Policy & Regulation News

NCQA Testing Patient-Centered Outcomes Measures in Value-Based Care

Patient-centered outcomes measures will look at elements of care that are truly valuable to patients.

patient-centered outcomes measures

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By Sara Heath

- The National Committee for Quality Assurance (NCQA) is teaming up with four healthcare providers and payers across the country to test new patient-centered outcomes measures.

The project, funded by the John A. Hartford Foundation and The SCAN Foundation, will look at measures that are truly important to patients. This is a change from more traditional clinical quality measures, which influence value-based care reimbursements.

Typically, clinical quality measures look at preventable hospital readmissions, certain disease metrics, mortality rates, or other provider-facing outcomes of quality care.

In these new pilots, NCQA and its partner organizations will identify which factors are most important to patient populations and use those to measure clinical quality. In some cases, those factors will be less about clinical outcomes and more about quality of life, according to NCQA President Margaret E. O’Kane.

“Most everyone agrees individuals’ priorities and health goals should guide their care,” O’Kane said in a statement. “Are people more concerned about lowering their A1C levels or walking to the corner market? Would they rather see improvement in BMI or be able to spend more time with a loved one?”

READ MORE: Using Patient-Reported Outcomes Measures to Improve Engagement

“Existing quality measures do not effectively evaluate what is most important to people, particularly older adults with complex care needs, and we hope to change that,” she added.

This project builds on a pilot study NCQA previously completed in partnership with the John A. Hartford Foundation and The SCAN Foundation. This study established a system for healthcare organizations to analyze patient-centered quality outcomes and standardized collection of those measures.

The pilot study found that this is a feasible approach to patient-centricity in value-based care models, NCQA found, thus prompting this latest program.

The project, which has racked up nearly $2.1 million in funding, will include a geographically diverse panel of early adopters. Program partners include Kaiser Permanente Northwest, Priority Health, Community Health Plan of Washington, and MedStar Good Samaritan Hospital Center for Successful Aging.

NCQA and its partners will specifically focus on an aging patient population who represent wide-ranging and complex health needs. Efforts to assess care outcomes that are important to patients themselves will bring value to care encounters and ideally lower healthcare costs, according to the program’s benefactors at The John A. Hartford Foundation.

READ MORE: Patient-Reported Outcomes Inadequate Clinical Quality Measures

“By streamlining and focusing quality measures – and all of health care – on what truly matters to older adults living with complex conditions, we can achieve better outcomes and greater value for payers, providers, and older patients and their families,” said Terry Fulmer, PhD, RN, FAAN, president of The John A. Hartford Foundation.

NCQA and its partners also hope that the project will prove the validity and feasibility of measuring outcomes that are fundamentally important to patients. Healthcare stakeholders have contended that this approach is too specific and may not be an efficient way to measure quality. This program may disprove that notion.

“In order to achieve truly person-centered care, we have to incorporate what matters most to older adults into every health care conversation,” said Bruce Chernof, MD, president and CEO of The SCAN Foundation. “This project will show how health systems can ask what matters in a sustainable way, and the value this knowledge brings to both provider-person interactions and the overall quality of care.”

NCQA and its four partner organizations did not disclose any of the potential measures against which it will measure care quality. Those measures will likely stem from patient questionnaires or other information-gathering strategies.

Healthcare professionals have long called for more patient-centered outcomes measures. In a 2017 Health Affairs op-ed, Patient Advocate Foundation CEO Alan Balch, and Darius Lakdawalla, the Quintiles Chair in Pharmaceutical Development and Regulatory Innovation in the School of Pharmacy at the University of Southern California, emphasized the need for patient-centricity in value-based care models.

READ MORE: Overcoming the Top Patient-Reported Outcomes Measures Challenges

“From a pragmatic perspective, it is time to shift the discussion toward helping patients understand what value actually means in choosing their health care and discharging their financial responsibilities,” Balch and Lakdawalla wrote. “Any plan that is enacted, whether a full replacement of the Affordable Care Act or ‘fine-tuning’ of the law, will likely require that patients make decisions about what constitutes value.”

Balch and Lakdawalla added that patient-centered outcomes measures should translate to accessible quality reports. Clinical quality measurement data is not useful to patients if that data is not presented in an understandable manner.

“Several vehicles we depend on to disseminate new information — for instance, peer-reviewed journals and academic meetings — often do not advance the cause of informing patients,” the two said. “We need to develop tools that support patient decision making about value in the real world and help to fill this gap.”

As more healthcare entities work to make clinical outcomes more patient-centric, they will need to address logistical issues and strategies to make this data more usable.


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