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Transitioning from Volume to Value: Consolidation and Alignment of Quality Measures

Over the last year, the Bipartisan Policy Center (BPC) has issued a series of white papers recommending changes in the health care delivery system to improve quality and slow the rate of growth in costs. These recommendations provide incentives for providers and patients to move toward organized systems of care?such as accountable care organizations (ACOs), patient-centered medical homes, and other payment models?and away from fee-for-service.

The use of meaningful quality measures is critical to assuring patients have access to and receive appropriate services and that incentives drive improved health outcomes and patient care experience. However, despite discussions and work on this objective, there remains little agreement on which?and how?measures should be used by patient, provider, and payer communities. Effective quality measures are imperative to accountability in organized systems of care, especially where performance affects the ability of the provider to share in savings or determines whether a provider avoids penalties or receives bonus payments.

As recommended in, A Bipartisan Rx for Patient-Centered Care and System-Wide Cost Containment, quality-performance measures must be precise and clinically relevant to incentivize better delivery of health care. In fact, these measures must also provide meaningful data that can be adapted and publically reported in a way that consumers would find useful in making health care decisions and that providers would find helpful in designing strategies to improve quality and patient safety.

In attempting to achieve these goals, payers, providers, standard-setting/accrediting bodies, and federal and state agencies have pursued quality metric design, evaluation, and reporting, as well as the identification of a multitude of different quality measures. Much progress has been made over the years to develop meaningful quality measures and the federal government has made progress on aligning quality measures across federal programs.

However, many entities have somewhat different perspectives and priorities, which, when combined with ill defined and overlapping roles and responsibilities, has led to confusion and inefficiencies, including the inability to use the same measures across different health care payers. This inability has led to implementation of numerous, disparate measures leading to provider burden and confusion among consumers. The use of non-standardized (non-endorsed) measures by payers (whether similar endorsed measures exist or not), modification of endorsed measures, and a lack of uniform use of measures further contribute to the confusion and inefficiencies.

The proliferation of these measures burdens providers and undermines both payers and consumers. Failure to address the shortcomings in quality measurement will impede the shift from fee-for-service to alternative delivery and payment.

In 2013, BPC outlined recommendations for prioritizing, consolidating, and improving the use of quality measures by consumers and practitioners. While some of those recommendations have been adopted, identifying and adopting a limited set of quality measures that can be used across payers has been a long-standing challenge for policymakers and has not been achieved.

This paper focuses on recommendations to strengthen the quality-reporting system and the validity of available metrics. BPC encourages the present trend of private and public organizations and relevant stakeholders working together to better align the current measures and agency promulgation of a core set of measures that are clinically relevant and useful to providers, and that can be adapted to be accessible to consumers.

Read more from BPC’s series on delivery system reform.

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