Does Use of Performance Metrics Assure Better Performance?

I was struck by an article on Government Executive’s website this morning titled “How Feds Could Soon Receive Better Quality Health Care.”   To me, the implication was that the Office of Personnel Management’s new metrics for rewarding health insurance companies who participate in the Federal Employees Health Benefits Program will lead to better health care.  However, I don’t believe that one necessarily follows the other.

On the one hand, I am a true believer in the axiom, “What gets measured, gets done.”  So, rewarding health insurers for the desired behavior is a great idea.  However, I am not convinced that the measures in the four performance areas of clinical quality, customer service, resource use, and contract oversight will improve health care.

Health Care Measures

Need a Focus on Outcome Measures

To me, the measures for each performance area (available here) seem to be a collection of customer satisfaction, process-related, and even subjective measures that do little to report on health outcomes or impacts, which from everything I read is supposed to be the touchstone for a successful health care system.

Without even getting into the issue of whether patients necessarily know whether they are getting good health care, let’s look at some of the patient satisfaction measures:

  • Member satisfaction with information on costs;
  • Member satisfaction with ability to get care;
  • Member satisfaction with claims processing; and
  • Member satisfaction with care coordination.

While these all seem like important measures when trying to determine whether patients believe the health care system is operating smoothly, do they indicate whether they believe it is operating effectively? 

They don’t even ask for: Member satisfaction with outcome of care.  Isn’t it more important that the patient be happy with the care they received—that the care helped them get better—than that they were satisfied with claims processing?

Try to Make Your Measures as Objective as Possible

On the process side, it seems like more of the same, measures tracking visits completed and tests administered.  While I think there may be some progress with a measure like “Appropriate use of imaging without overuse,” but this is very subjective and will have to be well-defined or be rendered meaningless.  Who defines appropriate?  The physician ordering the imaging?  The insurance company that doesn’t want to pay for it?

The well-meaning measure I like the least is “probability of readmission following inpatient hospital stay.”  Who is determining the probability?  Doesn’t this beg the question of why you would discharge a patient if there is a probability of readmission?  And, wouldn’t it just be better to use the actual readmission rate?

So, these changes may very well result in a better health care system for federal employees as measured by the proposed new metrics—better claims processing, more cost transparency, easier to get appointments, etc.  However, it will not necessarily lead to better health care outcomes.