provider quality. Careful review of the measures as a collection can help streamline providers’ reporting requirements, reduce reporting burdens, and foster a more accurate reflection of their performance.

The proposed use of measure sets in value-based care promises significant benefits for payers, providers, and patients. Such reforms could serve as a vital step toward more effective, efficient, and accountable value-based care programs, setting a new standard for how quality is measured and rewarded in healthcare.

Mathematica’s experts have extensive experience serving our nation’s healthcare systems as an authority on measurement and analysis related to issues such as controlling healthcare costs, designing efficient and effective delivery systems, and measuring and improving healthcare quality. To learn more about how payers can develop an effective measure set for value-based care, explore our work on clinical quality measures.