Defining and measuring the value of care with help from patients
The way the U.S. healthcare system measures quality is evolving. The idea of paying for volume is gradually being replaced by a paying-for-value approach. But how does the industry determine what value really means?
This question was posed to a panel at this year’s Astellas Patient Advocacy Summit during a session entitled ‘Evolving Quality Measures to Focus on Patient Outcomes’. The panel included:
- Karen Milgate, Former Deputy Director, Center for Strategic Planning, Centers for Medicare and Medicaid (CMS)
- Elena K Balovlenkov, Health Insurance Specialist, CMS
- Scott Flanders, Senior Director, Health Economics and Outcomes Research (HEOR), Oncology, Astellas
- Tonya Saffer, Senior Health Policy Director, National Kidney Foundation
- Andrew Webber, Senior Advisor, Discern Health and Former President & CEO, Maine Health Management Coalition.
Defining value and consistently measuring it
“Value equals quality over cost,” stated Flanders, in response to the panel’s first question: how is value defined? “In that regard, there are two ways to improve value: increasing quality or decreasing cost.”
Part of increasing quality is understanding what truly matters to the patient, explained Flanders – something that can be measured both during clinical trials and in real-world treatment settings.
The obstacle, however, is getting measurement tools to be consistent across the board, warned Flanders. “We need to come up with concise measures to better understand quality of care, but there’s a burden of using numerous measuring tools in clinical trials.”
Patient reported outcomes
The solution to the problem? According to Webber, it’s patient reported outcomes (PROs). “Historically, the number one issue has been access to care, but the community is getting much more sophisticated and understands that access to care isn’t enough.”
PROs are not well integrated into our system, explained Webber, “yet we need them to really be a patient-centric service.”
Despite their advantages, PROs are only useful if they are measuring what matters to patients, added Saffer. Her Foundation brought together health experts to develop three measures for chronic kidney disease.
As an early example of value-based purchasing, Saffer highlighted the CMS end-stage renal disease program which she described as “pioneering.”
However, the application of mainstream value-based purchasing is still some way off, according to Webber – something that will continue to impede healthcare’s overall progression: “If we don’t have measures of quality, we’ll never know whether we’ve made progress.”
Helping patients help themselves
“There’s been an evolution over time where all stakeholders are questioning whether what the patient wants has been integrated into care,” said Milgate, bringing the discussion to its final talking point: the integration of what matters to patients. “Measures are now present in every aspect of care and those measures need to dictate what really matters to patients.”
Addressing her colleague’s words, Balovlenkov stated that “patients aren’t so much concerned with the clinical outcome but instead about the impact of a treatment on their daily life” – insights that need to be heard and incorporated into the way value is measured.
“I believe the patient voice should be present at all times, but it can’t be useful unless it is communicated effectively.”
The patient needs to feel welcome to share what matters to them and be trained to do so as part of a two-way dialogue between patients and healthcare professionals, explained Balovlenkov.