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The Accountable Care Collaborative and the Three-Legged Stool

“To achieve better care quality, better health outcomes and lower health costs.”

That’s the Triple Aim, or the “three-legged stool,” behind many health reform efforts, including Colorado’s Medicaid Accountable Care Collaborative (ACC), which seeks to hold health care providers accountable for their patients’ health outcomes.

Assessing two of the stool’s legs—lower costs and better outcomes—may be an easier task than assessing the third—quality of care. The Statewide Data and Analytics Contractor (SDAC), which reports data on ACC clients to health providers, is an instrument for measuring patient outcomes and health expenditures. The SDAC data will also be used in a savings report expected this November. Evaluating progress toward care quality, however, may require further innovation.

According to the Institute of Medicine, components of care quality include the extent to which care is safe, effective, timely, efficient, equitable and patient-centered. It’s the patient-centered aspect that’s difficult to measure. Many metrics assessing quality in other states evaluate how the physician performed—such as did she do the recommended procedure or prescribe the appropriate medication—not the patient’s own experience of care.

Among Colorado’s seven Regional Care Collaborative Organizations (RCCOs), there is no standardized method for measuring patient experience. Some may use assessments that include questions such as “How often did your doctor show respect for what you had to say?” and “On a scale from 1 to 10, how would you rate your health care?” But there are concerns that some questionnaires may take too long or are difficult for patients to understand. Focus groups, patient interviews and other more qualitative methods have also been suggested. Without a consistent way for reporting patient experience, comparison across RCCOs, one of the ACC’s most useful capabilities, is difficult.

Measuring the patient experience of care may be less quantitative and, of course, the ACC is still learning and growing; care quality assessment may come with time. But “what gets measured gets changed,” so it’s important for the ACC to develop consistent metrics by which to assess the patient experience of care. Otherwise, we’ll be sitting on a “two-legged stool” and you can guess what will happen then.

The ongoing study of the ACC is the subject of CHI’s Safety Net Advisory Committee (SNAC) Labs. The next SNAC Lab, which will include a special segment on assessing care quality, is on Thursday, September 27. More information on previous SNAC Labs is available here.