OpenLoop Team|4/18/2024|3 min read

5 Quality Metrics to Measure Value-Based Care Success

Discover what to measure and how to use them to calculate success

female doctor smiling and greeting patient on video call

The industry’s pivot to a value-based care system is an opportunity for healthcare companies to reduce cost while increasing patient outcomes — something the original fee-for-service model has failed to achieve. 

Due to decades of serial overprescribing brought on by the current model, it’s led to wasteful healthcare spending and significant resource depletion. VBC can help healthcare leaders more efficiently distribute resources—but what metrics do we use to track that success? We'll break it up into five quality measurements.

What you can expect:

  • Brief overview of value-based care

  • How do you measure VBC success?

  • Clinical markers

  • Safety and utilization of care

  • Efficiency of care

  • Patient focus

  • Equitability

  • How to calculate overall successAnd how to calculate them using the Value Equation

Brief overview of value-based care

We won’t go too in depth here since it’s likely you’re already aware of the model and how it functions. If you’re looking for a more detailed overview, we have a great blog explaining the ins and outs of value-based care model

A value-based care model, in its simplest definition, is designed to prioritize patient outcomes over services provided. It incentivizes this by billing based on the patient outcome, not the amount of prescriptions, tests or labs prescribed. Ultimately, the goal is to reduce wasteful healthcare spending on unnecessary medical treatments and encourage increased quality of care. 

The key to a successful transition to value-based care is in your internal preparation. Create a benchmarking plan, identify areas to reduce cost and communicate realistic timelines to all stakeholders. 

How do you measure VBC success?

Several success metrics can indicate the relative success of value-based care. Let’s dive into what each of those look like. 

 1. Clinical markers

Clinical markers are one of the basic value-based care success metrics. They provide an easy measurement of improvement in the patient’s condition. A person with diabetes whose A1C is over 9% before treatment and down to below 7% one year later has shown an improved outcome. 

2. Safety and utilization of care

Let's say a patient receiving treatment for a chronic condition was admitted to the hospital twice the previous year and saw a 100% reduction in hospitalizations the next year. This indicates an improvement in their health through prevention of secondary infections or complications

Payers and healthcare leaders can then use this data to assess quality of care given by each individual provider. How many of their patients have improved in overall health? Of course, one provider may be dealing with sicker patients, or those who were already terminally ill. It’s important to keep this in mind 

3. Efficiency of care

Another way to measure quality of care is through the efficiency of care given. For Instance, greater efficiency can be as simple as getting patients the right care at the right time. By doing this, it can help reduce readmissions which are known contributing factors to higher healthcare costs. While there are certainly outside factors that can contribute to a patient's readmission, VBC programs instead focus on whether the level of care delivered by the provider could have prevented a readmission. Incorporating this type of physician assessment can help maintain a high level of patient care.

4. Patient focus

Overall, patients have better healthcare experiences when they feel like they are being listened to and heard by their providers. By implementing and rewarding patient-centered care experiences in your value-based care program, it increases patient compliance to treatment leading to more effective care coordination.

5. Equitability

Equitable care is perhaps the hardest to measure but also the most critical. It should provide care for all members of the community regardless of demographic. Value-based care puts a large emphasis on preventative care treatments and screenings. However, this can be contingent on these screening rates being comparable across a patient population. This can then incentivize better, more equitable care.

It’s important to understand and address the social determinant of health affecting certain populations. One of the best ways to measure this is by looking at the change in population health after implementing any new, targeted care programs. If there is one group or subset that is experiencing worse health outcomes than others, there is a clear need for more equitable care.

Currently, there is no universal measurement of value-based care; each organization's model can differ in their emphasis on quality measures. However, providing and measuring quality of care will be the key to a successful VBC program. 

How to calculate overall success with the value equation

But how do all these measurements come together? The University of Utah Health system came up with an equation that attempts to measure all these things as a whole. Called the Value Equation, it states that value in care is quality plus service divided by cost. It looks something like this: V = Q + S/Cost This gives patients, providers and shareholders a say in the overall value of care. Utah Health System claims the equation has led to their place as one of the top ten academic medical centers in the country, and continues to drive their successes.

Powering better patient outcomes and equitable care

Value-based care is a relatively new concept in healthcare and these metrics may further refine over time. However, the combination of quality, cost and equity is currently the best way to determine whether everyone involved is getting the most successful care possible. 

We’d also like to take a moment to introduce OpenLoop. We’re a white-label telehealth support company offering a full-suite of services from HIPPA-compliant tech to regulatory compliance support. Our mission is to help our clients provide healing anywhere, anytime in an effort to promote a more equitable, value-based healthcare solution. 

Resource shortages are a real issue facing the healthcare industry. OpenLoop offers our clients the tools to cut costs and industry expertise to build more efficient, patient-focused care solutions

Interested in what we can do for your organization? Get in touch here!

Here’s our full-suite of Telehealth Support Services to explore: