In a Harvard Business Review article Michael Porter wrote, “Rigorous measurement of value (outcomes and costs) is perhaps the single most important step in improving health care. Wherever we see systematic measurement of results in health care we see those results improve.” Porter is credited with defining the value equation; value equals outcomes divided by costs. The concept of value has transformed the dialogue centered around how to improve the US health care system. The value equation is simple when written as a mathematical formula but defining outcomes and even truly identifying costs can be extremely challenging.
Most health care organizations do not know what their costs are as you would aggregate them to define the system cost for an episode of care. Most systems use charge data as a surrogate for costs, though the two are entirely different. It is true that allocating some costs, like plant and equipment, can be challenging but health care in contrast to most industry still remains largely ignorant about what the true costs are for provision of services to patients. Given the magnitude of the challenge to identify true costs it is likely that systems will continue to use charge data as a surrogate measure for costs.
Outcomes on the other hand can be relatively easily measured. Most health care systems have historically measured outputs rather than outcomes. Outputs like the number of patients seen in a given period of time, the number of operations performed in a given period of time or the number of hospital days stayed can be easily measured. Most of these output measures are only loosely tied to outcomes. Porter, and a growing number of individuals following in his footsteps, argues that the outcomes that matter most are those that are identified by the patients we serve. This approach is aligned with the what is commonly stated on health care system sites, some variation of, “the needs of the patient come first.”
Identifying important outcomes
But how do we identify what outcomes are really important to patients? The International Consortium for Health Outcomes Measurement (ICHOM), cofounded by Porter, has defined a process to identify exactly such outcome measures. For example, when it comes to therapy for localized prostate cancer interviews with patients has identified that percent post-treatment urinary continence and erectile dysfunction are important outcome measures. But we haven’t necessarily routinely collected, and certainly have not published, results such as these.
How do we start to systematically collect outcomes measures? Not surprisingly some programs supporting the care for Medicare beneficiaries are using the power of the purse to redirect efforts in this regard. The Comprehensive Care for Joint Replacement program launched by CMS is one such effort. ICHOM has developed what they term as “standard sets” to also promote the routine collection of meaningful outcomes measures. Increasingly information technology is playing a central role in the collection of such outcomes measures.
VitalHealth Software’s suite of cloud-based solutions enables patients and care providers to sutomate the collection of standard outcomes measures. Such measures can be easily compared between practice sites, departments or at the provider level. Using that data, systems can identify best practices and disseminate them across the entire system. When linking such outcomes with the resources utilized to provide the patient care, a measure of value can be defined. In this way the collection of outcomes helps to drive improvement for the system and better care for patients. Collecting outcomes data can help to transform the delivery of health care in the United States.