Moving Forward With Person-Centered Outcome Measures

November 6, 2024 · Becky Kolinski

We all know what it’s like to be invested in a goal—that feeling of anticipation as you make progress, the motivation to keep going as you get closer to achieving it. Yet the idea of setting goals in a health care setting may be unfamiliar to many people, and can be challenging to navigate.

This is especially true for older adults with complex health needs—including behavioral or social needs—who may not have the opportunity to participate in authentic conversations about what matters to them and how their goals can lead to better care and health outcomes.

Clinicians also feel the frustration of being evaluated on interventions that are not always relevant to the populations they serve. They want to provide care that matters, but struggle to build it into their workflow.

The Evolution of PCOs

Over the past decade, with support from The John A. Hartford Foundation, The SCAN Foundation and The Gordon and Betty Moore Foundation, NCQA developed Person-Centered Outcome (PCO) measures to help older adults and their care teams align on goals and health outcomes that matter to the person receiving care.

“Person-centered outcome measures are about building trust and respect between the individual and the clinician,” explains NCQA’s Daniela Lawton, Director, Chronic Conditions. “When we tested these measures, we heard so many people say that no one in the health care system ever asked them what mattered most to them or followed up on it.”

PCO measures have three components:

• Identify a goal and document it in a structured way, using goal attainment scaling or a patient-reported outcome measure (PROM).
• Follow up on the goal.
• Measure achievement of the goal.

Defining a person’s goals—and ensuring that the care provided is consistent with those goals—can reduce unwanted care and lead to meaningful improvement.

PCOs Are Gaining Acceptance

NCQA began developing PCO measures for older adults in Medicare plans, but in response to the groundswell of interest in meaningful measurement, expanded the measures to include behavioral health, serious illness, primary care and long-term services and supports.

The PCO measures have been tested with more than 8,500 people and 180 clinicians at 17 care sites, including Area Agencies on Aging, Certified Community Behavioral Health Clinics, home-based primary care sites and other care coordination organizations.

“Person-centered outcome measures are a standardized, transparent and flexible approach that can be used for quality improvement and value-based payment,” says Lawton. “Forward-thinking organizations are using them now, even before they are recognized as the industry standard.”

For example, Connecticut is planning to use PCO measures for value-based payment, and CMS included person-centered care in its Universal Foundation measure set. NCQA plans to add PCO measures to HEDIS in measurement year 2027, and our next round of testing will move us closer to that goal.

Health Plans Are Testing PCOs

Implementation of PCO measures, through incentives and value-based payment, requires adoption by health plans. NCQA will begin testing the measures with Dual-Eligible Special Needs Plans (D-SNP), a type of Medicare Advantage health plan that provides benefits to individuals enrolled in both Medicare and Medicaid.

NCQA is launching a D-SNP learning collaborative. Testing the PCO measures with D-SNPs will help NCQA understand how clinicians and health plans document, track and share information, and allow us to provide support and technical assistance to participating plans.

D-SNPs provide the ideal environment for PCO measures to be tested and developed as HEDIS measures because:

• CMS requires D-SNPs to implement a Model of Care—a basic framework for providing high-quality care for enrollees.
• A key requirement of the Model of Care is an individualized care plan that documents a person’s goals.
• There are no standardized processes for D-SNPs to collect and document goals in a measurable way and health plans and clinicians have asked for guidance.

“NCQA is committed to implementing meaningful quality measures that help improve people’s lives,” says Lawton. “We are excited to work alongside our foundation partners as a catalyst for change in the industry.”

Learn More

Organizations interested in implementing PCO measures or joining the D-SNP learning collaborative can get started by:

• Emailing us at pcomeasures@ncqa.org.
• Visiting the PCO measures webpage.
• Watching the webinar, Person-Centered Outcome Measures: Measuring What Matters Most.
• Downloading the Person-Centered Outcomes Approach Toolkit.
• Taking our free, online training on identifying SMART goals and using either goal attainment scaling or PROMs to document and track goals over time. Find training sessions on the PCO measures webpage.