How Do You Measure Accountable Care?

There is a transformation occurring in health care. What traditionally had been the responsibility of payers is now shifting to providers. Providers and health systems haven’t been responsible for comparing the total cost of care against total health outcomes. As  part of this transformation, health systems will increasingly be held accountable for total costs of care.

My concern about putting the “accountable” in “accountable care” is measurement. What will be measured? How does a provider or health system that traditionally has billed for services now assume responsibility for the total cost of care?

New Metrics for Health Care Reform

By: Sandeep Wadhwa

There is a big shift occurring in the way we measure the efficiency and effectiveness of health care. The shift is moving beyond process measures toward patient-satisfaction measures, such as CAHPS surveys and outcomes measures, including hospital-acquired conditions and hospital readmissions. These new measures are quickly becoming the foundation of new payment systems.

For example, the CMS hospital readmissions reduction program will penalize excessive hospital readmissions. This provides a huge incentive for hospitals to improve protocols and procedures to lower readmission rates. However, it isn’t just a clinical care issue. It’s a measurement issue, too, as pointed out by the Healthcare Financial Management Association (HFMA) in their letter to CMS. HFMA argues for CMS to provide data on readmissions and to change how they are defined and calculated. (They also made an unsolicited endorsement of 3M classification methodologies. Thanks, HFMA!)

Traditionally our industry has focused on quality process measures such as whether a medicine was delivered or not on time. Process measures are important.  That’s a critical step in an equality hierarchy, but they’re not a measurement of the outcome of interest. If you’re trying to measure infection rates after surgery or a lung puncture or aspiration pneumonia, that’s the outcome.

Putting the “Accountable” into Accountable Care

By: Sandeep Wadhwa

The talk about Accountable Care is turning into action with the announcement of the Pioneer ACO awardees from CMS.  In addition, the Medicare Shared Savings Program solicitation has been released with initial responses now being accepted.  As delivery systems and providers consider whether they want to respond, I’d like to suggest some key areas to consider.