As the Patient Centered Medical Home Model of Care (PCMH) spreads it is receiving more scrutiny from stakeholders who want to be assured of PCMH performance. As a result, PCMH performance metrics are being published by various groups representing consumers, clinicians, employers, and government purchasers challenge PCMH providers in that the sheer number of performance metrics can be overwhelming. This can lead to a situation in which providers are producing metrics that are required by external stakeholders but not highly relevant for daily clinical practice.
Based on the lessons learned from the Patient Centered Medical Home Collaborative (PCMH Collaborative) and Community Health Solution’s (CHS) work with more than 100 practice teams on various aspects of practice improvement, performance measurement works best when it is clinically relevant and strategically focused. Performance measurement is clinically relevant when the metrics are selected by clinicians and used to inform clinical decisions for the patient population. Performance measurement is strategically focused when the metrics are selected to address the questions and priorities of key funders and service partners. Ideally, a provider organization will produce a core set of performance metrics that are relevant for clinical care and stakeholder support.
Recently the PCMH Collaborative is discussing various approaches to performance measurement and reporting. In response CHS compiled an inventory of more than 60 performance metrics from multiple sources. As an exercise to inform the Collaborative’s ontinuing discussion, members are invited to scan the various matrices with three questions in mind:
- 1) Which metrics is the most clinically relevant for our patients and practitioners?
- 2) Which metrics is the most strategically relevant for our stakeholder partners and funders?
- 3) Which metrics might make it onto both lists?
Sources for the metrics in the inventory include:
- Commonwealth Fund,
- NCQA (Medicaid),
- CMS (Medicare),
- CMS (Medicaid),
- Bureau of Primary Health Care, and
- Patient Centered Primary Care Collaborative (PCPCC).
As you review the metrics you will notice that the majority of them are in the realm of clinical quality. A smaller but very important list of metrics can be found under Healthcare Utilization, Healthcare Costs, and Worker Productivity. These come primarily from the Patient-Centered Primary Care Collaborative (PCPCC), an employer-led group of patient centered primary care advocates. Employers tend to be less focused on the details of clinical metrics and more focused on overall utilization, especially hospital utilization. This is a different perspective typically seen in clinically-oriented studies of the Patient Centered Medical Home Model of Care published in the health journals.
Scanning the Metrics