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Cost-of-Care Measurement Development

Measuring Cost and Efficiency in Health Care
Existing efforts in the Quality Alliances and elsewhere have developed an expanding set of quality-of-care measures, but cost-of-care measures have not been consistently implemented, even though cost information is essential to determining the value of care. This lack of broad acceptance of the proprietary cost-of-care measures currently available is due to the shortage of publicly-available information on their validity and reliability. Full transparency in the development of these measures is a critical requirement for their use.

Developing Episode-Based Cost-of-Care Measures Will Help Improve Quality and Lower Cost
The Engelberg Center is working to support the development and implementation of episode-based cost measures for 20 common types of health care services. This will provide a national starter set of episode-based cost measures developed through an open and transparent process and that will be made available for wide-scale use. As a result, this project holds the potential to fill critical gaps in using better information on quality and cost to improve the delivery of health care services nationwide.
 
With support from the Engelberg Center and guidance from the QASC, staff from the American Board of Medical Specialties will develop and test detailed measure specifications for each of 20 selected high-priority conditions. The measure specifications will include:
 

  • Defining the process(es) or care being measured;
  • Defining which clinically appropriate services group to any given episode using common diagnostic and other codes;
  • Delineating condition-specific episode length and/or clean periods;
  • Conditioning specifications by required data types (e.g., pharmacy, outpatient, etc.); and
  • Data formats.

 
Once the measure specifications are defined, the project team will test the robustness and reliability of each measure. The measures are being developed to reflect strategic guidance from the National Quality Forum (NQF), and when testing is complete in 2009, the specifications for these measures will be submitted to the NQF for endorsement. Upon endorsement, the measures will be available for use nationally.
 
Working Measure Specifications
The following documents include the specifications for episode-based cost-of-care measures for patients with acute myocardial infarction (AMI), diabetes, congestive heart failure (CHF), coronary artery disease (CAD), low back pain (LBP), or pneumonia, as well as for patients undergoing breast biopsy and colonoscopy procedures. The Engelberg Center and American Board of Medical Specialties Foundation are currently supporting the testing and validation of these measures, and so they are subject to revision. Measures of the costs of care in treating patients with other conditions are also under development.