Prioritize use of metrics that capture the goals of the episode, including outcome metrics, particularly patient-reported outcome and functional status measures; use quality scorecards to track performance on quality and inform decisions related to payment; and use quality information and other supports to communicate with, and engage patients and other stakeholders.
Contracting with Providers E-book | Contracting with Providers Resource Slides | Contracting with Providers Meeting Summary
Quality Measures Part 1 E-book | Quality Measures Part 1 Resource Slides | Quality Measures Part 1 Meeting Summary
Quality Measures Part 2 E-book | Quality Measures Part 2 Resource Slides | Quality Measures Part 2 Meeting Summary
Which measures will be utilized to measure quality?
- What are the areas for improvement based on current performance?
- How can the designing entity best engage providers and stakeholders in choosing measures?
- What measures are already being collected, reported or publicly available, including those used by other payers, and can feasibly be integrated into this model with little burden or infrastructure cost?
- Which measures have meaningful state, regional or national benchmarks and can serve multiple purposes through implementation in this model?
How will the payer and provider determine performance? If payment or participation in general in the model will be linked to quality performance, the designing entity must determine how performance will be assessed.
- Assess performance relative to benchmarks or targets
- Assess performance relative to other providers
- Assess performance relative to individual provider’s past performance
How will performance on measures be tied to savings or risk? There are various ways to link payment to performance, once the performance assessment is made. Two options include:
- Integrate quality directly into the financial model and allow for performance to adjust the savings (or loss) percentages.
- Use quality performance independently of the financial model, and reward with a separate quality bonus pool or another mechanism.
Further, to consistently improve upon patient engagement activities, it will be important to use patient activation metrics to track overall patient engagement. A change score for the Patient Activation Measure (a healthy person version recently endorsed by the National Quality Forum [NQF]) administered near the beginning and end of pregnancy would incentivize those participating in the episode payment to build women’s skills, knowledge, and confidence as they approach giving birth and new parenthood.