An implicit goal of an improved Healthcare structure is to create an improved system of care for patients. So in addition to measuring patient-level outcomes, it will be important to measure whether the system itself is improving in ways that are believed to result in better patient care and better outcomes in the future. Some of the questions to be answered and measures to be developed include:
Are we strengthening primary care?
• Do more patients report that they have a primary care physician or team?
• Do more patients report that they can find a primary care team easily?
• Are patients able to communicate with their primary care team more readily?
• Do more primary care physicians report “joy in work” and being “fairly paid?”
• Has access to specialists, as reported by patients and primary care physicians, improved?
• Is primary care becoming more patient-centered?
• Do more patients report that they are getting exactly the care they need, exactly when and as they need it?
• Do more patients report that they fully understand their care, understand what they need to do to stay healthy, and that the care fully reflects their preferences?
Are decisions about payment and other issues more oriented toward patients’ interests than providers’ interests?
• Do patients report that their providers coordinate services effectively?
• Is care of patients with chronic illness becoming more efficient?
• Have expenditures for specific patients and conditions met the target levels?
• Has the percentage of care managed without face-to-face contact and in single visits increased?
• Have hospitalizations been reduced?
• Has there been a decrease in the frequency of procedures that had been performed previously at a rate above the national average?
• Has the rate of test repetition decreased?
• Have patients reported any greater problems in accessing care?
Are outcomes for chronically ill patients improving?
• Have blood pressure levels improved?
• Have Hemoglobin A1c levels improved?
• Do patients experience fewer limitations affecting their quality of life?
Are data being used for management and continuous improvement?
• How many quality/outcome/cost measures are available?
• How promptly are the measures available?
• Does the managing board of the provider review the measures regularly?
• Is the CEO compensation/performance plan tied to the measures?