SCAN Health plan's successful suit of the CMS over an obscure provision (Tukey outlier detection) in the regulations will result in ~250 million dollars changing hands from the CMS to SCAN health plan. Got me wondering about what the healthcare system is getting out of measuring quality. So I took a look at two of the common healthcare quality measurement systems, HEDIS and STARs. I broke all the measures into six categories: *Screening/Assessment/Evaluation *Survey *Immunization/Vaccine *Medication/Adherence *Biometric Control *Non-Screening Procedure or Service The first two are obviously pure process measures (did you screen a patient or provide a follow-up visit). The next two reflect clinical patterns but do not measure outcomes (e.g. are the medications working). I would argue the last two reflect actual clinical outcomes or impacts. HEDIS MY 2024 broke out as: *Screening/Assessment/Evaluation - 43% *Survey - 6% *Immunization/Vaccine - 3% *Medication/Adherence - 25% *Biometric Control 6% *Non-Screening Procedure or Service - 16% STARS: *Screening/Assessment/Evaluation - 28% *Survey - 44% *Immunization/Vaccine - 2% *Medication/Adherence - 19% *Biometric Control 5% *Non-Screening Procedure or Service - 2% Most of what the healthcare system pays for in terms of quality is Medication Adherence and Screening. I have long advocated for using episodes of care to help improve both financial incentives and quality. Quality is easier to measure within a specific episode of care, especially when using Patient-Reported Outcomes. As a comparison below is how the new Enhancing Oncology Model Quality Measures break out: *Screening/Assessment/Evaluation - 14% *Survey - 29% *Immunization/Vaccine - 0% *Medication/Adherence - 14% *Biometric Control - 0% *Non-Screening Procedure or Service - 43% Still room for improvement. I've seen some very interesting work done by Patient Discovery and others around patient reported outcomes for cancer. I'd like to see more of this implemented in both CMS programs and private ACO initiatives. Important to think about what we are paying for in quality measurement.
Not only measuring adherence but also showing improvement over time provides those metrics. The ultimate goal of moving patients to become more self managed can be accomplished using proven methods and models. Our programs in particular start at the physician prescription level and follow the patient through discharge and beyond. Providing follow up interventions first with benchmarking their existing level of adherence, and then tailored counseling and educational dialogues is providing those metrics and services hospital systems are looking for.
Sr. Strategic Account Manager | Regional | Digital Healthcare | Healthcare IT | Oncology | Strong track record of account growth and customer retention
9moGreat insights here, Eric! Could you clarify in more detail what exactly the percentage breakdowns represent?