PNS147 A FRAMEWORK FOR VETTING "GOOD” OUTCOMES-BASED MEASURES IN ALTERNATIVE PAYMENT MODELS

Abstract

Alternative payment models (APMs) are part of a growing trend to shift away from volume-based, traditional fee-for-service payment models toward payment for value. APMs generally seek to achieve high-value care and reduce high cost, low-value care by incentivizing providers and their clinicians to make economical care decisions while a) maintaining or improving the quality of care, and b) linking pre-specified outcomes to quality measures related to financial performance-based payments. But how can stakeholders be confident we are truly measuring value? A major concern is that current measures lack the patient voice and inadequately reflect the quality of care provided, instead emphasizing utilization, cost and short-term complications. Using oncology as a learning case, we sought to explore how high quality, patient-informed core outcome sets (COS) developed for research might help improve the patient-centeredness of APMs. In doing so, we engaged a multi-stakeholder working group to identify and prioritize characteristics of “good” outcomes-based quality measures. We conducted a directed literature review, key informant interviews, web-based multi-stakeholder workgroup discussions and a COS vetting and prioritization exercise using the web-based survey platform Qualtrics. The following characteristics of “good” outcomes or outcomes-based quality measures in APMs were identified and prioritized as: clinically relevant, meaningful to patients, actionable, inclusive of important patient populations, feasible to observe (and measure) from data, associated with observable differences in a reasonable amount of time, associated with cost savings, and associated with minimal burden on providers. Based on our exploration of how COS can help improve the patient-centeredness of APMs, we propose a framework to guide future discussions engaging providers, payers, clinicians and patients to select appropriate and relevant outcomes-based measures for APMs and other value-based payment initiatives. This framework can help connect what patients value in research to the systems that are shaping reimbursement policies and influencing the experience and decision-making of the patient-clinician encounter.