Table 2.

Brainstorming Themes Regarding Measurement Discussed at the 2016 Starfield Summit

Themes of Starfield Summit Participants' Discussion on MeasurementRepresentative 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.