title: Looking Under the Streetlight? A Framework for Differentiating Performance Measures by Level of Care in a Value-Based Payment Environment.
abstract: The majority of quality measures used to assess providers and hospitals are based on easily obtained data, focused on a few dimensions of quality, and developed mainly for primary/community care and population health. While this approach supports efforts focused on addressing the triple aim of health care, many current quality report cards and assessments do not reflect the breadth or complexity of many referral center practices.In this article, the authors highlight the differences between population health efforts and referral care and address issues related to value measurement and performance assessment. They discuss why measures may need to differ across the three levels of care (primary/community care, secondary care, complex care) and illustrate the need for further risk adjustment to eliminate referral bias.With continued movement toward value-based purchasing, performance measures and reimbursement schemes need to reflect the increased level of intensity required to provide complex care. The authors propose a framework to operationalize value measurement and payment for specialty care, and they make specific recommendations to improve performance measurement for complex patients. Implementing such a framework to differentiate performance measures by level of care involves coordinated efforts to change both policy and operational platforms. An essential component of this framework is a new model that defines the characteristics of patients who require complex care and standardizes metrics that incorporate those definitions.
authors.affiliation: J.M. Naessens is professor of health services research, Mayo Clinic, and scientific director, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida. M.B. Van Such is principal analyst, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota. R.E. Nesse is senior medical director for payment reform and professor of family medicine, Mayo Clinic, Rochester, Minnesota. J.A. Dilling is chief operating officer for quality, Baylor, Scott & White Health, Dallas, Texas. S.J. Swensen is professor of radiology and past director of quality, Mayo Clinic, Rochester, Minnesota. K.M. Thompson is assistant professor of emergency medicine and performance improvement officer, Mayo Clinic, Jacksonville, Florida. J.M. Orlowski is chief health care officer, Association of American Medical Colleges, Washington, DC. P.J. Santrach is associate professor of laboratory medicine and pathology and chief quality officer, Mayo Clinic, Rochester, Minnesota.
authors.forename: James M
authors.initials: JM
authors.lastname: Naessens
authors.forename: Monica B
authors.initials: MB
authors.lastname: Van Such
authors.forename: Robert E
authors.initials: RE
authors.lastname: Nesse
authors.forename: James A
authors.initials: JA
authors.lastname: Dilling
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Swensen
authors.forename: Kristine M
authors.initials: KM
authors.lastname: Thompson
authors.forename: Janis M
authors.initials: JM
authors.lastname: Orlowski
authors.forename: Paula J
authors.initials: PJ
authors.lastname: Santrach
mesh_terms: D003695:Delivery of Health Care / Q000191:economics*; D005102:Health Expenditures / Q000592:standards*; D006801:Humans; D010043:Outcome and Process Assessment, Health Care / Q000191:economics*; D011320:Primary Health Care / Q000191:economics* / Q000592:standards; D011785:Quality Assurance, Health Care / Q000191:economics* / Q000592:standards*; D014481:United States; D062505:Value-Based Purchasing / Q000592:standards*