In a recent issue of JAMA, Sara Singer PhD, MBA and Stephen M. Shortell PhD, MPH, MBA, wrote an informative commentary about a topic that is receiving a lot of attention in the health care industry right now: Accountable Care Organizations (ACOs).
In Implementing Accountable Care Organizations: Ten Potential Mistakes and How to Learn From Them, Singer and Shortell discuss a number of things that could serve as potential roadblocks for healthcare organization’s making the transition to ACOs.
Potential mistake No. 3 is especially relevant to the work that Dynamic Clinical Systems has been engaged in since its founding in 2004: “The Overestimation of Ability to Report Performance Measures.” As health care moves from a fee-for-service to a pay-for-performance model, a lot of people are wondering exactly how performance will be defined and measured. It’s important because, after all, it will determine how and how much organizations and providers will get paid for the care they provide and thus how much health care will cost governments, payers and patients.
In assessing the performance measurement issue, Singer and Shortell write that “experience with pay-for-performance programs suggests the challenge of collecting, analyzing, and reporting performance data” and “will depend on the ability of electronic health records to reliably document the delivery of clinical care.” The authors suggest that the solution can be found in the “development of a mature performance measurement system.”
Their analysis is dead-on, but I’d suggest that they are mistaken in one small area: a mature, performance measurement system already exists: patient-reported outcomes or PROs.
PROs are well suited for ACOs because, as we outlined in a previous blog post Breaking Down the Wall, clinicians trust the scientifically valid measures that they create. This validity should make it easier for payers to feel comfortable about using them to determine reimbursements.
But more importantly, the essence of PROs – asking the patient how she is doing before, during and after treatment – is synergistic with the overarching concept of ACOs, that paying for better outcomes will lead to better care.
I can’t imagine an outcome more desirable than a patient’s quality of life improving because of the care they receive. But how do you determine that? It’s simple; just ask the patient.
That’s what PROs have been doing in both clinical and research settings for decades.
Chris Weiss
Co-founder, President
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