The Missing Link in Value-Based Care

EHRs and other healthcare technologies provide tons of data about patient outcomes and evidence-based practice-yet, there’s something missing in many assessments of clinical outcomes: the voice of the patient.

Patty Taddei-Allen, PharmD, MBA, BCACP, BCGP, director of outcomes research at WellDyneRx, and her colleague Nick Page, PharmD, chief pharmacy officer at WellDyneRx, discussed patient input and its role in the evolution of clinical care October 23 at the Academy of Managed Care Pharmacy (AMCP) Nexus 2018 in Orlando.

Shifting care models

Healthcare is undergoing a major change as reimbursements shift from a fee-for-service to a value-based model. Measuring performance under this new system has been a challenge, and traditional outcome measurement has relied primarily on physiologic parameters and biomarkers of disease.

With this new state of healthcare, however, there is another consideration in outcomes assessment: The increasing focus on patient-reported outcomes and measurement tools for those outcomes.

Patient-reported outcomes are being used in a variety of ways, from clinical trials to methods of care delivery. It can be confusing, though, with so many measurement tools, to understand the difference between patient-reported outcomes, patient-reported outcome measurement tools, and traditional physiological markers.

Taddei-Allen and Page outlined the differences and similarities between patient reported outcomes (PROs), patient reported outcomes measures (PROMs), and other healthcare outcome measures, as well as how they can be used to influence payers, evaluate outcomes, and develop quality improvement programs.

“The goal of our session is to describe patient-reported outcomes (PROs), how they differ from other healthcare outcomes, and how they can be applied to help improve healthcare,” Taddei-Allen told Managed Healthcare Executive prior to the conference.  

Related article: Patient-reported outcomes poised to improve cancer care

PROs assist in improving healthcare and clinical outcomes at both a patient-specific and population-health level. At a patient-specific level, Taddei-Allen said PROs allow for improved patient-provider communication, patient satisfaction with the care they are receiving, and overall improvement in chronic condition management. 

“PROs can help organizations improve their overall clinical care programs, which translates into improved downstream healthcare costs,” she said.

PROs in the real world

Patient-reported outcomes aren’t easy to rely on for traditional practitioners. Some patients may be poor historians. Some might confuse their wants versus needs when it comes to healthcare and report outcomes or experiences influenced by that confusion.

What providers must realize, Taddei-Allen said, is that the use of validated PROs is increasing. With improved tools, the goal is to get better feedback from patients and help clinicians use that feedback to improve the overall care of patients.

For example, in many disease states, Taddei-Allen said she has seen a multitude of medication options with similar results and widely-varying price tags. Patient-reported outcomes may serve as a valuable tool for differentiating treatments and determining the full value of some treatment options.

“There is a lot of research not only in how to best incorporate obtaining PROs in practice, but which ones help provide improvement in the overall care of the patient,” Taddei-Allen said. “PROs are not meant to be used alone, but they should be incorporated into the overall assessment of a patient, which helps strengthen patient-centered care.”

Taddei-Allen said she hopes her session drives home for attendees the value of PROs and helps them understand that patient-report outcomes are gaining traction as a major factor in quality of care assessments. She added the caveat that while PROs are becoming increasingly important, they will never entirely replace clinician-reported and assessed outcomes measures.

“We hope that clinicians and payers will begin to see that PROs are valuable tools to enhance and promote patient-centered care across the healthcare continuum-from direct patient contact to better engage patients in their healthcare to the population level that improves clinical programs and ultimately results in improved clinical outcomes,” she said.