Format

Send to

Choose Destination
See comment in PubMed Commons below
Am J Manag Care. 2008 Jun;14(6):360-8.

The value of ambulatory care measures: a review of clinical and financial impact from an employer/payer perspective.

Author information

1
Bridges to Excellence, 13 Sugar St, Newtown, CT 06470, USA. francois.debrantes@bridgestoexcellence.org

Abstract

To understand the value for payers and purchasers of primary care quality measures in an insured population, we conducted a 2-part analysis. In the first part, we reviewed the economic and clinical literature supporting 62 quality metrics spanning primary care that had been proposed for use in a physician recertification program and in a pay-for-performance program. We then ranked these metrics by both economic and clinical evidence of effectiveness. For many of the metrics, there was little clinical or economic support for inclusion in a pay-for-performance program. For the 20 with both clinical and economic evidence of effectiveness, we constructed actuarial models to understand the potential financial effect that attainment of these metrics would have in an insured population, from the perspective of a payer. Of those, 16 were found to be cost-saving in the short term with respect to direct medical costs incurred by payers. This analysis suggests that many recommended primary care quality measures may have little clinical evidence of effectiveness beyond expert opinion, and may provide scant clinical or economic benefit to payers if achieved. A minority, however, may deliver substantial savings in the short term. Given the current emphasis on pay-for-performance and pay-for-reporting programs, and recent studies showing a lack of relationship between measures and clinical/economic value, this analysis informs payers, purchasers, providers, and policymakers about the importance of choosing the right metrics and the methods for collecting them.

PMID:
18554074
[Indexed for MEDLINE]
Free full text
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Managed Care & Healthcare Communications, LLC
    Loading ...
    Support Center