Are Patient-Reported Outcomes The Answer To Improved Care?

Widespread agreement exists that today’s movement toward healthcare transformation requires emphasis on patient experience and engagement. Therefore, judging “value-based care” will require use of patient-reported outcomes (PROs) that assess quality from the patient’s perspective, including aspects like quality of life and functional status. Achieving a vision of patient-centered healthcare requires multi-stakeholder collaboration each step of the way. That’s why Avalere, through a two part Dialogue Series, gathered input from more than 18 organizations spanning payers, providers, patient groups, product developers, research communities, and government to examine, explore, and provide recommendations for advancing the use of PROs for measuring performance.

Quality leaders at the Department of Health and Human Services have prioritized the need for PROs in value-based payment models to assess several priorities of the National Quality Strategy. Private payers are also beginning to plan for different ways PROs can be deployed to support alternative payment models. Currently, the number of PROs in payment and delivery programs is limited to measuring satisfaction and patient experience rather than meaningful clinical outcomes such as functional status.

To address this gap, our two part Dialogue Series resulted in the following recommendations:

1. Supplement existing PRO-related efforts by establishing a national measure development research agenda that reflects patient experience and patient engagement.
2. Continue to identify clinical areas where PRO measures can support high-quality, patient-centered care.
3. Refine and prioritize existing measures to establish their clinical practicality via testing and evaluation.
4. Invest in openly accessible tools that providers, payers, and patients can build into health information technology and clinical practice.
5. Create an interoperable, data-sharing mechanism that allows PRO data to be entered, used, and interpreted by every level of a care team (e.g., patient, caregiver, nurse, physician’s assistant, post-acute care/long-term care provider).
6. Support workforce development, training, and education to advance best practices for PRO data collection, interpretation, use, and evaluation.
7. Provisionally adopt PRO-based performance measures in pay-for-reporting and accreditation programs.
8. Gradually integrate PRO-based performance measures into provider practice transformation initiatives such as pay-for-performance, then into new payment and delivery models.

Despite the upsurge of activity to advance patient-centered measurement, our collective healthcare knowledge on these measures is in its early stages, and linkages between PROs and clinical outcomes are still evolving. There is a need for a rigorous, step-wise, and nimble PRO development and translation process to accommodate new information and best practices as they emerge. Advancing the use of PRO measures in payment and delivery models will require thoughtful allocation of new and existing resources and infrastructure through the public and private sectors. There is an opportunities for these activities to (1) help today’s healthcare system overcome key challenges that have impeded our vision for patient-centeredness, (2) enable more effective implementation of PRO measures in new payment and delivery models, and (3) incrementally enhance our understanding and recognition of the true value of care delivered to patients.

There are many practical ways that patients, payers, providers, and life sciences companies can benefit from experimentation with PRO measures. For example, patients can increase their engagement levels by completing PRO surveys; providers can use PRO measures in clinical practice as a vehicle for driving care improvement and delivering value; payers can experiment with PRO-based performance measures for accountability; and manufacturers can continue to develop instruments for clinical trials.

Significant progress needs to be made to ensure fair use of PROs for accountability purposes in the context of performance-based payment models. That work, however, can be a rapid learning process that provides great value to all stakeholders along the way.

Joshua Seidman is Vice President, Center for Delivery System & Payment Innovation at Avalere Health

Nelly Ganesan is a Senior Manager at Avalere Health

Nikita Jeswani is a Manager at Avalere Health