Solutions for Filling Gaps in Accountable Care Measure Sets

Authors: McClellan, M; Penso, J; Westrich, K; Dubois, RW; Dugan, D; Valuck, T.
Publication: The American Journal of Managed Care. October 2015.

Measurement in accountable care programs is essential for promoting quality improvement and balancing financial incentives, but gaps in measurement can result in missed opportunities to improve patient care and health systems.

This peer-reviewed study, “Solutions for Filling Gaps in Accountable Care Measure Sets,” explores measurement gaps for high-priority conditions and identifies ways to improve measure sets.

Researchers examined gaps in accountable care measures as compared with evidence-based guidelines for 20 prevalent and costly conditions, such as breast cancer, diabetes, HIV, and heart disease. The findings were reviewed via a roundtable discussion with national thought leaders. Some conditions have a number of quality measures, while others have none.

The researchers suggested using and promoting the development of the following three types of measures to address widespread gaps in accountable care measure sets:

• Outcome measures, which are meaningful to patients and providers, allow for flexibility and innovation in improving care, and can efficiently replace multiple process measures;
• Cross-cutting measures, which assess care across conditions, settings and time; and
• Patient-reported measures, which emphasize the outcomes that matter most to patients, such as functional status and quality of life.

The researchers also recognized that accountable care systems use measures at multiple levels of management. By using layered and modular approaches, accountable care systems can customize and optimize measurement efforts by focusing the measures on specific purposes, such as external accountability or internal improvement for the layered approach or a specific subpopulation for the modular approach.

The study was conducted jointly by experts from the National Pharmaceutical Council (NPC), Discern Health, the Brookings Institution and the American Medical Group Association, and published in The American Journal of Managed Care.

The paper follows on last year’s white paper, “Accountable Care Measures for High-Cost Specialty Care and Innovative Treatment: You Get What You Pay For—Improving Measures for Accountable Care,” and related conference, “Mind the Gap: Improving Quality Measurement in Accountable Care Systems.” Both the white paper and conference took an in-depth look at the challenges with quality measures. In addition, NPC and the University of Maryland School of Pharmacy have developed a continuing education course on quality measures.