Get on the quality train. It is time to spend wisely.

Sanchit Somani
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Datashop-11We have been working some long hours lately on the performance measurement in health care and the ability to calculate the standardized quality metrics that will help achieve the goal of better care, smarter spending and healthier people.  Here are some of our thoughts.

NO COUNTRY IN THE WORLD SPENDS more money on healthcare than the U.S.  Spending more does not lead to better clinical outcomes. Surely there exists a minimum level of expenditure, whether per capita or per procedure, that is necessary to achieve good outcomes, but the value linkage between cost and quality decreases significantly beyond a certain point.

Quality measurement in health care is the process of using data to evaluate the performance of health plans and health care providers against recognized quality standards.  The National Quality Forum (NQF), which serves to vet quality measures for scientific, evidence-based soundness, sums it up best:

  • How do patients know if their healthcare is good care?
  • How do providers pinpoint the steps that need to be improved for better patient outcomes?
  • How do insurers and employers determine whether they are paying for the best care that science, skill, and compassion can provide?

Metrics serve an important role of providing doctors in pay-for-performance models with actual data showing how they are doing in designated areas of care, rather than relying on impressions. A doctor might genuinely believe, for example, that he or she orders mammograms for all patients who need them according to the latest guidelines. Then you provide them with the facts, and they see it’s 75%, not 98% like they thought. So it’s taking the time to provide insight into what’s actually happening, which is really important to start with.

From a provider perspective, they may have to track one set of measures for a health plan, another for CMS, and a third set for an accreditation agency.  Having to meet different requirements can be burdensome for providers. Our mission at Innovaccer is to provide custom analytical models and a data science platform which is simple to use and understand about what provides value and what is wasteful. In addition, our integrated enterprise analytics platform Datashop effectively perform care coordination to eliminate duplicative and unnecessary tests, procedures, medications, admissions, and office visits.

We have reviewed the measures internally, with a team that includes healthcare consultants as well as experts in medical analytics. We completely believed in and are determined that implementing these best practices will succeed in a value-based world. It’s not the easy road; it’s the right road.

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