Value-Based Care Needs Only Five Quality Measures

I was the editor of a healthcare business magazine for 11 years. I was in charge of hiring and firing our editorial staff of reporters, editors and designers. My performance measures for new hires were pretty simple: get to work on time, work hard, do a good job, don’t cause any trouble and leave on time.

You’d be surprised how many people said they could meet that five-part test if I hired them but who then had issues meeting one or more of those performance criteria after I hired them.

We also had performance measures for our editorial staff as a whole. Metrics like corrections to measure our accuracy, letters to the editor to measure our reader engagement, scoops to measure our deadline performance against our peers and editorial awards to measure the quality of our work.

But that’s nothing compared with the number of performance criteria facing primary care physicians (PCPs) in value-based care (VBC) contracts, according to a short but revealing research letter in JAMA Health Forum.

Four researchers affiliated with the Booth School of Business at the University of Chicago and the Providence Research Network in Portland wanted to learn more about the number of quality measures PCPs face in VBC contracts with health insurers. Organized medicine often blames the volume of metrics as a reason why more doctors don’t enter into VBC contracts that link their reimbursement with their patients’ health status and clinical outcomes.

To find out, the researchers looked at the employment contracts of 890 PCPs continuously employed by an integrated delivery system from 2020 through 2022. Here’s what they found out.

• Each PCP participated in an average of 11 VBC contracts over the three-year period.
• Each PCP faced an average of 57 unique quality measures over the three-year period.
• The average number of unique quality measurers per contract per payer was 10.2 over the three-year period.
• The payer with the highest average number of unique quality measures per contract over the three-year period was Medicare with 13.4, followed by commercial health plans at 10.1 and Medicaid at 5.4.

Fifty-seven unique quality measures seemed like a pretty high bar to the researchers.

“Value-based contracting is intended to incentivize care improvement, but it is unlikely a clinician or practice can reasonably optimize against 50 or more measures at a time,” the researchers said.

Further, they said, “Increased use of such levers may also carry unintended consequences. Clarity and salience are crucial to changing behavior, and the burden of extraneous information and processes has been increasingly associated with adverse outcomes, such as physician burnout.”

Interestingly, the number of unique quality measurers per PCP dropped more than 18% to about 52 in 2022 from about 64 in 2021, perhaps reflecting the researchers’ sentiment. Or the integrated delivery system’s need to recruit and retain PCPs.

This all made me think of the quality measures I used when I was editor to track the performance of our individual reporters, editors and designers and our editorial staff as a whole. Did I use too many? Did I use too few? Were they the right measures?

But then I thought, maybe we’ve made VBC too complex with too many measures. Why not apply the same measures to PCPs? Did they get to work on time? Did they work hard? Did they do a good job, i.e., keep their patients healthy or as healthy as possible? Did they cause any trouble, i.e., harm patients with unnecessary or unsafe care? And did they go home on time?

Maybe providing great care to patients and improving clinicians’ work environment isn’t as complicated as we think it is.

Thanks for reading.