I’ve been looking into how to develop Patient-Reported Outcomes-based Performance Measures (PRO-PMs) lately, and I figured I’d list some helpful resources here. Quality metrics are important in medicine, in that they incentivize physicians to accomplish the IHI Triple Aim:
- Improving the patient experience of care (including quality and satisfaction);
- Improving the health of populations; and
- Reducing the per capita cost of health care.
Payers like the Centers for Medicare & Medicaid Services (CMS) are increasingly trying to integrate patient preferences into these measures to enhance patient experiences of care and, thereby, improve their buy-in to maintaining their own health – which theoretically should lead to better patient health outcomes and lower overall costs to the system.
MIPS Value Pathways, or MVPs (which I’ve discussed previously here and here) are one manifestation of this effort. CMS’ Quality Payment Program website describes the MVP framework as one that works “to align and connect measures and activities across the quality, cost, and improvement activities performance categories of MIPS for different specialties or conditions.” And there’s a population health angle as well: “the MVP framework incorporates a foundation that leverages Promoting Interoperability measures and a set of administrative claims-based quality measures that focus on population health in order to reduce reporting burden.”
Ultimately, the MVP framework strives to keep the patient at the center of care by aggregating performance data to help guide patients toward make better informed decisions about their own care.
According to CMS’ “Finalized MVPs and Policies” (available for download here), MVPs have to include at least one outcome measure, and one such outcome measure is the PRO-PM. At the present time, CMS is encouraging “interested stakeholders” to submit MVP candidate measures for consideration “that measure the patient journey and care experience over time.” Additionally, CMS is exploring how MVPs can be used within a multi-disciplinary, team-based care model.
There’s a lot more to say about MVPs and PRO-PMs, and as this framework evolves I’ll check back in to elaborate on how things are progressing. For now, here is a helpful description of the difference between patient-reported outcomes measures (PROMs) and PRO-PMs, and how they’re related:
- PROMs are tools used to collect patient-reported outcomes
- Measure developers can use PROMs as the basis for patient-reported outcome-based performance measures (PRO-PMs). More specifically, a PRO-PM is a way to aggregate the information from patients into a reliable, valid measure of performance at the measured entity level, e.g., clinician. The CMS consensus-based entity (CBE) only endorses use of PRO-PMs in performance improvement and accountability. The same measure evaluation criteria and justification principles that apply to other outcome measures also apply to PRO-PMs.
And without further ado, here some helpful resources for the PRO-PM development process: