Segment 3: Choosing Between Process Measures and Outcomes Measures

While the science of quality measurements is still in its infancy, Jennifer Malin, MD, staff vice president, Clinical Strategy, Anthem, said in a panel discussion with her peers that these metrics have allowed her and her team to open the door of communication among providers and educate one another on how important quality truly is.

From a health plan perceptive, Dr Malin explained that quality metrics in oncology are difficult to tackle because there are a lot of clinical details that make it challenging to obtain and understand meaningful quality measures without getting in the way of the practice. However, she added that it’s important to balance multiple stakeholders’ needs in addressing quality measures as a means of helping patients find the best practices of care.

“The quality measures that are out there are allowing us to have the conversations with practices about how important quality is and how we can improve quality,” Dr Malin said. “But as a health plan, we really want to get to that next step of transparency and being able to share the quality scores of practices with our members so that they can use that information in helping to decide where to go to get care.”

When choosing between process measures or outcome measures, Dr Malin explained that the answer isn’t necessarily black and white. While it depends on the patient’s situation and the disease type, oncology specifically is a combination of both types of measures.

Complex cancer surgeries that demonstrate 30-day survival rates are paradigms that demonstrate meaningful outcome measures, but process measures allow health plans and providers to figure out what’s happening in real-time and what that quality currently looks like, she said. “For many other types of cancer though, the outcomes that are really meaningful happen 3, 4, or 5 years later. Commonly, we look at things like 5-year survival. Well that’s not very helpful in a setting of looking at quality of care, where you really want to know what’s happening now,” Dr Malin added.

Dr Malin suggested considering a blend of the 2 because outcome measures don’t necessarily demonstrate what needs to be improved in a timely manner, while process measures can quickly obtain that information.