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Better Measures

The familiar adage “you can’t fix what you can’t measure” applies to health care in spades, and is why measurement is an important building block for improving quality. It gives providers the information they need about their own performance to identify areas for quality improvement, provides consumers with information to make informed choices about their care, and allows purchasers to know the value they are getting for the money they spend.

The current state of performance measurement in the U.S. is not equipped to drive the improvements we need in health outcomes. There is wide variation in the quality of care patients receive from health care providers, and U.S. quality outcomes lag behind other developed countries. Most existing measures were developed to evaluate adherence to standards of care under the current fragmented, fee-for-service delivery system, and there is a serious lack of measures of clinical outcomes, patient-reported outcomes, care coordination, appropriateness, efficiency, resource use and total cost of care.

The Consumer-Purchaser Alliance (CP Alliance) works for more meaningful performance measures in health care—those designed with consumer and purchaser needs in mind—including measures of health care outcomes and costs. Additionally, CP Alliance advocates for new, more robust measures that support emerging models of care (e.g., Patient-Centered Medical Homes and Accountable Care Organizations) and payment systems (e.g., shared savings and bundled payments).


Our overall goal is to increase the way performance data is gathered, reported, and used in a way that is meaningful, understandable, and accessible to those who receive and buy care. Improving the availability of meaningful measures will facilitate informed patient decision-making, value-based purchasing, and the development of a patient-centered delivery system that includes improved clinician practice and clinical outcomes.

To help realize these goals, the Consumer-Purchaser Alliance consistently offers deep, evidence-based expertise to policymakers and other measurement organizations. We are known for our adept, unbiased information that we frequently share through regular webinars, tutorials, comment letters, and designated spokespeople.

 

July 11, 2013
PRO Webinar
The Consumer-Purchaser Alliance hosted a webinar on patient-reported outcomes (PROs), including an overview of PRO measures, examples of application, and a discussion of opportunities for embedding PROs in the nation's performance measurement infrastructure. Please click here to access materials and additional information.

 

January 14, 2013  
CP Alliance Calls for Renewed Efforts in Meaningful Use Stage 3
The Consumer-Purchaser Alliance responded to a Request for Comments (RFC) from the Health Information Technology Policy Committee (HITPC), urging it to work with ONC and CMS to accelerate the trajectory of the Meaningful Use Program, in its third stage, with a focus on the kinds of rigorous requirements that drive true transformation. In a letter to the HITPC, 25 consumer, labor, and purchaser organizations advocated strongly for (1) Information sharing; (2) Patient and family engagement; and (3) Using HIT to improve quality and reduce costs.

 

May 7, 2012
Consumers and Purchasers Weigh In On Meaningful Use
Twenty-six consumer and purchaser organizations praised CMS for moving Meaningful Use in the right direction in a letter to the agency and a press release. They also called on CMS to maximize health information exchange, and rapidly develop high value quality measures and build them into the program.

 

March 29, 2012
CP Alliance Meaningful Use Strategy Session
CP Alliance held a strategy session to highlight gains and opportunities for improvement in the Meaningful Use (Stage 2) proposed rule. We expect opposition to some of the gains and strongly encourage consumers and purchasers to voice their opinions. The session's recording and slides are available for download.

 

March 1, 2012
Meaningful Use Webinar Series
On March 1, the Consumer-Purchaser Alliance held the first of a two-part webinar series on the Meaningful Use program. The purpose of the first webinar was to provide an update on the status of Meaningful Use Stage 1, and discuss upcoming advocacy work related to implementation of Stage 2. Slides for the March 1 webinar are available here, and a fact sheet on the program is available here.

 

December 14, 2011
Discussion Forum on Cost and Resource Use Part II: Utilizing Cost and Resource Use Measures in Payment and Public Reporting Programs
The agenda is available here.
A recording of this discussion forum is also available.
Consumer-Purchaser Alliance Opening remarks
Debra L. Ness, President, National Partnership for Women & Families
William Kramer, MBA, Executive Director National Health Policy, Pacific Business Group on Health
Innovative Models for Accountable Care
Paul Handel, MD, Sr. Vice President and Chief Medical Officer, Health Care Service Corporation
Leveraging Transparency to Improve Quality and Lower Cost
Robert Greene, MD, Vice President of Clinical Analytics, United Health Care Clinical Services
All-Payer Claims Databases: State Progress and Future of APCDs
Denise Love, Executive Director, National Association of Health Data Organizations
How Do Consumers Respond to Comparative Cost and Resource Use Information?
Shoshanna Sofaer, Dr. P.H., Professor and Chair of Health Care Policy, Baruch College/CUNY

 

