Thresholds

Thresholds Evaluation Department on Quality and Accountability in Healthcare

Notes from the Field: Quality and Accountability in Healthcare

The Affordable Care Act gave focus and momentum to quality and accountability in healthcare. As we debate the future of healthcare in our country, this should continue to be a focus of any changes or reforms. Value-based healthcare—the concept of linking payment to performance or outcomes achieved relative to costs, rather than the volume of services provided—will continue to be implemented and tested across the healthcare system. Here at Thresholds, that means several things: investing in integrated care and workforce development, partnering with insurers, advocating for standardized measures of value, and developing an evaluation strategy that will lays a foundation for value based care within a fee for service environment.

One part of our strategy is to elevate and focus on process measures, instead of outcome measures. What is a process measure? Process measures are the steps, activities, or evidence-based practices that lead—or you believe lead—to a particular outcome. For example, important process measures in behavioral health include how many consumers with a diagnosis of schizophrenia receive diabetes screening, how many consumers are counseled to stop smoking, and how many consumers have created an action plan to manage their illnesses. Process measures improve quality and can reduce cost by reducing variation in care, and in the process, allowing you to test what outcomes the process measure leads to. Process measures allow providers to systematize their care and allow you to know why you are getting the outcomes you are.

An important process measure that the evaluation department has been tracking is how many of our clients are connected to one of our three integrated care partners. Evidence shows that consistent primary care correlates with lower mortality rates and better management of chronic conditions. As Atul Gwande points out in a recent essay on the value of primary care in the New Yorker, “ … the more complex a person’s medical needs are the greater the benefit of primary care.” For persons with serious mental illness, being linked to a primary care or integrated care partner, with whom we share a philosophy of care and have an ongoing relationship, increases this benefit.

In sum, value-based care has renewed urgency for answers to how to document success and impact. While it is important to document success, it is equally as important to identify those processes, steps and practices that lead to good outcomes. Insofar as processes are often recorded as administrative data, these data are often easier to export, track, and report on than outcome data. Identifying, tracking, and reporting on process measures is a necessary step to improving care and showing good outcomes.

To learn more about Thresholds Evaluation Department, visit thresholds.org/evaluation