Transitioning healthcare to an outcomes-based model requires tracking different metrics than we do today.
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When it comes to improving population health and then making that improvement scalable and cost-effective, metrics matter.
I’m reminded of the challenge issued by former HHS Secretary Alex Azar in 2018: “Imagine a day when healthcare delivery in the [U.S.] functions the way other parts of our economy do. We as patients would pick providers with the level of information we have when using Amazon or Yelp.”
Of course, patients can already choose a healthcare provider based on information posted on Yelp or Google. If you scan those reviews, you’ll see five stars awarded to providers with comments like “really listens,” and “cares about addressing concerns,” and “replies quickly,” while more critical comments focus on the rudeness of the person answering the phone or an unexpectedly long time spent in the waiting room.
Are these truly the metrics that matter when it comes to healthcare?
Secretary Azar was advancing a proposal in which consumers would identify the value of the care they received, but it’s worth noting what came later in his speech: an acknowledgment that patients need much more information to make that assessment. They need to understand the cost of the services they’re receiving as well as the quality so that true value can be identified and rewarded.
Which brings us back to the question of which metrics we should track, especially as we move from the traditional fee-for-service model to outcomes-based care.
We can learn from the progress being made in government programs administered by the Centers for Medicare & Medicaid Services (CMS), where metrics for success are being tracked—in the case of accountable care organizations—to generate shared savings when providers achieve specific outcomes in patient wellness and satisfaction. CMS tracks patient survival, readmissions, functional changes (such as improvement in mobility and self-care), and safety, as well as patient-reported outcomes related to perceived pain, quality of life, and healthy behaviors (including diet and exercise).
It’s a solid foundation. But I think we can do better. I’d advocate building on that foundation with additional metrics that will help us more fully measure the quality of the care that’s being delivered—and its cost-effectiveness.
The Additional Data We Need
There are three key areas in which we can loosely group the metrics of healthcare quality and effectiveness: clinical data, patient-centered data, and financial data. Within those, there are seven key metrics (my business colleagues would call these KPIs) that directly impact outcomes-based care:
- Chronic disease control: Tracking important benchmarks for chronic diseases, meaning HbA1c levels under 8% for diabetes and blood pressure less than 140/90 for hypertension.
- 30-day and 90-day readmission rates: Tracking care coordination effectiveness by monitoring readmissions.
- Emergency department utilization: Calculating the emergency department visits per 1,000 patients to measure initial care effectiveness.
- Preventive care gap closure: Measuring completion of essential screenings (mammography, colorectal screening), immunizations, and wellness visits.
- Patient satisfaction scores: Capturing direct feedback from patients on their pain reduction, functional status, and personal well-being.
- Care plan completion rates: Tracking the percentage of high-risk patients who have active, reviewed care plans in place.
- Total cost of care: The actual overall expenditure per patient across all care settings.
When you look at this list, you can begin to recognize what’s missing from the traditional fee-for-service model. Fee-for-service reimbursement is tied to billable codes that are entered into a claim for payment. Service that’s delivered needs to have a billable code; if not, that service will not be reimbursed.
But there’s no code for patient satisfaction or wellness. There’s no code for educating patients, nor for the metrics that are easy to spot in the Google and Yelp reviews, things like a provider’s ability to listen.
We shouldn’t allow codes to dictate the care that’s provided. Instead, we should be actively tracking population health and using that to identify—and reward—healthcare that’s cost-effective and delivering measurable quality outcomes. We should be acknowledging the importance of a healthcare system that is local and anchored in relationships, in people caring for and about each other.
Secretary Azar was correct that patients deserve much greater clarity about their care. But eight years later, we know that it’s not simply a matter of more stars next to a provider or hospital. Instead, we need metrics that track what actually keeps people healthy: controlling chronic diseases, avoiding readmissions, and ensuring that people are screened and immunized to prevent illness from occurring in the first place. And, of course, healthcare that costs less because patients are seen regularly and cared for by providers who listen.
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