November 17, 2011
Discussion Forum on Cost and Resource Use Part I: Understanding How Cost and Resource Use are Measured
Resources and Background Materials
A recording of this discussion forum is also available.
Consumer-Purchaser Alliance Opening Remarks
Debra Ness, President, National Partnership for Women & Families and Co-Chair, Consumer-Purchaser Alliance
Bill Kramer, Executive Director National Health Policy, Pacific Business Group on Health and Co-Chair, Consumer-Purchaser Alliance
Total Cost of Care & Total Resource Use Overview
Sue Knudson, Vice President, Health Informatics at HealthPartners, Inc.
Episode-Based Cost and Resource Use Measurement
Mark Rattray, MD, President at CareVariance, LLC.
An Overview of NCQA's Relative Resource Use Measures
Phyllis Torda, Vice President, Strategic and Quality Solutions Group at National Committee for Quality Assurance Relative Resource Use

 

September 16, 2011
Setting Higher Standards To Advance Meaningful and Usable Measures of Performance
Consumers, purchasers, policy-makers, and other stakeholders seek improved quality and affordability in our health care system. A strong set of meaningful and usable performance measures is an essential tool in this pursuit, yet we do not have enough of these measures. In response, the Consumer-Purchaser Alliance developed "Ten Criteria for Meaningful and Usable Measures of Performance," which lays out practical actions that those working in measurement can take to drive the development and implementation of robust performance measures. It includes recommendations on a dashboard of measures that provides a complete picture of care and how measures should be constructed to generate more valuable information.

 

March 3, 2011
Promoting Measurement of How Providers Care for Their Medicaid Patients
The Consumer-Purchaser Alliance provided feedback to the Agency for Healthcare Research and Quality on the set of measures that the agency proposes to recommend that states use to assess how well providers care for adults enrolled in Medicaid. Public accountability has been sorely lacking in Medicaid, particularly for adult beneficiaries under age 65, making this voluntary reporting program an important step forward. CP Alliance made recommendations on how the agency should focus on a parsimonious set of high-value measures to promote use and impact.

 

February 25, 2011
Moving Meaningful Use Forward to the Next Stage
In a letter to the Office of the National Coordinator, 27 consumer, purchaser, and labor organizations commended the HIT Policy Committee on the draft definition for Stage 2 of the Meaningful Use incentive program. The draft definition sets the bar high enough to achieve meaningful results, while at the same time be reasonably met by providers. The 27 organizations were supportive in particular of the focus on getting providers to demonstrate significant functional capabilities, increasing the number of patients that will be given access to their health information, and improving care coordination. They also provided specific suggestions and examples for how the draft definition can be bolstered to better support consumer and provider decision-making.

 

January 14, 2011
CP Alliance Comments on Proposed Quality of Care Measures Delivered Through Medicaid and the Children's Health Insurance Program (CHIP)
In a letter responding to the Agency for Healthcare Research and Quality (AHRQ)'s request for public comments, CP Alliance supported the addition of some measures while urging the Agency to focus on measures that provide information on health outcomes. CP Alliance also identified existing core set measures that would benefit from refinement and suggested topics for pursuit of measure development.

 

August, 2010
What Stage 1 of Meaningful Use Means for Consumers and Purchasers
The briefing provides information on the how final rules align with the perspectives of consumers and purchasers, and what the next steps for meaningful use will entail.
Slide version
Audio version

 

July 2010
"Meaningful Use" Criteria Will Be Meaningful
Purchasers and consumers have a right to expect that the federal tax dollars used for health IT adoption will lead to significant improvements in health care quality and provider accountability. The inclusion of pharmacy, imaging and lab orders in electronic records can improve patient safety and reduce duplication by automatically by applying evidence-based rules and care alerts. Click here for more information on the final rules for the first stage of meaningful use. CP Alliance held a briefing on the how the final rules align with the perspectives of consumers and purchasers, and what the next steps for meaningful use will entail.

 

March 1, 2010
Improving Quality Measurement in Medicaid and the Children's Health Insurance Program (CHIP)
The Secretary of the Department of Health and Human Services was required under Title IV of Children's Health Insurance Program Reauthorization Act (CHIPRA) to draw up a list of recommended measures for states to use, and report, on a voluntary basis, to the Department for their Medicaid and CHIP programs. These measures were publicized in a federal register notice, along with a request for comments on how to best implement the measurement program to achieve broad participation by the states, since it's not a required reporting program and there are no direct financial incentives tied to the reporting. CP Alliance submitted comments to the Agency for Healthcare Research and Quality (AHRQ), mostly praising the proposed set, and providing suggestions for an additional asthma measure, as well as suggestions for how to spur implementation of these measures by the states.

