Patient-Reported Outcome-Based Performance Measures in Alternative Payment Models: Current Use, Implementation...

Area of Science:

• Healthcare Quality Measurement
• Health Services Research

Background:

• Patient-reported outcome-based performance measures (PRO-PMs) enable entity-level performance assessment using aggregated survey data.
• A literature gap exists regarding PRO-PM implementation barriers, current utilization, and success principles.

Approach:

• Key principles for PRO-PMs and the role of alternative payment models (APMs) were reviewed.
• The Centers for Medicare and Medicaid Services (CMS) Measures Inventory Tool was searched for active PRO-PMs in May 2023.
• Principles for successful PRO-PM integration within APMs were identified.

Key Points:

• Five implementation barriers identified: instrument development, response rates, provider burden, fairness concerns, and outcome attribution.
• 54 active PRO-PM instances were found across 14 CMS programs, comprising 46 unique PRO-PMs.
• Five priority principles for PRO-PMs: clinical salience, adequate sample size, meaningful performance range, equity focus, and appropriate risk adjustment.

Conclusions:

• Addressing identified barriers and prioritizing key principles are crucial for PRO-PM development and implementation.
• Linking PRO-PMs to payment programs requires careful consideration of provider and stakeholder engagement.
• Successful PRO-PM integration can enhance healthcare quality measurement and accountability.