New efforts are warranted to develop and refine quality-of-care and other performance measures that can assure new payment models will improve medical care without harming patients, according to a study recently released by RAND Corporation. The study reveals that although certain currently employed quality measurement tools may be useful to new performance-based payment models, significant work required in order to create and test methods for application in measuring the quality of care provided under innovative payment reforms. "Insurers and purchasers of healthcare in the U.S. are on the verge of potentially revolutionary changes in the approaches used to pay for healthcare," states Eric Schneider, the study's lead author and a senior natural scientist at RAND, a nonprofit research organization. "A significant investment is needed to develop new performance measures that can assure high quality care as the U.S. experiments with these new payment models."
Sponsored by the National Quality Forum, RAND’s research entailed a study of 90 payment reform programs and the identification of 11 general payment reform models. The latter reward providers for delivering better-quality, cost-conscious care or pay health care providers a fixed amount to coordinate treatment of a given illness.
Researchers say the 11 payment models vary widely in how they alter current payment methods, the patients and services affected, and the number of clinical providers that might be subject to the new payment arrangements. They identified several priority areas for further development and refinement of healthcare quality measures they believe are applicable to many of these models, among them health outcome measures for use in assessing the health status of populations (for example, patients' quality of life and safety outcomes) and quality measures for use in examining how care is coordinated among health providers (for instance, when a patient is transitioned from a hospital to outpatient care or a nursing home). Other areas identified include programs that can be used to assess the participation of patients and their caregivers in their medical care, as well as measures that can be utilized to evaluate the structure of health systems, particularly those built to respond to the new payment models. Items to be assessed, the researchers recommend, should encompass the quality of care management and the use and functionality of electronic health records.
The researchers also note that while payment reform models developed to date have focused on hospitals, outpatient medical practices, and physicians, future performance-based payment reform will also include other types of providers, such as long-term care settings and surgical centers. They emphasize that effort is necessary to ensure that payment reforms do not increase disparities in healthcare. Measures for this purpose would monitor access to care and detect whether providers are turning away high-risk or medically-complicated patients.