New Marketplace
Clip
The Perks and Pitfalls of Quality Measures (04:46)

You know that an iPhone 8 is better than an iPhone 5 by comparing specs for the two phones, says Harvard Business School Professor Robert Huckman. How can patients and providers do that in health care? How should quality measures be used — or not used?

“As a patient, how do we engage in that iPhone 5 verses iPhone 8 comparison when it comes down to whether we should have surgery done by Provider A or Provider B or whether we should have surgery done at all?” asks Huckman. “For providers themselves, how do I know, relative to the industry, if I’m an iPhone 5 or an iPhone 8 when it comes to serving my patients in a particular area?”

Quality measurement has some good uses, one of which is to describe a problem, answers Harvard Medical School Professor Michael McWilliams. Many seminal articles on deficient quality in health care relied on measures. Another use for quality measurement is evaluation.

“But we do run into problems when we tie public reporting or financial incentives to them,” says McWilliams. “There are some serious costs.” Some of these include inadequate risk adjustment leading to disparities, detracting resources away from things that can’t measure well but that are important for quality, gaming behavior, wasteful behavior like risk selection, and the reporting burden on providers.

That said, McWilliams agrees that health care is missing out on quality comparisons like the iPhone example. He acknowledges that “you are an astute observer of what you like; you know what you like in an iPhone.”

“To some extent, we should rely on what patients think, but they don’t have MDs so they can’t appreciate a lot of clinical complexities,” says McWilliams. “The only people left over — doctors, nurses, health care professionals — are trained to help us know who gives better quality care.” If you need surgery or an emergency hospital visit, for example, and asked a physician for his or her opinion on different surgeons or hospitals, you would “get a very strong opinion,” he says. A lot could be done to expose physicians to more information so that they can improve those impressions and better guide referrals, and this would help guide quality improvement.

What if, asks Huckman, underlying that clinician opinion is a reputational concern, not necessarily an understanding of the quality measure? How do we know that we’re getting the clinician’s opinion, not the reputational one?

How provider markets are structured plays a part in that, says McWilliams. “A big requirement for this to start working would be more competitive provider markets. For example, if I am not happy with the way my practice is providing primary care in this market where we have a lot of dominant health systems, I just don’t have that many choices as to where I want to practice.” More competition means more choices and would go a long way toward exposing physicians to variability in quality that is not measure dependent. “That being said, there is clearly data you can gather to help that process,” he says.

From the NEJM Catalyst event Navigating Payment Reform for Providers, Payers, and Pharma, held at Harvard Business School, November 2, 2017.

More From New Marketplace
Conceptual Framework for Evaluating Specialty Care Partnerships

How to Engage Specialists in Accountable Care Organizations

Should an ACO insource or outsource specialty care? Here’s a framework to help leadership decide.

Illustrative Examples of Health Policies, Possible Goals, and Relevant Evidence Base

Evidence-Based Health Policy

Having a clear framework for characterizing what is, and isn’t, evidence-based health policy is a prerequisite for a rational approach to making policy choices.

U.S. and Canadian Prices of Some Generic Drugs with U.S. Prices That Recently Increased by 1000% or More

The Price of Crossing the Border for Medications

The health and safety risks faced by the many Americans who cannot afford medications necessitate consideration of alternative strategies to provide less expensive medications.

Economic Investment and the Journey to Health Care Value — Part III: Health Care Purchasers

Early successes suggest that value-based purchasing programs can both transform employer-based health care and have a powerful and lasting impact on the economic strength of U.S. businesses.

Single-Payer Health Care Is the Favored Outcome of Future Payment Reform

Survey Snapshot: Deep Frustration with the Current Payment System

Many NEJM Catalyst Insights Council members are frustrated with the pace of value-based payments and expect single-payer health care to gain traction — though maybe not soon enough.

Value-Based Payment Models Payer-Provider Contracts Value-Based Arrangements

Economic Investment and the Journey to Health Care Value — Part II: Health Care Payers

Payers’ broad scale of investment in value-based arrangements makes a compelling case for the importance of sustained efforts to identify effective value-based payment models.

Four Principles for Navigating Payment Reform

The changes needed in health care are happening way too slowly. Health care stakeholders must insist on value in what they pay.

Economic Investment and the Journey to Health Care Value — Part I: Health Care Providers

Early evidence suggests that value-based payment and care delivery can transform our health care system, but providers must increase the momentum for this positive change.

Shift Toward Value-Based Payments in the Industry and at Organizations Is Accelerating

New Marketplace Survey: What’s Next for Payment Reform?

As health care reform struggles to gain traction legislatively, health care professionals report that payment reforms continue to move forward at a moderate pace, and indeed are essential to achieving the Triple Aim.

Patrick Conway and David Cutler head shots

The Highest Quality at a Lower Cost? We Don’t Have That Yet

David Cutler asks Patrick Conway what worked and what didn’t at CMS, advice he’d give to the Trump administration, and his predictions on Medicare and Medicaid.

Connect

A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

Topics

Value Based Care

164 Articles

Effective Consolidation: A Model for Reform…

UPMC’s payer-provider partnership integrates real-time data to support improved clinical decision-making and optimizes clinical and…

Financial Incentives and Vulnerable Populations —…

Understanding APMs’ potential consequences for vulnerable populations is critical if we wish to maximize benefits…

Effective Consolidation: A Model for Reform…

UPMC’s payer-provider partnership integrates real-time data to support improved clinical decision-making and optimizes clinical and…

Insights Council

Have a voice. Join other health care leaders effecting change, shaping tomorrow.

Apply Now