Last month, I traveled to India with a friend. When we landed in Frankfurt for a layover, we both got off the plane needing a good stretch after what felt like an eternal plane ride. I scanned nooks and crannies of the airport, searching for a somewhat private spot to stretch out, and came across a closed door marked “Yoga.” Incredulously, I poked my head in to find a quaint yoga studio, with a beautiful mural on the wall, a video playing of an instructor practicing poses, and high-quality yoga mats. I thought to myself—what if this is how we cared for people who touch our health care system? What if success meant doing right by the people using health care services and always keeping in mind what would make their experience the best it can be?
Quality metrics are a big deal in health care right now, as our health systems undergo transformations that increasingly tie hospital and provider payments to quality assurance. Metrics of this kind help us better understand how well health care providers and systems are performing and where to focus improvement efforts. Quality metrics assess safety, timeliness, effectiveness, efficiency, equity, and patient-centeredness (PDF). Some of the ones I find most compelling are those that are patient-reported regarding the patient experience, health and health care outcomes, and ways that our systems can better meet the needs of patients. As our providers are being held accountable for the Triple Aim, it’s an apt time to ensure patient satisfaction, and to align payment incentives around positive results.
Earlier this year, the Centers for Medicare and Medicaid Services (CMS), in partnership with a group of plans, physicians, consumers, and employers, derived seven core sets of quality measures. This Measures Inventory references more than 540 performance measures and has information from over 130 benchmarking databases (Excel Spreadsheet). Health First Colorado (Colorado’s Medicaid program) evaluates the experience of its enrollees with the Consumer Assessment of Healthcare Providers and Systems (CAHPS) questionnaire, and those receiving behavioral health services are additionally surveyed with the Experience of Care and Health Outcomes (ECHO) questionnaire. Measuring quality can allow different stakeholders in health care to recognize and seek out real value, and it can give consumers the power to influence the process of quality design, implementation, and tracking of health systems. This is a critical part of making our health system more patient-focused.
However, to be done well, patients need to be involved in developing and testing the measures we’re collecting, and there’s evidence that’s not happening. For example, the CAHPS survey is written at a 7th grade reading level (PDF), which may be too high for respondents’ reading comprehension. If our measures or data collection tools are flawed, are health care providers and hospitals truly measuring their performance against the values, needs, and priorities of consumers? How else can we ensure that what is measured and reported aligns across entities and initiatives and matters to the individual consumer navigating the system?
Practicing yoga so far away from home felt comforting and enhanced my travel experience. Because of their attention to consumer needs, it’s no surprise that Frankfurt Airport ranked highest of all German airports in customer satisfaction. The health care system can achieve this success, too, if we keep aiming for person-centeredness, which requires including patients in the process from beginning to end.
Read more on this issue next week in Part II, when we dive deeper on what success looks like from the patient perspective!