Brainstorming Themes Regarding Measurement Discussed at the 2016 Starfield Summit
| Themes of Starfield Summit Participants' Discussion on Measurement | Representative Statements Reflecting Theme |
|---|---|
| Measurement must reflect characteristics of health systems we know are related to improved population health, including accessibility, comprehensiveness, continuity, and coordination. | • What really matters is the unmeasurable…We must measure trust, communication, relationships, openness … These are what correlates with outcomes. |
| • Measures don't capture the range of what I do in my daily practice. | |
| Indicators of quality care must reflect various patient populations and individual patients' goals. | • What are the priorities of my patients? |
| • How can we bring in the patient's voice? | |
| • Patient preferences and quality of life change over time; how do we reflect that? | |
| Measurement leads to fatigue and burnout and thus, lack of innovation. | • If our system was not so prescriptive, it would allow individuals and organizations to develop their own solutions. |
| • We rely too much on clinician incentives and undervalue intrinsic motivation. | |
| Measurement needs to shift towards care coordination and team care, as one physician or one clinical practice is not responsible for health outcomes. | • Break down the silos between primary care and specialties. |
| • Measurements are disproportionately focused on certain providers–disease-specific measures do not capture primary care, but similarly, radiologists do not get measured on patient outcomes. | |
| Measurement needs to account for social determinants of health, as only 10% to 20% of individual health is related to clinical care. | • Patient outcomes and patient panels are measuring the wrong issue because people with the worst problems don't come in for care–therefore, we need to have community-based measurement. |
| • How do we create measures to account for community issues that neither patients nor providers can control–like transportation, access, employment? | |
| Measurement systems are too complicated. | • Simplify the verbiage. |
| • Too much reporting burden. | |
| • All payers should be using the same system. | |
| Measurement and payment need to be reformed together. | • We can't really talk about population health outcomes without universal access. |
| The current measurement system does not measure value. | • Value is hard to define…and it is different for every provider and every patient. |
| • Does measurement produce the product we want and need? Does it measure health or quality of life and care? | |
| • Do we really need to have incentives? The system is set up in the wrong way for us to deliver care we believe in. | |
| Measurement should focus on trends, not a point in time. | • We need more long-term measures–not the first avoidable re-admission, but the number of re-admissions over a year or over five years. |
| • There's so much devil in the details, no one gets it right the first time. |