It’s hard to get rid of something you use but don’t like, even if it’s no longer practical. Things that are familiar have a lot of staying power. That may be why we can’t seem to shed ourselves of the suffocating layers of quality measures that have accumulated over the years.
There are over 4,600 healthcare quality measures and measure sets in the public repository set up by the National Quality Measures Clearinghouse. Granted, these measures represent all settings and aspects of care delivery and management. The numbers are still staggering: Continue reading
What is the impact of the social determinants of health, such as income, education and occupation, as U.S. health care moves from volume to value-based care with a focus on population health management? Providers of health care have been well-trained to focus on the clinical manifestation and treatment of disease, but often struggle with the environmental and social context within which they occur. Continue reading
In a Commonwealth Fund/Kaiser Family Foundation survey, 50 percent of PCPs report that quality metrics have a negative impact on their ability to provide quality care to their patients.i
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If you spend any time in a primary care office practice this should come as no surprise. PCPs tend to be deeply dedicated to their patients and want very much to do the right thing. Continue reading
This blog offers further commentary on the excellent conversation that Paul Levy began in his column, “The Triple Aimers have Missed the Mark.” In his blog, he provides a succinct definition of the Triple Aim as “improving the individual experience of care; improving the health of populations; and reducing the per capita costs of care for populations.” Continue reading
The Triple Aim is a construct developed to move past the trade-offs typical in health care improvement: improved quality at the expense of increased costs, decreased costs at the expense of quality or access, improved guideline adherence at the expense of patient experience of care, etc. The Triple Aim defines success as simultaneous improvement in population health and outcomes, patient experience of care, and cost trends. Continue reading
We are in the midst of an information explosion in healthcare, which brings more responsibility to healthcare payers, providers, and patients themselves. Providers must be able to help patients distinguish between information that is useful for achieving important healthcare objectives, such as those espoused by the Triple Aim, and what is just noise. Continue reading
Reducing healthcare costs through better care delivery begs the question: “Where do we start?” When the goal includes something to the effect of “the greatest possible improvement for a population,” it is good to reflect on the body of evidence pointing to high performing population health outcomes.
The work of Starfield and others is instructive: High performing health systems have high performing primary care as their foundation. High performing primary care has four cardinal features:¹ Continue reading
Anyone who has renovated a home while living in it should relate to the challenges of shifting to value-based payment. It is takes time, money and grit to redesign a house and maintain any sort of normalcy for the occupants. The transition from fee-for-service reimbursement to value-based payment isn’t a tidy process either. As with home renovation, having a blue-print and a project plan makes it manageable. Continue reading
Medical care produces both benefits and harms. There are risks associated with care delivered in the hospital, including infections, medical errors and delirium. There are side effects associated with medication and, ultimately, there are risks associated with all medical procedures. When a patient is suffering from a painful or debilitating illness, it is understandable how they might overestimate the benefits of medical care and underestimate its risks in an effort to obtain a cure or symptom relief. More worrisome is that some physicians may be poor estimators of risk. The medical community often ascribes to the adage that it is better to act than do nothing, whereas “nothing” may be in the best interest of the patient. Continue reading
Health care is not a commodity. Shopping for health care services is not like shopping for a refrigerator, a tennis racquet or a DVD. Identical commodities can be offered by numerous vendors and consumers can reasonably access their prices for comparison as an important element of their purchasing decision. Consumers, however, can’t (and shouldn’t) compare health services on price alone. Health care is a service, but one unlike most other services we use on a regular basis. Continue reading