Health and Disability

Despite the current uncertainty surrounding the fate of the Affordable Care Act (ACA), health care leaders must not let debates over access detract from what needs to happen regardless of the legislation’s fate: Their organizations must improve the value of care they deliver. When the ACA was passed, in 2010, many observed that although the ACA expanded access to health care, it did less to address the equally critical issue of improving the delivery of that care. Regardless of whether the ACA is repealed, this challenge remains.

Our suggestion for a starting point to measure outcomes is simple, easy, and inexpensive: Ask the patient. For many years, health care providers have worked to collect so-called patient-reported outcomes measures, or PROMs, which are measures of function and health status reported by patients. The widespread and consistent use of PROMs, however, has proven to be elusive for a range of reasons, including the complexity of the measures tracked and the varying reliability of patient assessments on many measures.

“The Elements of Value,” an article in the September 2016 issue of Harvard Business Review, discusses the role that product or service quality plays in customer advocacy. The article states: “Across all the industries we studied, perceived quality affects customer advocacy more than any other element. Products and services must attain a certain minimum level, and no other elements can make up for a significant shortfall on this one.” What this suggests is that patient-reported satisfaction may be a reasonable proxy for quality. But what does it reliably tell us about clinical outcomes?

Another recent HBR article by authors from the Geisinger Health System, which offers a satisfaction guarantee to patients, acknowledges that “critics of programs that improve patient satisfaction will often imply that there is a false equivalence between efforts geared towards improving quality and those aimed at improving patient experience — that quality efforts are in some way superior.” The authors challenge this critique, noting, “[Recent] strong evidence [see this article and this one] suggests that improved patient satisfaction is in fact correlated with better health outcomes and quality: Increased satisfaction is associated with decreased length of hospital stay, lower readmission rates, reduced mortality, and fewer minor complications.”