It’s time for an annual car inspection, and you are afraid of it. Last year, you chose the lowest cost mechanic you could find. This year, you are looking for new mechanics in the market. Wandering around, you once again made a shortlist of the most affordable car shops in the area. But does affordability affect service quality?
Now, apply this logic to the cost of shoulder surgery. Knowing that you may need to have shoulder surgery again within two weeks, will you pay less for shoulder surgery?
Due to price transparency, most patients will tend to reduce costs. However, if shoulder surgery is performed by a provider whose quality is 50% lower than other providers in the region, the patient is likely to undergo the operation again within a few weeks or have poor results-reducing the burden is meaningless. Only in the healthcare sector will we require health plans and patients to pay unpredictable amounts for unpredictable results.
The White House attaches great importance to the pricing transparency that took effect earlier this year, but rarely pays attention to an important part of the value equation: quality measurement transparency.
If consumers cannot measure the quality of services, they cannot judge the value. In other words, if consumers do not know how to cross-reference cost and quality, why would they care about price? If we want to solve the value problem, we need to start with the widespread adoption and use of standardized quality metrics to solve the problem of quality transparency.
Why do we need standard quality measures
As Lord Kelvin and Peter Drucker once said “We can’t improve what we can’t measure.” If there is no standardized quality measurement standard, we can’t be sure that every supplier measures the same way.
The interpretation of the composition of behavioral health practitioners by large government agencies is an example of the level of difference in quality measurement. By insisting on a loose interpretation of who counts as “effective practitioners,” this huge government was able to include marriage counselors in their behavioral health measures. On the surface, the agency seems to have accepted more behavioral health examination patients than it actually is. This improves the quality measurement score of the agency. In contrast, health systems that insist on stricter definitions of who are considered “effective practitioners” of behavioral health seem pale.
When we measure in different ways, quality comparisons can become a misrepresentation of performance and prevent individual comparisons between care institutions and providers. If we want patients to make informed decisions about their health, we need to make quality measures standardized and transparent.
Where traditional quality measurement can go wrong
Non-digital, non-standardized quality measurement makes human variation rampant. Interpretation becomes part of the job and part of the process, just like defining “effective practitioners”.
Even simple “AND” and “OR” statements can cause misunderstandings by coders. A measure that requires patients to have a diagnosis code (F33.1) AND (F43.23). If the accidental code is (F33.1) OR (F43.23), the result will be very different.
With standardized digital quality measurements, there is no room for explanation or error. The specification is written in Clinical Quality Language (CQL) and can be implemented without anyone rewriting it. This work has already been carried out in some institutions.
The advantages of digital quality measurement are inherent
Some health systems are more innovative and have adopted digital quality measures. Others are still hesitant, mainly because this is an investment with no immediate return. However, once digital quality measurements are adopted and implemented, the return on investment will snowball over time, and the advantages become obvious.Essentially, digital measurement is Learning health system, A framework for continuous learning and improvement to drive better results and cost efficiency.
Having standardized digital quality metrics means that it is easier for the payer and the provider to have a conversation around performance. Digital measurement can ensure the accuracy of the measurement results and provide intermediate results for providers so that they can understand why the patient is not in the molecule of the measurement. In addition, the ability to view quality measurements in near real-time means that suppliers will be able to improve their performance before submission. The traditional measurement process can never achieve this.
Another obvious advantage of standardized digital quality measurement is the ability to make one-to-one comparisons or similar comparisons. With digital measurements, we can evaluate the quality measures reported by two independent health systems and be confident that one is indeed better than the other.
Applying standards and transparency to quality makes it easier to manage value-based contracts and alternative payment models. Today, a health system may implement the same measures 10 times in multiple different departments for multiple different contracts. Health systems that adopt and implement digital quality measures have the advantage of reusing the same CQL measures for many different purposes.
Where can we go from here
Standardized quality measurement has the power to revolutionize healthcare, but we need to invest and commit as an industry to make it work. There are still obstacles to the development of digital measurement, because unfortunately, traditional measurement can still make money. Some suppliers across the industry do not want to switch from traditional measurement to digital measurement, because at the end of the day, complex traditional measurements may be profitable.
The Joint Committee—the oldest and largest healthcare standard-setting and certification body in the United States—has adopted standardized digital quality measures, and the National Quality Assurance Committee (NCQA) has promised in the near future. CMS has repeatedly reiterated the importance of standardized digital quality measurement and is mandating standardized digital formats.
The industry has a responsibility to take bold steps to get rid of the obsolete process of traditional measurement and accelerate the adoption and implementation of digital measurement.
We can first accelerate the transition to digital quality measurement around the CMS and NCQA strategies, and transparency will follow.
Photo: atibodyphoto, Getty Images
