Tuesday, May 22, 2012

Outcome Measures for Both the Patient Centered Medical Home (PCMH) and Population Health Management (PHM)

The Disease Management Care Blog remembers years ago when it watched several captains of the disease management (DM) agree in a meeting that "third party" organizations were in the best position to evaluate the industry's outcomes.  The good news is that that approach minimized the industry's conflicts of interest.  The bad news is that it also led many companies to effectively "outsource" what should have been a core competency of rigorously conducted self-evaluation.  Years later, when the Congressional Budget Office (CBO) could find no evidence supporting DM, the result was an industry-wide near death experience.  

Good thing the Patient Centered Medical Home (PCMH) isn't making the same mistake. In addition to relying on third parties like the National Committee for Quality Assurance (NCQA) to set recognition standards, PCMH advocates have committed considerable time and energy into conducting their own detailed outcomes studies. While the published results haven't been a slam dunk, they have informed the PCMH's continuing evolution.

Enter the Commonwealth Fund with this 12 page "Data Brief" on Recommended Core Measures for Evaluating the Patient-Centered Medical Home: Cost, Utilization, and Clinical Quality. The Fund assembled 75 experienced health services researchers who, after numerous meetings, two publications, presentations at national scientific meetings and close collaboration with the NCQA and AHRQ, developed a standard set of PCMH clinical and economic measures. As you might expect, there was agreement about the need for transparency and validated algorithms.  There was less certainty over the approach to standardized pricing and risk adjustment.

Because the document does a nice job of compactly summarizing the recommended outcome metrics in easy-to-read tables, this handy brief could turn out to be a widely used reference document. Unfortunately, while HEDIS®, PQRI, AQA and CAHPS are prominently mentioned, the authors neglected to take advantage of the additional insights provided by the Care Continuum Alliance's Outcomes Report

That'll be important in networks where the PCMH and population health management (PHM) are converging in combined arrangements that use the best of both approaches to care, including measurement.  That's probably one reason why the PCMH's own Patient Centered Primary Care Collaborative links the CCA's document here.

1 comment:

Troeltsch said...

I would be interested to get your feedback on the inclusion of "30 day hospital readmission" as a metric in the Commonwealth report. I thought Jha and Jhont did a bang-up job in the NEJM discussing why this metric was inadequate, and in some cases, even harmful.