Value-Based Care News

Proper Measures Needed to Close Accountable Care Service Gaps

By Ryan Mcaskill

A new study examined accountable care measures for innovative treatment approaches and specialty forms of care.

- Recently, the National Pharmaceutical Council and Discern Health examined the accountable care measures for specialty care and innovative treatment. It released a report of it findings.

Mark McClellan, MD, PhD, director of the Health Care Innovation and Value Initiative at the Brookings Institution and co-chair of the expert advisory group for the project, said in the report that the industry is moving toward health care payment systems, benefit designs and public reports that can help achieve better care at a lower cost. However, these efforts are still a work in progress.

“Better measures can give clinicians more flexibility in reforming care through new personalized services, care teams, and other care innovations, and they can provide better evidence that we are making real progress for all patients in closing gaps in quality and improving outcomes,” McClellan said.

The biggest takeaway from the report is that there are several gaps in accountable care measures as compared with evidence-based guidelines for 20 prevalent and costly conditions. This includes ailments like breast cancer, diabetes, HIV and heart disease. What became clear is that some conditions have a number of quality measures, while others have none.

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  • According to Robert Dubois, MD, PhD, chief science officer, NPC, and research co-author, while there are gaps, more measures for certain condition may not be needed if a strategic approach is used like layered and modular models. If additional measures are needed, measure set enhancements could include the increased use of outcome, cross-cutting and patient-reported measures.

    Outcome measures – Meaningful to patients and providers, allow for flexibility and innovation in improving care and can efficiently replace multiple process measures.

    Cross-cutting measures – Assess care across conditions, settings and time.

    Patient-reported measures – Emphasize the outcomes that matter most to patients, such as functional status and quality of life.

    Layered and modular approaches – meant to optimize measurement efforts by focusing the measures on specific purposes, like external accountability or internal improvement for the layered approach or a specific subpopulation for the modular approach.

    The report also laid out a strategy that could help accountable care measure set developers to analyze their own set developers to analyze their own sets. The steps include prioritizing measure gaps for the most prevalent and costly conditions, identifying unmeasured aspects of care and using early monitoring indicators such as readmissions to indicate problems; using alternative measurement approaches; using the most meaningful measure types; addressing barriers to measurement by enhancing data sources and overcoming measure methodological issues; and assessing opportunities to continuously improve through feedback loops.

    The basic takeaway from the report is that accountable care has potential to improve health and health care delivery while lowering costs. However, there needs to be balance by measures to ensure the provision of appropriate care when transitioning to higher value care.