Measuring and Implementing High-Value Care

Harvard Business Review recently (9.22.15) posted an article about the public availability of Cleveland Clinic's Outcomes Data.

I think insights within these books are helpful and should help direct similar programs. There are limitations naturally and I for one would like to see more granularity in reporting and I have included a few examples below but all-in-all, a positive step toward transparency and improving high-value care.

Cleveland Clinic is willing to share their summary reports and to encourage others to do the same. They include suggestions as well...

1. Identify the target audience, because the audience shapes the reporting. We have chosen peer physicians, but one could argue the case for patients, employers, or even commercial insurers as target audiences. Whatever audience you choose, make the choice early — it will greatly affect how you present the data, the language you use, and the look and feel of your published products.
2. Recognize that most measures of substantial interest are the long-term ones, so they are likely to take years to collect properly. Fortunately, we were a very early adopter of an electronic health record system, which has greatly facilitated some of our measurement. However, organizations just starting down this road may have a very limited number of outcomes available for reporting, which could be discouraging, although specialties that report to national registries can begin with those data. Wherever you are now in this process, have hope: The many pages of measures that Cleveland Clinic reports across our 14 books has grown considerably, even though we started relatively small.
3. Accept that reporting outcomes requires resources, and plan to fund and support your effort. Data collection, preparation, analysis, and reporting all take time and effort from many people. If the top leadership of your organization supports the effort to report outcomes, it is much more likely to be sustainable.

There are 14 books although I focus primarily on these 3 in my own research and reporting:

1. Medicine Insititute
2. Neurological Institute (primarily cognition)
3.Taussig Cancer Institute (Cancer Institute data provides a variety of outcomes measures that are informative and not often reported in the literature.)

How do we guard against cherry-picking outcomes? Each book is reviewed by the Outcomes Books Editorial Board — a group of 18 volunteers, primarily physicians representing 14 clinical institutes plus a few statisticians. This group helps to identify missing outcomes that should be reported, as well as outcomes that are unclearly presented or poorly measured.

​We have been annually producing our Outcomes Books for more than a decade, but we certainly have room for improvement. Sometimes, for particular treatment –condition combinations, we have only volume or process measures. In those cases, we report what we have, with an eye toward better measurement next time. In consultation with Cleveland Clinic’s Quantitative Health Sciences Department, we always look for better data sources and methods of analysis.--Michael W. Kattan chair of Cleveland Clinic Outcomes Books editorial board

Available books for 2014 outcomes...

---

The data from breast cancer screening demonstrates performance above the national benchmark. I would like to argue that screening isn't without harms (false positives, over-treatment of indolent cancers) and perhaps screening guidelines that discuss harms along with benefits would be helpful in directing care and resources to those likely to benefit from care. What types of cancers were detected? How many false positives? Indolent cancer types? Aggressive cancers? Is the goal detection or improving outcomes for phenotypes responsive to treatment?

Improving population health and reducing the cost of care are important metrics to include. A deeper dive into the data reveals the pain points and successes of one of the most influential care centers in the nation. I encourage you to access the reports and integrate the findings into discussions of screening appropriateness, drug targets, and emerging algorithms. Health care will not improve without meaningful metrics, robust debate, and most of all--transparency. 

Thoughtful discussions about content development and outcomes analytics that apply the principles and frameworks of health policy and economics to persistent and perplexing health and health care problems.