- Delivering quality care and creating high-value hospital encounters is essential to a positive patient experience. Understanding how to measure value will help target organization efforts. But how does the medical industry ensure quality measures truly facilitate the best possible care experience?
Creating useful quality measures is one of the key challenges facing healthcare today, according to experts from the Innovation and Value Initiative (IVI).
The first step to surmounting that challenge is understanding how the definition of value changes amongst stakeholders, according to Mark Linthicum and Jennifer Bright, IVI’s director of scientific communications and executive director, respectively.
“You can't understand the value of something if you don't understand the value of it to its ultimate consumer, regardless of whether you’re a patient or an insurer or anyone else in the system,” Linthicum said in a recent interview with PatientEngagementHIT.com.
Typically, value is defined as clinical effectiveness over cost, Bright added, but that definition often falls short, especially for patients.
“Patients look at value in a much broader way,” she explained. “They're looking at it from the lens of having a family, or a job, or transportation needs, or global out-of-pocket costs, not just what their co-pay is or the co-insurance. How does health affect their ability to buy food or take a family vacation? All those things factor into a patient's concept of value, but we don't have good ways of capturing that in a quantifiable way.”
Looking at various patient-facing factors, such as those measured in patient-reported outcomes measures or the social determinants of health, are important to understanding value for the patient.
But value is often different for providers and payers, Bright and Linthicum added.
For providers, value can be defined as what is most clinically useful for them, or what can drive the best possible result while keeping costs down.
And on the payer side, it’s all about economic efficiency, Bright explained.
“How can I get as much benefit as possible from the minimum amount of cost?” she posited. “From their perspective, the payer is looking at cost in a very narrow way. They're looking within the area of expenditure, for example, within the confines of a particular budget year.”
Those conflicting perspectives of value make things complicated. How can the healthcare industry represent the perspectives of all stakeholders? How can they efficiently deploy measures that also consider multiple perspectives?
There isn’t an easy answer to those questions right now, but Linthicum and Bright’s team is currently working to tackle the problems nonetheless. Through considerable research and experimentation, IVI is developing open source quality measures that consider not just clinical factors, but also the overall patient experience.
IVI has chosen to develop open source quality measure models because it wants the entire healthcare industry to iterate and innovate together, Bright said.
“One of the biggest challenges we're facing in this conversation about value is there's still a deficit of trust among all the subcultures involved,” she pointed out. “There's a lot of finger pointing and frankly, the patient is the one who gets the shortest stick in that scenario. We all have to put our walls down and say there are better methods to getting to an answer that's reflective of all of the actors that are important to this concept of value. How do we work together in an open environment to do that?”
Open source modeling is another way for IVI to consider all perspectives on value, Linthicum added.
“We have tried to honor that diversity by approaching our work – and the way we build our models and think about value – in a way that brings all those stakeholders to the table,” he said. “We all want to be heard and all of their perspectives can be included.”
This approach has worked thus far, Linthicum reported. An open source quality measure model has allowed IVI to integrate a more accurate portrayal of patients’ view on value.
“We built a model focused on rheumatoid arthritis as our first open source value model and one of the things we heard from patients was that the way that the medicine is administered is something that's of importance of them,” he explained. “IV versus infusion versus oral, and particularly IV versus injection. IV infusions take a lot of time, and patients have to go into the clinic. You could potentially have injected or oral treatments at home and they're much faster, and that can have a real impact on day-to-day life.”
IVI is continuing to tap into the patient perspective of value, the pair added. Current models include qualitative research, patient focus groups, and structured patient interviews.
The Insitute is currently using that development model for a project on non-small cell lung cancer. In gathering the patient perspective, Linthicum and Bright hope to understand what is important to patients in their treatment and their concerns about treatment.
Other areas of interest include the quality-adjusted life year (QALYs), one of the generic measures of disease burden. IVI is working to adapt QALYs so they more fully capture the patient experience, but they are hitting some roadblocks.
“One of the things that's tricky about QALYs is that they're usually not disease-specific, so they're just a general measure,” Linthicum noted. “As a first step towards moving in that direction, we're working on a research project to come up with a disease-specific QALY measure for non-small cell lung cancer that we can use in this model.”
As noted above, this work is not simple, Bright stated. But as the healthcare industry continues on its track toward reimbursement and benefit design that reflects value, the medical industry needs to acknowledge and tackle the nuances of value.
“It's not enough to say ‘it's complicated’ and we don't have adequate tools or methods to measure value from patient perspective,” she asserted. “We, somehow, have to figure this out because there is so much data coming to the fore that is patient-specific - whether it's about biomarkers or evidence in the real world about how therapies behave in real patients. We have no way of incorporating that data into our understanding of value, at present.”
“At the end of the day, you're working with a bunch of different pieces and ingredients,” Linthicum concluded. “You've got survival, you've got impact on quality of life, you've got cost, you've got all these different pieces, and then the way that you measure value is essentially deciding which recipe to use.”