A Measure Menu, Workbook and Guidance for Value-based Care, Payment and Reporting Programs
The U.S. health care system continues to move from fee-for-service toward fee-for-value, or value-based care and payment. Children’s hospitals are increasingly under pressure to adopt and report on meaningful quality measures that demonstrate value in the care provided to patients.
Selecting meaningful measures for your hospital’s value programs is critically important, complex, and time and resource intensive. There are hundreds, even thousands of pediatric measures in use, but few agreed upon, standard measures and measure sets in children’s health care. Moreover, the small number of national and regional pediatric measure sets that do exist include few pediatric acute inpatient and specialty care measures. In the absence of recognized measure sets, you are left to select measures, or have measures imposed upon you, without the benefit of industry experience.
Common questions providers pose include:
- Where can you go to find out what measures are available?
- What are the measures with real-world application?
- How do you evaluate which measures are best suited to your program?
“Demonstrating Value in Pediatrics: A Measure Menu, Workbook & Guidance for Value-based Care, Payment and Reporting Programs” released by the Children's Hospital Association (CHA) can save hospitals and health systems significant time and effort in identifying meaningful quality measures for value-based programs. The Demonstrating Value in Pediatric resource includes: the measure menu listing 67 carefully vetted pediatric measures, measure menu Excel-based workbook to simplify measure selection, seven steps to successful measure selection and use, and commentary on gaps and opportunities in pediatric quality and measurement.
To create the Demonstrating Value in Pediatrics Measure Menu, CHA worked with an advisory panel of stakeholders and Discern Health. Our objective was to identify measures that:
- Are recommended by experts—including families and patient advocates, clinicians, hospital administrators, health care systems, and public and private payers— for value-based care and payment programs.
- Minimize challenges commonly faced with pediatric measurement.
- Capture key aspects of care across pediatric sites of care, including inpatient, specialty, primary and behavioral health care.
- Capture aspects of care that matter most to children and their families.
- Are aligned with existing federal, state and private programs.
The measure menu is not a dashboard addressing all aspects of child health quality, nor an ideal set of measures. However, in the absence of ideal measure sets and national data sets, the Demonstrating Value in Pediatrics Measure Menu and Guidance can be used as a measure selection resource for value-based programs.
What the Report Covers
Chapter 1. Child Health and Quality Measurement
Children’s health care measures must account for the unique physiology and health care needs of children, summarized as the “five Ds”:
- Developmental status and change
- Differential epidemiology
- Demographic patterns
- Detecting differences
The fifth “D” acknowledges that health measures for children are often challenged to identify and differentiate high or low quality from average quality due to a variety of factors.
Chapter 2. Demonstrating Value in Pediatrics Measure Menu
The Demonstrating Value in Pediatrics Measure Menu was developed with consensus-based recommendations from stakeholders using CHA’s measure set selection and evaluation process rooted in industry best practices. The resulting measure menu includes 67 quality measures in four areas of care:
- Acute inpatient care (15 measures)
- Ambulatory specialty care (15 measures)
- Primary care and community engagement (27 measures)
- Behavioral/Mental health care (10 measures)
Chapter 3. Using the Demonstrating Value in Pediatrics Measure Menu and Measure Implementation Guidance
Seven steps lead to successful measure selection and implementation in value-based programs, starting with defining the objectives and scope of the value-based program, to aligning select program and measure requirements, and ending with ongoing implementation considerations:
- Define value-based program objectives and scope
- Anticipate key child quality measurement issues
- Specify program and measure requirements
- Select measures from the Demonstrating Value in Pediatrics Measure Menu
- Evaluate selected measure set
- Interim testing
Chapter 4. Gaps and Opportunities for the Demonstrating Value in Pediatrics Measure Menu
We identified three gap areas in measuring quality of care in children’s health care including communication and coordination/integration of care, structural and health system areas (e.g. workforce shortages), and clinical care. Measures covering communication and coordination/integration of care were identified as the highest priority gap areas by families, patient advocates, clinicians, payers and hospital administrators alike.
The work also identified ten “emerging measures,” representing opportunities for the future. Emerging measures address important topics but require specification revision or refinement, more testing or real-world experience and/or overcoming some other technical obstacle.
White Paper: What Matters Most to Children and Families (Appendix C)
Child health quality measure sets should capture aspects of quality that are meaningful for children and their families. The patient perspective should, in a patient-centered quality program, be the primary focus of decision-making.
This white paper presents a child-centric stakeholder group’s examination of “what matters most to children and families” across six domains of quality: communication and coordination, community engagement, effectiveness of care, safety, experience of care, and wellness and prevention.
Three themes touching all or most of these domains were identified:
- Communication and care coordination are foundational, safety is essential, and wellness and effectiveness are objectives.
- Quality care is dependent on all stakeholders knowing and performing their roles.
- What matters most is for some an aspirational idea and for others a realistic expectation.
Four Case Studies on Opportunities for Quality Improvement (Appendix D)
Presents four case studies describing real actions by children’s hospitals to improve child health care quality and outcomes and how quality measures can be used to support, supplement and incentivize quality improvements in pediatric settings. These case studies include examples of the effective coordination of care for children with complex health care needs, adaptation of adult-focused value-based inpatient reimbursement structure, effective use of learning networks, and feasibility and benefit of addressing social needs.