It’s hard to imagine making any purchase without thinking about quality. We read Amazon reviews obsessively to see which brand is best before we buy a new appliance. We scroll through Yelp and OpenTable to discover which restaurants have great food and service. We check out Google Reviews before hiring a plumber to fix a clogged pipe. Even for short weekend stays, we scrutinize Airbnb listings to make sure we book the perfect getaway spot.
While these purchases matter, they’re usually not life-altering. But when it comes to choices that could meaningfully impact our lives—such as which doctor to see, which hospital to schedule a procedure at, or which urgent care clinic our neighborhood standby should be—we often don’t consider quality at all. Strange, isn’t it?
The concept of quality in healthcare isn’t a new one, but the way we define, measure, and use quality data has evolved rapidly in recent years. Let’s explore what quality healthcare looks like, and how we can (and should) be using this information to make better decisions about our health benefits and care.
How is healthcare quality defined?
Most consumers agree on what quality means when we’re talking about a physical item (good materials, desirable features, solid performance, long-lasting) or everyday services (responsive, timely, expert work that avoids unnecessary line items). But what exactly does “quality” mean in healthcare?
The Agency for Healthcare Research and Quality (AHRQ), one of the leading quality measurement organizations in the US, defines quality healthcare as “the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” Said more simply: Quality healthcare follows clinical best practices and helps patients and doctors achieve positive results.
However, this simple definition leaves a lot of unanswered questions. What is a “clinical best practice”? What do we mean by “positive results”? And what actions or outcomes should we track to tell whether a clinician or a facility provides “quality” care? This is where quality measurement comes in.
How is the quality of care measured?
Healthcare delivery is complicated, so evaluating healthcare quality isn’t simple, either. Independent groups that develop quality measurement frameworks look at hundreds of different factors to understand whether individual doctors and facilities provide good care. The National Committee for Quality Assurance (NCQA), one of the leading quality accreditation organizations, includes over 200 measures in its HEDIS quality framework. The Agency for Healthcare Research and Quality (AHRQ) tracks 60 quality measures across four different focus areas. And there are many other measurement frameworks out there that health plans and providers use to evaluate the quality of care.
While there are hundreds of distinct quality measures in use today, they all share a few common themes. Here at Amino, we incorporate quality data from multiple quality measure sets into our platform (and derive our own measures from medical claims) to guide people to smarter care choices. To keep things simple for our clients and users, we group quality measures into three high-level categories:
Safety measures gauge whether a doctor or facility follows established guidelines to avoid preventable harm to patients, and provides education and support to help patients stay safe throughout their treatment. Many of these measures focus on hospital care, but there are safety measures that apply to PCPs and specialists too.
Appropriateness measures evaluate how providers practice healthcare. They determine whether the care given to patients aligns with established scientific evidence, treats their issues in a timely fashion, and accommodates individual health needs and preferences. These measures also indicate whether a provider helps their patients stay on track with preventive screenings and visits, and avoids giving wasteful or unnecessary tests, imaging, and procedures.
Experience measures indicate how much in-the-field time a doctor has treating a particular condition or performing specific procedures. These measures look at how long someone has been practicing medicine, how frequently they’ve provided different services, and what types of patients they care for most often based on demographics.
What’s the impact of care quality on patients?
If measuring healthcare quality is so challenging, why do we bother doing it? Because high-quality care has a big impact on patients. When people are treated by top doctors and get care at great facilities, they benefit from:
- Better health outcomes such as faster recovery times, lower risk of complications and mortality, and improved long-term health. For example, a high-quality cardiologist is two times less likely to perform a repeat cardiac stent procedure than a low-quality surgeon, which spares patients from having to go through a second procedure and all the potential risks associated with it.
- Better healthcare experiences that avoid unnecessary treatments, roadblocks to care, and delays in treatment. For example, our data shows that a high-quality OB-GYN is three times less likely to perform a primary Cesarean section for a low-risk pregnancy than a low-quality doctor, which leads to shorter hospital stays and easier recoveries.
- Fewer long-term health and financial impacts. Quality providers help patients get healthy and stay healthy, and practice medicine efficiently to reduce overpriced or unnecessary bills. This has positive impacts on work absenteeism, financial stress, and overall quality of life.
How are healthcare quality and cost related?
When we’re purchasing a retail item or an everyday service, we have a clear idea of how cost and quality relate. We typically expect a higher-cost item or service to deliver better quality, or offer something unique or exclusive that other options don’t.
The relationship between healthcare cost and quality, however, isn’t as straightforward. In many cases, higher-quality doctors and facilities are actually less expensive than lower-quality ones. Additionally, what we value most from a provider changes depending on our health needs. For a routine service like an MRI, finding a lower-cost option is the highest priority. But for a heart surgery, choosing the most qualified, experienced doctor with the best outcomes matters more than simply picking the lowest price tag.
In short: healthcare cost and quality can’t be evaluated in isolation. Price transparency tools that surface healthcare cost estimates without pairing this information with quality can lead to misguided decision-making that increases costs without actually improving healthcare outcomes. Conversely, quality data that doesn’t incorporate cost misses an important signal about provider efficiency and appropriateness of care. This is why many self-insured employers adopt healthcare guidance solutions that surface both cost and quality information to help their plan members find and choose great providers.
Quality healthcare has many different aspects. Leading measurement frameworks look at hundreds of factors to evaluate whether individual doctors or facilities provide “good” care. When patients are treated by high-quality providers, they reap substantial benefits for their health outcomes, costs, and overall care experience. The more we can use quality information to inform healthcare choices, the more value we’ll get as individuals and employers who pay for health insurance.
Looking for a healthcare navigation solution to help your employees find high-quality providers? Amino Guidance makes it easy for them to choose the best care at the best cost.