As value-based payment takes hold in health care, the definition of quality and how it’s measured is quickly becoming a significant source of confusion and contention. But according to Scott Wallace, a leading authority on value-based delivery models, the only metric that matters is, “Did you get better?”
The notion that health care providers should be paid according to outcomes achieved (value), not quantity of services delivered (volume), is the latest frontier in the “wild west” that is U.S. health care reform. Last week, the Obama administration proposed that half of Medicare payments to hospitals and care providers be calculated based on patients’ results by 2018. Because Medicare is such a massive part of overall health care spending, the hope is that such changes will trickle out to doctors’ offices and hospitals across the country, and reshape how everyone in every age group gets treated. But the reality of what it takes to improve care while cutting waste in America’s nearly $3 trillion health care system isn’t so straightforward.
As Wallace, a professor in the Master of Health Care Delivery Science program at Dartmouth’s Geisel School of Medicine, explained in a Wall Street Journal article, “Measurement fatigue is a real problem.” Not only is there little agreement on what measures are most important or are more likely to produce good value, but most of these quality measures are focused on process, not results. And that equates to additional costs for providers and not much, if any, sustained improvement in care for patients. But it’s not just the metrics that need to change, he says. The delivery model needs to be transformed too.
“The current approach to care (and payment) seeks to have universal measures of quality – things that apply to every patient with every health system encounter,” says Wallace, who works with care providers, health plans, governments and vendors seeking to improve value creation in health care delivery. “Using the same measures for every care encounter requires measures that are too general and therefore not meaningful.”
The care needed for someone with Type 2 diabetes is vastly different than the care required for a woman with breast cancer or an elderly person with a hip fracture. Wallace believes organizing care and ultimately measuring related outcomes according to patients’ medical conditions is critical.
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“What I envision health care getting to is functional outcome measures – what are patients able to do that they couldn’t before? In the preventive care arena, what capabilities are safeguarded so that the patient can keep doing those things?” After all, he says, “This is the essential purpose of health care: restore or protect capabilities.”
An accomplished adviser and masterful educator, Wallace combines his deep expertise with engaging style to offer distinct, world-class learning experiences – in speeches, in the classroom and through his highly customized Redefining Health Care workshops – that spur the meaningful discussion needed to develop new capabilities in health care delivery and build new frameworks for improving health outcomes.