Quality measures are used to evaluate the performance of health systems and providers with a goal of improving health care quality. Quality measures are becoming an integral component of health care as the health care system moves to value-based payment models that focus on quality and cost. Increasing utilization of quality measures will benefit the country’s progression towards high-quality, patient-centered, and accessible care. These measures hold providers accountable for the quality of their services and their patient’s satisfaction. With increased accountability and profitable incentives, the US health system can identify and fill the gaps in patient care.
Quality Measures & Payment
In addition to the enhancement of patient care, quality measures can be a rewarding business opportunity for pharmacists. As payment models continue to shift from fee-for-service to pay-for-performance, pharmacists can help improve quality measures which drive value in new payment models. Pharmacists can leverage medication expertise, including partnering with providers to help them meet quality measures. Further, pharmacists and pharmacies can be selected for preferred networks based on their performance on key quality metrics.
A major financial opportunity for pharmacists is to improve quality as part of risk-sharing payment models. This will empower pharmacists to be compensated by payers and healthcare plans if they can properly manage the potential downside of non-performance in risk-sharing.
Creating Quality Measures
Government agencies, nonprofits, and for-profit companies have been focused on or formed to create and collect measures. Measures that are endorsed by professional societies are notably more credible because they represent content that has endured evidence-based review and practical testing. Stakeholders gravitate towards these types of measures because they have been tested on their ability to increase the quality of patient care.
The majority of measures can be categorized by Donabedian’s Structure-Process-Outcome (SPO) framework to describe the inputs and outputs of healthcare: structure, process, outcome and patient experience. The definitions of these components are described below by the Pharmacy Quality Alliance.
- Structure measures describe the presence of something that is associated with quality.
- Process measures are actions associated with quality.
- Outcome measures are the end results attributed to healthcare products and services.
By narrowing down the assessment of health care into these smaller clusters, providers can efficiently identify and resolve gaps in the system.