Policy & Regulation News

Streamlined Core Measures Advance Cost-Effective Healthcare

By Jacqueline DiChiara

- Improved health at lower cost means paying special attention to magnified metrics. This task is no simple feat. Although there are currently thousands of possible core measures providing healthcare professionals, payers, policy makers, and beneficiaries with meaningful, actionable information, such information is not always directly effective in enhancing and advancing a deeply multi-faceted healthcare industry. The high volume of measures alone often hinders focus and promotes inadequate consistency and weakly implemented organization.

Streamlined Core Measures

A committee from the Institute of Medicine (IOM) recommends 15 streamlined core measures and 32 related priority measures within a recent report for tracking the advancement of improved health and healthcare. The objectives of this initiative include diminishing the burden of unnecessary reporting and concentrating on vitally needed change for the healthcare industry. According to IOM, such measures may provide consistent guidelines for healthcare’s evolution while eliminating gaps in system performance.

Confirms David Blumenthal, MD, MPP, President of the Commonwealth Fund and Chair of the Committee on Core Metrics for Better Health at Lower Cost within The Journal of the American Medical Association (JAMA), “The committee sought a limited set of measures that are outcomes oriented, reflective of system performance, and meaningful and have utility at multiple levels of the health care system (while recognizing that any particular measure will vary in its utility at different levels).”

The 15 core measures, according to JAMA, represent the most vital signs for monitoring progress to advance high quality, low cost health and healthcare. They are:

  • life expectancy – measure for a validated basic health concept reflecting overall system performance with respect to a wide range of factors influencing health
  • well-being — measure of self-reported health status, as a general indicator of elements shaping quality of life
  • overweight and obesity — measured by BMI and largely the product of diet and physical activity patterns, together representing leading sources of preventable early deaths
  • addictive behavior — measure of dependence on tobacco, alcohol, or other drugs, which impose high social and economic burdens on individuals and their families
  • unintended pregnancy — measure with generational implications that reflects a combination of behavioral, social, and cultural dynamics
  • healthy communities — index of a community’s profile on health-related social and environmental dimensions, such as education, housing, income, parks, and air and water quality
  • preventive services — index of receipt of immunization, screening, counseling, and chemoprophylaxis services
  • care access — measure of ability of individuals to receive needed and timely care
  • patient safety — index of system priority and performance in avoidance of harm to patients in the course of care
  • evidence-based care — index of system priority and performance in the delivery of care best supported by scientific evidence as to appropriateness and effectiveness
  • care match with patient goals — measure of the extent to which patient and family goals have been ascertained, discussed, and embedded in the care process
  • personal spending burden — measure of personal expenditures for healthcare relative to income
  • population spending burden — measure of aggregate health care expenditures for a population relative to that population’s income
  • individual engagement — index of personal involvement in health-related behaviors, self-care, caregiving, and social activities that reflect a personal health orientation
  • community engagement — index of community priority and relative social and economic initiatives, investments, and opportunities that reflect a health-oriented culture

Three of these aforementioned core measures – addictive behaviors, personal spending burden, and personal spending burden – stand out in terms of their immediate financial implications and cost concerns.

IOM confirms addiction, such as substance abuse, costs the healthcare industry $500 billion annually.

Regarding the personal spending burden core measure, IOM confirms, “Care that is too expensive can limit access to care, lead people to avoid care, or prevent them from spending money in other areas of value to them – with far-reaching economic impacts.”

In relation to the core measure involving population spending burden, IOM adds, “Health care spending consumes a large portion of the U.S. gross domestic product, dwarfing the health care spending of other nations. This burden can be measured at national, state, local, and institutional levels.”

According to IOM, an increase in the number of clinical measures, even those providing valuable information, directs attention away from system capacity and overall effectiveness. Attaining high quality, economically advantageous care requires a clear understanding of the core measures and priority measures that really matter. Variations across measures tracking a range of items, including patient experience, transparency monitoring, and funder reporting, prevent comparisons across states, institutions, and individuals, confirms IOM.

“Implementation of this measure set will depend on leadership at every level of the health system, but in particular on the leadership of the secretary of the U.S. Department of Health and Human Services,” IOM confirms, “who is the natural mainstay of the coordinated, multistakeholder process for refining and implementing the core measures that the committee envisions in its recommendations.”

Recommendations for core metrics to enhance progress

IOM simultaneously released a series of ten recommendations along with the 15 core measures. The following highlights are worthy of revenue cycle note:

  • The secretary of the Department of Health and Human Services (HHS) should use core measures to refine effort and consistency and reduce the volume and and burden of measure reporting requirements in HHS-administered programs, including the Meaningful Use program, administered by the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator (ONC) and CMS’s strategies for promoting quality improvement and innovation in healthcare financing through the work of the Center for Medicare and Medicaid Innovation
  • The cost-conscious set of measures identified by the committee should be broadly adopted for improved healthcare access, and collective progress toward a goal of improved health at lower cost
  • Employers and community leaders should use the core measures to shape, guide, and assess their incentive programs, their purchasing decisions, and initiatives aimed at achieving transparency in health costs
  • Payers and purchasers should use the core measures to capture data that can be used for accountability for results that matter most to population health, refine involved analytics, and utilize databases of available measures for continuous improvement

Return on investment unlikely

The process of collecting, analyzing, and accumulating a high volume of measures manifests a hefty burden on the healthcare industry as a whole, specifically for healthcare providers and healthcare organizations.

“Preliminary research commissioned by the committee finds that the growth in measurement and reporting activities results in considerable expense and requires substantial time commitments — without a matching return on investment. The establishment of a core set of measures could improve efficiency and ensure a focus on the most important health outcomes.”

15 measures are not conclusive

The 15 measures are not finalized or considered perfect at this time. IOM confirms the 15 presented measures lack sufficiency to meet every organization’s needs. A lack of established methods of measurement is also a particular hindrance. To accommodate these challenges, IOM identifies 39 additional adjunct priority measures. IOM maintains, “Successful implementation of the core measures will depend on their relevance, reliability, and utility to stakeholders.”

Furthermore, IOM confirms “leadership will be required at nearly every level of the health system. CEOs of health care organizations, payers and employers, standards organizations, and public health agencies will have important roles in the uptake, use, and maintenance of the core measures as practical tools.”

Why the measures matter

Numerous reports continuously confirm the healthcare industry is falling behind its international competitors. “The United States health care system is the most expensive in the world,” confirms the Commonwealth Fund, which ranks the US healthcare system as last among 11 nations regarding indicators of efficiency, equity, and outcomes. “The U.S. underperforms relative to other countries on most dimensions of performance,” adds the Commonwealth Fund.

According to Blumenthal via a news release, "US health care costs and expenditures are the highest in the world, but health outcomes and the quality of care are below average by many measures."

Confirms Bluementhal, "If we want to know how effective and efficient our health expenditures are in order to improve health and lower costs, we need to measure the most crucial health outcomes to guide our choices and gauge impact.”

Hopefully, to keep costs down and quality high, the healthcare industry will place the proposed metrics under a collective microscope and zoom in to examine how they best align with individualized needs to strengthen the healthcare industry and keep beneficiaries healthy and happy.