Innovating CMS Value-Based Measure Development

Submitted by danny@pcorcds-ln.org on Fri, 06/01/2018 - 12:44

Providers of medical care can be paid by volume or value. Paid for volume, or fee-for-service, means providing more services, receiving more pay. Fairly straightforward. Paying for value depends on the definition and measurement of value. Value to whom? Value to patients, value to clinicians, value to communities, value to insurers? We like to think that evidence – research – heavily influences clinical decisions, yet we know that payment influences clinical decisions as well. We could argue which influences decisions more, but let’s just say they both do. Evidence certainly affects measurement of value. Politically and practically, measures of value depend on what is measurable and what has been studied. We look where the research is.

As patients and clinicians make more clinical decisions together within more equal relationships, their perceptions of value change. That change requires different clinical quality measures of value. The research isn't there yet. How can the value-based measure development system support this evolution in patient / clinician experience of medical care value?

This post is written with many stakeholders in mind but primarily for people at the center of care (patients, direct care clinicians, and people that support them).