Value-Based Care Needs to Measure What Matters to Patients
October 29, 2024 · Guest Contributor
By Brett Kay, Director, Healthcare Quality Strategy, Strategic Customer Group, J&J Innovative Medicine
Although there are many ways to measure the quality of care patients receive, not many focus on what patients want and need from the healthcare system, beyond a clinical outcome. Many conditions—ranging from behavioral health issues like depression and schizophrenia, to immunological disorders such as psoriatic arthritis and ulcerative colitis, to cancers like multiple myeloma and prostate cancer—present challenges that may limit a person’s ability to work, travel, maintain relationships and enjoy life.
Patients are more than their clinical presentation; they are individuals with hopes, dreams, goals and all the complications and contradictions of being human. Their medical providers, the measurement community—and the healthcare system in general—should see them as more than a problem to solve, but as people who must be considered holistically within the broader context of their lives.
Research suggests as much as 50% of health outcomes are not related to clinical care, but rather to external impacts such as social determinants of health (e.g., housing, food, transportation, social isolation).1 However, outcome measures that truly focus on patient needs and goals have not yet been fully realized, nor has the concept of using patient-centered metrics to improve care, seek value and hold entities accountable.
We need to account for the non-clinical aspects of patients’ lives when considering what we should measure. For example, few measures in value-based payment models capture critical intermediate outcomes in cancer care—such as when patients experience longer periods of symptom-free remission during cancer treatment.2 While the patient’s long-term goal is to be cancer-free, their more immediate goal may be to feel less nauseated, continue working or have the energy to play with their grandkids.
Implementing measurement frameworks and accountability based on understanding what motivates patients, incorporating them into care plans and fostering a true sense of patient-provider collaboration will ultimately lead to better outcomes.
CMS has defined a useful framework for developing more meaningful measures3:
- A patient-reported outcome (PRO) is a report on the status of a patient’s health condition or behavior that comes directly from the patient without being interpreted by a clinician or anyone else.
- Patient-Reported Outcome Measures (PROM) are structured tools used to collect data on PROs, tested for validity and reliability in the population of interest.
- Patient-Reported Outcome-Performance Measures (PRO-PMs) aggregate information collected using PROMs into a reliable, valid measure of performance at the measured entity level (e.g., clinician or health system).
Patients, clinicians and payers benefit from the use of patient-reported data, which facilitate shared decision-making and care plans that better align with patients’ values and goals; improve patient expectations about treatment; generate effective communication between patients and clinicians; and reduce disparities for marginalized groups.4 For payers, these data allow payments to be based on patient outcomes. Developing measures related to non-clinical, patient-directed goals allows patients and providers to align their needs to help meet a common goal: improved health and well-being.
Johnson & Johnson supports efforts to use patient-reported data in a variety of ways, including advancing the use of electronic patient-reported outcomes measures (ePRO) to help oncology patients and providers manage care better. By using ePRO data, providers can identify potential problems from side effects and adverse events between office visits earlier, potentially mitigating unnecessary emergency visits and hospital admissions, which put patients at risk and increase utilization and costs for the system.5,6 Effective use of patient-reported data is a necessary component of a healthcare system grounded in person-centered care.
By putting patients at the center, we can build a health system that achieves high-quality outcomes that align with patients’ goals for their health. J&J is proud to be working with the healthcare community toward that future.
This blog is brought to you by Johnson & Johnson and the views expressed are solely those of the sponsor.
1 Addressing Social Determinants of Health: Examples of Successful Evidence-Based Strategies and Current Federal Efforts. Assistant Secretary for Planning and Evaluation. Office of Health Policy. Report, April 1, 2022. https://aspe.hhs.gov/sites/default/files/documents/e2b650cd64cf84aae8ff0fae7474af82/SDOH-Evidence-Review.pdf. Accessed September 25, 2024.
2 Kline RM, Hughes DL, Schreiber M. Quality Measurement in Oncology: Time to Take the Next Step!. JCO Oncol Pract. Published online August 12, 2024. doi:10.1200/OP.24.00348. Accessed at https://ascopubs.org/doi/10.1200/OP.24.00348 on October 22, 2024.
3 Centers for Medicare & Medicaid Measures Management Hub. https://mmshub.cms.gov/sites/default/files/Patient-Reported-Outcome-Measures.pdf. Accessed September 23, 2024.
4 Mass General Brigham’s Patient-Reported Outcomes Measurement System: A Decade of Learnings. New England Journal of Medicine Catalyst. NEJM Catal Innov Care Deliv 2024;5(7), June 19, 2024. https://catalyst.nejm.org/doi/pdf/10.1056/CAT.23.0397
5 Enhancing Oncology Model (EOM)ePROs Implementation Fact Sheet. Centers for Medicare and Medicaid. Accessed at https://www.cms.gov/priorities/innovation/media/document/eom-epros-fs. October 22, 2024.
6 Patt DA, Patel AM, Bhardwaj A, et al. Impact of Remote Symptom Monitoring With Electronic Patient-Reported Outcomes on Hospitalization, Survival, and Cost in Community Oncology Practice: The Texas Two-Step Study. JCO Clin Cancer Inform. 2023;7:e2300182. doi:10.1200/CCI.23.00182. Accessed at https://pmc.ncbi.nlm.nih.gov/articles/PMC10642897/. October 22, 2024.
