Implementing High-Quality Primary Care Rebuilding the Foundation of Health Care (2021) / Chapter Skim
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8 Primary Care Measures and Use: Powerful, Simple, Accountable
8 Primary Care Measures and Use: Powerful, Simple, Accountable
Pages 259-280
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From page 259... ...
Such a set would need to be established through a coordinated process involving key stakeholders and a systematic review of current measures used with consideration both for a reduction in the number of measures employed and an addition of measures able to cover critical gaps in the scope of primary care assessment. This is beyond the scope of this report.
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From page 260... ...
. This chapter also highlights the need to change the process for assessing primary care performance and accountability using a simple core set of measures, similar to the strategy promoted in the Vital Signs report regarding how best to design a core set of population-based health measures (IOM, 2015)
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From page 261... ...
Combined, these form the ecology of primary care measures. A high-performing ecology of primary care measures facilitates patient care team relationships, integrated health care delivery, design of care teams as best fits health stewardship, and the ability of primary care to mitigate social inequities that may prevent optimal health attainment.
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From page 262... ...
Creating an environment that can foster and sustain high-quality primary care requires that the measurement enterprise reorient itself to support primary care quality and accountability aligned with expectations, values, and professional norms as shared across stakeholders. Previous studies, such as To Err Is Human (IOM, 2000)
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From page 263... ...
. One unintended result of this misalignment between the content of quality measures used and the clinical reality of primary care is that an approach to measure implementation by practices and systems often focuses on administrative behaviors, rather than shared norms of professional behaviors and expectations.
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From page 264... ...
Such measures enable shared and commonly held expectations of primary care, such as the following (Green and the Starfield Writing Team, 2017) : • Primary care is a function, not a specific discipline, specialty, or service line.
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From page 265... ...
measurement systems have resulted in the failed national assessment of primary care quality and performance and under-reported the benefits of primary care to populations and health systems. These include a lack of national agreement regarding which parsimonious set of measures should be applied to primary care and how to specify them (Cook et al., 2015; Phillips and Bazemore, 2010b)
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From page 266... ...
. However, the administrative burden related to the high number of misaligned and non-meaningful quality measures on which primary care is required to report undermines effective use of primary care resources (Casalino et al., 2016; Dean and Adashi, 2015)
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From page 267... ...
. Balance Patient-Centered Care with Person-Centered, Team-Based Care to Promote Health Equity High-quality primary care cannot be supported by payment models that divorce accountability from shared agreement about primary care values and professional norms among stakeholders.
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From page 268... ...
This can be accomplished by adopting meaningful primary care measures, aligned with primary care purpose and function, and making greater use of patient-reported assessments of care. GUIDANCE FOR SELECTING PRIMARY CARE MEASURES Primary care measures enable clinicians and care teams to achieve the purpose of primary care by providing actionable markers for improvement of the relationship with the patient and the coordination of care beyond episodic interactions.
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From page 269... ...
. Achieving parsimony is one goal of effective and efficient measurement of primary care, because a core set of measures increases focus, reduces burden, and is an opportunity to increase alignment across payers, patients, health systems, and clinicians.
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From page 270... ...
, there are currently no measures tailored to achieve the desired outcome -- removing bias and eradicating health disparities based on race, ethnicity, and other socially defined markers of inequity. During the pandemic, many insurers and health systems temporarily suspended the need to systematically report current primary care quality
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From page 271... ...
MACRA legislation makes this point and recognizes that current quality measures, particularly those for primary health care, are not up to the task. The central messages of Vital Signs, MACRA, and primary care leadership are aligned: quality measures are necessary to achieve national health objectives, yet current measurement systems are costly and provide limited return.
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From page 272... ...
. The measurement atlases compiled by AHRQ and the core set of quality measures recently proposed by CMS and America's Health Insurance Plans are important steps (Conway, 2015)
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From page 273... ...
Given the rationale for a central federal entity to advance the work of aligning existing primary care activities and implementing primary care policy and workforce recommendations, it is then important to consider which entity or entities within the federal government might be able to carry out these tasks in a coordinated manner. CMS is the major payer in the United States, but its purview is technically limited to the over age 65 and disabled population, individuals with end-stage renal disease or amyotrophic lateral sclerosis, and state Medicaid programs.
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From page 274... ...
Expanding its remit beyond its current form requires an act of Congress, and it does not have capacity or ownership over a broad research program, nor has it coordinated workforce or quality efforts outside of safety net systems and federally qualified health centers. If strengthened and broadened, it could coordinate key workforce priorities and align with other entities below to carry out these recommendations.
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From page 275... ...
Effective primary care measurement relies on appropriate design of the use environment and should align both external and internal motivations of actors. It should do so in ways that embrace both patientand person-centeredness in order to promote health equity.
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From page 276... ...
2019. Primary care physician characteristics associated with low value care spending.
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2020a. Children's health care quality measures.
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From page 278... ...
:461–468. Green, L., and the Starfield Writing Team.
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From page 279... ...
2021. Primary care measures (generated interactively via the Quality Positioning System tool)
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From page 280... ...
Annals of Family Medicine 8(1)
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