OM: Are You Suffering From Measurement Fatigue?

NYAPRS Note: This great article summarizes what many providers in NY are going through now, particularly with all the talk of moving to an outcome-oriented managed care system for behavioral health services. As Monica Oss points out, systemic fixes to the problem of measurement fatigue may be essential, but we cannot wait for them. Not only that, but that set of recommendations hinges on a policy environment that would have to compliment each of the reforms in turn before meaningful reform could bear change in practice. Sometimes, the easiest way to simplify the measurement strategy of your agency, is by grabbing that old fashioned pencil and paper and sketching out your capacity and your needs.

 

Are You Suffering From Measurement Fatigue?

Open Minds; Monica E. Oss, 3/20/2015

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Measurement fatigue. That’s the phrase used in Getting More Performance from Performance Measurement, a recent article in The New England Journal Of Medicine (NEJM) to describe the proliferation of measures in the health and human service field.

What does this proliferation look like? There are well over 1,600 federal quality measures spread out over 33 programs – and an untold number of state, local and private health plan measures – according to Debate Heightens Over Measuring Health-Care Quality that appeared in a recent issue of The Wall Street Journal. No wonder managers are looking a bit perplexed.

What are these measures? Here are just a short list of some of the organizations that either gather heath care performance measures or recommend them:

1. National Committee For Quality Assurance (NCQA) – see NCQA Reports Behavioral Health Performance Decline and NCQA Proposes New Medicaid Behavioral Health HEDIS Quality Measure For 2016 and 30 State Medicaid Plans Now Reporting On Some HEDIS Measures For Adults
2. National Quality Forum (NQF) – see National Quality Forum Endorses Rehospitalization Measure and NQF Endorses Medicare Spending Per Beneficiary Measure For CMS’ Value-Based Purchasing & Quality Reporting Programs
3. Centers for Medicare and Medicaid Services (CMS) Five Start Rating System – see Medicare Updates Metrics For Nursing Home Compare Five-Star Rating System,Understanding The CMS Five-Star Quality Rating System: How Provider Organizations Can Help Payers Close The Quality Gap, and Nursing Home Quality Of Care Rankings Put Alaska First & Texas Last
4. CMS Medicare Accountable Care Organization (ACO) Shared Savings Program – see CMS ACO Outcomes Data Identifies Highest-Performing ACOs, 10 ACOs Earned $135 Million In Medicare Shared Savings Payouts, 43% Of Total Shared Savings Payments, and Pay-For-Performance In Emerging Care Coordination Models: How ACOs & New Models Of Care Are Managing Value In Health Care
5. Agency for Healthcare Research and Quality (AHRQ) – see AHRQ Releases Nine Core Integrated Behavioral Health Care Quality Measures and Atlas Of Integrated Behavioral Health Care Quality Measures; Integration Framework & Associated Core Measures.

No wonder there is measurement fatigue. The NEJM article succinctly summarized the problem:

The current measurement paradigm…does not live up to its potential. Many observers fear that a proliferation of measures is leading to measurement fatigue without commensurate results. An analysis of 48 state and regional measure sets found that they included more than 500 different measures, only 20% of which were used by more than one program… Similarly, a study of 29 private health plans identified approximately 550 distinct measures, which overlapped little with the measures used by public programs… Beyond the problem of too many measures, there is concern that programs are not using the right ones.

As a solution, the New England Journal Of Medicine authors outline how stakeholders can help reshape the measurement framework in health and human services:

1. Clinicians – Develop and implement measures relevant to your practice, explore data to find opportunities for improving care, and build the necessary data-collection infrastructure.
2. Consumers – Call for transparent quality measurement and reporting, and participate in efforts to collect patient-reported outcomes information.
3. Payers – Align with other payers on a smaller required set of high-impact and outcome-oriented measures.
4. Tech vendors – Establish the electronic building blocks for measures (rather than constructing and specifying measures one by one).
5. Measure developers – Accelerate the development and endorsement of measures to fill critical gaps, and in high-priority areas, allow for rapid feedback and adaptation to respond to any unintended consequences or changing evidence.
6. Hospitals and health systems – Invest measuring and understanding health at the population and community levels, with a focus on metrics that may stretch beyond the clinical encounter within the health system walls.
7. Researchers – Produce the next generation of research in the science of measurement development and implementation, including risk adjustment, attribution methods, and defining episodes of care; monitor for unintended consequences and adjust measures accordingly.
8. Employers and purchasers – Purchase health care on the basis of meaningful, actionable quality and cost measures, focused on outcomes and team- and system-level performance.

That’s great advice, but what to do in the meantime?  I have some very simple (but hard to execute) advice for managers of health and human service organizations:

1. Start with a blank sheet of paper and forget about what you are measuring now and how.
2. Separate your compliance measurement requirements (what funder or regulators require you to measure), from your performance management measurement needs.
3. Create a grid of your compliance measurement requirements, and figure out how to measure those items in the most inexpensive way (you should also create an estimate of the cost of those measurements – which should be incorporated in your future costing and pricing models).
4. For your team’s performance measurement needs, use a structured approach to mapping out what you need and how make that information available to your team. Start with the performance measurements you need at each level/business unit of the organization; for each, determine whether they are a leading/actionable performance measurement indicators and whether they are currently automated in your system.
5. From an implementation perspective, leading indicators that are currently automated are high priority. And, leading indicators that are not automated need an ROI analysis.

For a very cool tool to compare the many measurement sets, check out NQF’s Community Tool to Align Measurement, a new tool that provides insight to those interested in starting or expanding measurement and reporting efforts in ways that align with others and key national programs.

We have great resources on the development of key performance indicators – see Market Intelligence Toolkit on Organizational Key Performance Indicators and Metrics-Based Management: Key Performance Indicators. For more, join me on October 26 for the executive development workshop, Optimizing Your Operations With Analytics, Performance Measurement & Metrics-Based Management, before The 2015 OPEN MINDS Technology & Informatics Institute.