Report Outlines How to Improve Measures for Accountable Care

Gaps in accountable measure sets exist among some of the most prevalent and costly conditions, according to a new report from the National Pharmaceutical Council and Discern Health.

These gaps in measurement lead to missed opportunities to improve patient care and health systems. Although current accountable care measure sets prioritize population health conditions such as diabetes and heart disease, prevalent and costly conditions are typically not represented.

Although care delivery innovations are being created to address gaps in quality of care, traditional payment systems provide little financial support. In accountable care models, measures are one way to help align financial incentives.

“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,” 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 a statement.

The “Accountable Care Measures for High-Cost Specialty Care and Innovative Treatment: You Get What You Pay For” paper examined gaps in measure sets for 20 conditions, including breast cancer, diabetes, HIV, and heart disease, through an analysis of each condition and a roundtable discussion with national thought leaders.

“Gaps in accountable care measure sets cannot be completely addressed with more of the same measure types and measurement strategies currently in use,” said Tom Valuck, MD, JD, MHSA, a partner at Discern Health and co-author of the research. “Measure sets need breadth, depth, and new approaches to promote appropriate care across the relevant population.”

The report outlines a framework to prioritize measure gaps for the most prevalent and costly conditions, use alternative measurement approaches, and address barriers to measurement by enhancing data sources, among other steps.

The authors also highlighted new approaches to measurement:

Outcome measures

Allow for flexibility and innovation in improving care and can replace multiple process measures.

Cross-cutting measures

Assess care across conditions, settings, and time.

Patient-reported measures

Emphasize the outcomes that matter the most to patients, such as functional status and quality of life.

Layered and modular approaches

Optimize measurement efforts by focusing on specific purposes, such as external accountability or internal improvement for the layered approach.