A Comprehensive Guide to Quality Measures: Improving Value-Based Care Delivery

Team Innovaccer
Mon 23 Oct 2023
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Improving healthcare is a complex task, and without proper measurement, it is harder to achieve. With thousands of healthcare organizations treating various ailments, it is essential to have a way to measure their performance. The organizations operate under different payment models such as fee-for-service and value-based care, where incentives depend on the quality of services provided. This system encourages providers to strive for high-quality care that satisfies patients' expectations and meets federal standards.

Retail giants like Walmart are pushing for a consumer-centric approach to healthcare by providing patients with more information about their healthcare options. Patients are now able to evaluate their providers based on quality measures that assess every aspect of care delivery. In this blog, we explore who governs quality in healthcare, the different quality measures, the significance of electronic quality measures (eCQM), and ways that providers can improve the quality of their services.

What are Quality Measures in Healthcare?

Quality measures are essential tools to evaluate healthcare delivery performance effectively. They help to assess different aspects of care delivery, including effectiveness, safety, patient experience, efficiency, equity, and timeliness. Providers can use these measures to pinpoint areas where they can improve services, while patients can compare the performance of multiple providers based on these measures. (Think STAR Ratings!)

Types of Quality Measures in Healthcare

Quality measures in healthcare can be categorized into the following types:

  1. Cost/Resource (Use): This measures the application of healthcare services, such as diagnoses, procedures, or encounters, in terms of units or dollars to a population or event.
  2. Efficiency: This measures the cost of care associated with a specific health outcome.
  3. Outcome: This measures the resulting health status or change in health status from the care services provided, whether desirable or adverse.
  4. Patient Reported Outcomes: This aggregates performance data from patients themselves, rather than healthcare entities.
  5. Process: This measures adherence to the steps that should be followed to provide high-quality care.
  6. Structure: This measures the organizational capabilities and resources to assess the capacity to provide healthcare.

By utilizing these various types of quality measures, healthcare providers can assess and improve the delivery of high-quality care.

Choosing the Right Data Source for Accurate Quality Measurement

The choice of data source plays a crucial role in determining the scope and purpose of a quality measure. To navigate the available data sources, CMS provides a comprehensive resource. Here's a brief explanation of the main types:

  • Administrative data sources: These collect information primarily for administrative purposes, such as birth registries, tax records, individual-level demographics, census data, and more.
  • Claims data sources: These include information on admission and discharge data, diagnoses, procedures, and the source of care.
  • Electronic clinical data sources: These primarily consist of individual-level information that can be extracted and uploaded in a compatible format into the electronic health record (EHR) system.
  • Patient medical records: These records may be documented on paper or electronically in the EHR. They can include data from laboratory tests, imaging services, personal health records, and pharmacy records.
  • Surveys: This type involves questionnaires or assessments that collect more in-depth information, such as health-related quality of life and social determinants of health (SDoH).

By considering the strengths and limitations of each data source, stakeholders can make informed decisions to ensure accurate and meaningful quality measurement.

Which Quality Measures Should Providers Focus On?

The topic of which quality measures healthcare providers should focus on is somewhat complicated for two reasons. Firstly, providers cannot ignore the requisites set by CMS for participants in a value-based payment model. Secondly, providers can establish their metrics, but these measures must satisfy critical criteria such as scientific acceptability, feasibility, and most notably, it should not overlap with pre-defined measures by CMS.

Regardless of whether providers are relying on pre-defined measures by CMS or establishing their measures, they should consider the following before selecting which measure to focus on: Does the measure hold significance for patients? Does the measure address healthcare aspects where there is a performance or measurement gap? Is there a validated source available to collect information accurately and consistently to report on this measure? Does this measure add accountability in the care delivery cycle?

If yes is the answer to every question, then providers can move forward to find the right way to collect, analyze, and report on the measure. Innovaccer can help healthcare organizations achieve this.

Simplify Your Quality Measurement Tasks with Innovaccer

Innovaccer provides a data platform that effectively collects, cleans, and standardizes healthcare data into longitudinal records. This unified patient data forms the foundational layer for our suite of comprehensive applications designed for specific healthcare purposes such as care management, coordination, analytics, and reporting. Our robust dashboards simplify tracking, assessing, sharing, and reporting quality measures to CMS with just a few clicks. Additionally, healthcare providers can define and track customized metrics using our data platform.

Experience our data platform in action and learn how we can help your organization with quality measurement tasks by booking a demo with our experts.


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