Person Driven Outcomes: Opportunities for Your Quality Measurement

There is consensus. Using measures to ascertain the quality of delivered health care is a good thing. However, there are concerns too. Are there too many measures?  And, are measures are more focused on processes, rather than outcomes?

NCQA constantly looks for ways to improve our measures. For some time, we’ve worked on how to measure what matters to patients—what many refer to as “outcomes” measures.

Our research team decided to use complex patients as the targeted population for these outcome measures. These could be older adults, people with mental illness, disabled and/or frail people, or others with multiple diseases or those who may experience inequity and other social challenges. Many times, they experience fragmented care and may be seen in very different settings on any given day.

While there are existing measures for the targeted population, feedback tells us the measures used sometimes feel like “box-checking.” They don’t clearly foster integration of personal and medical care and impede clinician workflow and efficiency.

With that in mind, NCQA pushed forward to work on measures that:

  • Address “what matters most” to the patient—their personal goals.
  • Improve communication between clinicians, patients and their families.
  • Apply to numerous clinical settings with different patient and clinician types, improving care integration.

SO, what are these measures? We call them “Person-Driven Outcomes” because they are the outcomes identified by the individual (or caregiver) as important to them. These outcomes identified by the individual (or caregiver) can then be used for care planning and quality measurement.

The approach to finding a Person-Driven Outcome Measure varies, of course, by the individual. But the goal remains the same::Elicit what’s important to the patient, include that in goal setting, and work toward achieving the goal.

NCQA participated in a few pilots and projects that tested and applied this approach to a variety of care settings: Medicare-Medicaid Plans, Dual Special Needs Plans, Health Home Programs, Hospice Programs, etc.

In those testing sites, patients appreciated the experience and for some, it was their first time being asked, “what mattered.”

How States Can Incorporate These Measures Into Their Programs

The Person-Driven Outcomes Measures fit in delivery settings for complex patients where goal setting is required, such as in Long-Term Services and Supports (LTSS), Home-Based Primary Care and Age-Friendly Health Systems.

States can incorporate Person-Driven Outcomes measures into some of their existing policy and programs by leveraging the ways in which these measures fit into current NCQA programs.

Additionally, with new funding from the American Rescue Plan, states can incorporate Person-Driven Outcomes measures into existing or new Home and Community Based Services.

What’s Next

If you’re interested in discussing PDO measures and their applicability in your state policies, contact us at publicpolicy@ncqa.org

For more information about the PDO, watch the full webinar.