 

March 2010
Meaningful Use of Health Information Technology
Health IT has tremendous potential to transform how health care is delivered. Congress sought to realize this potential in the Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH), a part of the American Recovery and Reinvestment Act of 2009 (ARRA), by including $34 billion in financial incentives for Medicare and Medicaid providers (e.g., hospitals and health care professionals) for their meaningful use of certified electronic health records (EHRs). For providers, the financial implications will extend far beyond the $34 billion in incentives, with Medicare providers facing what will become substantial payment reductions if they are not meaningful users of health IT after 2015. The congressional intent is that providers, to receive these incentives and avoid future payment reductions, will have to do more than simply install EHRs in their practices; they will have to meaningfully use them to improve patient care. The concept of meaningful use is strongly supported by consumers and purchasers because it supports critical goals, which include:

  • Increasing care coordination and fostering better doctor-patient communication
  • Reducing medical errors and improving patient safety
  • Supporting delivery of evidence-based care
  • Reducing disparities by recording demographic information
  • Improving quality of care, while fostering more cost-effective delivery
  • Advancing payment reform (by supplying needed data on provider performance)
  • Providing patients with their own, portable health information

CP Alliance developed a portfolio of advocacy and education tools to support consumers' and purchasers' work in this area, including:

In addition, CP Alliance worked closely with the consumer coalition Consumer Partnership for e-Health (CPeH), which also submitted comments to CMS that were supported by a great deal of consumer organizations, many of whom are CP Alliance members.

 

December 10, 2007 and January 17, 2008
National Performance Measurement Landscape: Basics for Consumers & Purchasers
This briefing provides an overview of the national "measurement enterprise," describing the process and the major entities involved in measurement development, endorsement, and developing strategies for implementation.
PDF version
November 5 and 15, 2007
Physician Measurement and Reporting: "Show Me the Data"

  • New York Attorney General and Physician Tiering
  • Consumers' CHECKBOOK Medicare records lawsuit
  • CMS System of Records - Performance Measurement and Reporting System

 

October 2007
Using Electronic Data for Performance Measurement
The urgency consumers and purchasers feel for information to make well-informed decisions about health care is frequently out-of-synch with the slow pace of performance measure development and reporting. Electronic data, and in particular electronic health records, hold the promise of being the means to a feasible data system more readily able to collect robust measures of performance. This issue brief describes electronic data, compares it to other sources of data used for performance measurement, and highlights actions to speed its use.
Full Document

 

September 2007
A Pocket Guide to Seven Key Measurement Issues
In discussions with clinicians and researchers, consumer advocates and purchasers often encounter common arguments. This guide provides talking points which articulate purchaser and consumer positions on seven key issues and draw on the Institute of Medicine's definition of health care performance - a multidimensional concept which includes safety, timeliness, effectiveness, efficiency, equity and patient-centeredness.
Full Document

 

November 2006
Measures to Market Report
CP Alliance commissioned a broad-based research effort with support from the Robert Wood Johnson Foundation to identify business models that would support and sustain all elements of the measurement enterprise, spanning measure development, endorsement, data collection and reporting of physician performance in the ambulatory setting. Despite pioneering efforts by numerous regional and national organizations, sustainable business models that support all of the required business activities remain elusive. The Measures to Market report identifies two business models for their potential to accelerate broad-based, sustainable performance measurement and reporting. The two models both share a "Common Foundation" for the business activities of measure development, maintenance, consensus and endorsement and both reflect public/private engagement.
Executive Summary
Full Report
View presentation

 

September 30, 2006
Guidelines on Physician and Hospital Performance Updated
An uncommon coalition of more than 25 of the nation's leading consumer, employer and labor organizations have announced guidelines to promote rapid, industry-wide adoption of performance measures to help patients compare the relative quality and cost of care provided by the nation's hospitals, physicians and health care systems. These guidelines have been updated to recognize other quality alliances, such as AQA or Hospital Quality Alliance, that engage in consensus measure selection.
Press release
Download guidelines
Endorsing organizations

 

September 29, 2006
Using Electronic Data to Assess Physician Quality & Efficiency
Resources & Background Material
Using Electronic Data to Assess Physician Quality and Efficiency
Resources and Background Materials, September 2006
Promise and Perils of Electronic Data
Peter Lee, Consumer-Purchaser Alliance
Physician Performance Measurement
Earl Steinberg, Resolution Health
Efficiency Performance Measurement
Mark Rattray, President of CareVariance
January 17, 2005
HCAHPS - Hospital Patient Experience Survey
Centers for Medicare & Medicaid Services