Cutting Through Complexity to Achieve Value-Based Care

Posted by Quest Diagnostics on Sep 22, 2016 1:49:34 PM


Quality measures, including those that quantify healthcare processes, outcomes, and patient perceptions, are critical to improving healthcare efficiency and effectiveness. With potentially hundreds of measures for physicians to track, however, measuring quality at the point of care has become challenging and time-consuming.

A 2013 study of 48 state and regional measure sets identified more than 1,300 measures, 509 of which were distinct. In fact, only 20 percent of all measures were used in more than one program, and not a single measure was common across all programs.

To better understand how this complexity is affecting physicians, and potentially slowing the adoption of value-based care, we recently commissioned a study of 450 physicians and health plan executives.

Our study, Finding a Faster Path to Value-Based Care, asked physicians and health plan executives numerous questions about quality measures. Their responses paint a clear picture: complexity of quality measures is impeding adoption of value-based care.

According to the study, 74 percent of physicians and health plan executives said that quality measures are too complex, making it difficult for physicians to achieve them. Additionally, while three quarters of physicians and health plan executives agreed that quality measures are useful in improving care quality, only half agreed that quality measures set under value-based care models are top of mind when physicians meet with patients. This finding highlights an interesting disparity too: more health plan executives (59 percent) than physicians (46 percent) agreed that measures are top-of-mind, suggesting they both may underestimate the true complexity at the point of care.

Perhaps even more concerning is that less than half (47 percent) of physicians and health plan executives agreed that it’s clear to physicians which quality measures apply to their individual patients under relevant value-based care models. Eighty percent also agreed that physicians do not know the quality metrics that apply to individual patients, which would allow them and their practice to qualify for financial incentives under value-based care models. It would seem that complexity is causing financial burdens as well.

So what’s the solution? One path forward is evident in recent remarks from American Medical Association CEO Dr. James Madara. He said, "The future is not about eliminating physicians; it’s about leveraging physicians. That means leveraging physicians by providing digital and other tools that work like they do in virtually all other industries–making our environments more supportive, providing the data we actually need in an organized, efficient way, and saving time so we can spend more of it with our patients.”

Our study aligns perfectly with Dr. Madara’s future vision. Nearly nine out of ten physicians surveyed said they were likely or very likely to use a tool that provides on-demand patient-specific data to identify gaps in quality, risk, and utilization as well as medical history insight within the clinical workflow in real time. Presumably, they too see the opportunity to provide data in an organized, efficient way that frees up more time for patients.

Quality measures are designed to improve patient care, but the complexity of administering them is clearly holding the industry back. Hopefully our study and others like it will continue to galvanize all parties, from physicians to health systems and health plans, around new solutions that tap the true potential of value-based care.

*All databases are limited to the data input into them.

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