AARP Presentation
Elliott Fisher, MD, MPH
February 12, 2007
Performance Measurement: Accelerating Improvement
CECS
Center for the
Evaluative
Clinical Sciences
IOM Committee on Redesigning Health Insurance
Gap between current care and vision of Chasm report remains wide
Current system: high and rising costs, poor quality, safety and reliability low
Chasm envisioned: safe, timely, effective, efficient, equitable and patient
centered care
Achieving National Quality Reporting
Performance measurement is the key to further progress
Progress?
Every approach to performance improvement depends upon measurement
Pay-for-performance, consumer engagement, quality improvement initiatives,
market-based approaches (competing providers)
Elliott S. Fisher, MD, MPH
Professor of Medicine
Center for the Evaluative Clinical Sciences
Dartmouth Medical School
Recent public and private sector initiatives important, but unlikely to
achieve the effective national performance system we need
Narrow and timid focus of measurement (technical quality)
Multiple measures and systems -- burdensome, duplicative, inconsistent
Independence and integrity of data and measures uncertain (limited funding)
Measurement system fails to learn from current efforts (success or failures)
Senior Associate
VA Outcomes Group
White River Junction, Vermont
Slide 1
Slide 2
Performance Measurement: Accelerating Improvement
Performance Measurement
Recommendations
Where are we now?
Establish and fund a National Quality Coordination Board
IOM Redesigning Health Insurance Committee P4P report
Set clear short and long-term goals for improving health care system
Designate (or if necessary develop) standardized performance measures
Ensure the creation of a data repository system capable of reliable, valid data
collection at patient level (capable of rolling up to provider, community)
Develop and release useful reports responsive to all stakeholders
Identify and fund a research agenda
Evaluate over time how performance improves -- and how to improve policy
Recommended moving forward with P4P (as means to learn about payment
change)
Called for use of quality, costs and patient centered measures
Underscored need for ongoing evaluation and “learning system”
Congress has not acted on implementation of effective national
performance system -- voluntary, consensus based process remains
in place
Endorsed a starter measurement set and important new areas
National Quality Forum may be stepping into the breach
Committee endorsed many of the existing consensus based, provider specific
measures
Endorsed one “new” measure: one year outcomes (mortality and SF-12) and
costs for patients with AMI
Called for development of new measures: efficiency, longitudinal care,
system-level measures and shared accountability
Development of a measurement framework for “efficiency” -- broadly
defined to encompass quality, costs and value.
Establish national goals for health system improvement (in two pilot areas)
Identify gaps in existing measures and call for their development
Slide 3
Slide 4
Performance Measurement
Where might we think of going?
Consider what would be required to put in place an effective national
performance measurement system
Comparative effectiveness research infrastructure (RCT and observational)
envisioned: (compare treatments, controlling for patient and providers)
Performance measurement system is essentially the same (compare providers,
controlling for patients and treatments)
Well-designed information systems should support both (and policy
evaluation as a bonus)
Focus of measurement should be carefully considered (what would we
really like to know?) Some thoughts…
Benefits and risks of current treatments (and how these vary)
Meaningful health outcomes (mortality, function, quality of life)
Total costs of care
Are the goals, processes and incentives of providers aligned with their
patients’ values and best interests?
Slide 5
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