Performance Measurement of Disease Management Programs

Abstract

After the establishment of an industry trade association and accreditation, standardizing performance measurement is the third critical milestone in the maturation of the disease management (DM) industry. The publication of Standard Outcome Metrics and Evaluation Methodology for Disease Management Programs by American Healthways, a leading DM vendor, in 2003 is the first credible effort at achieving this milestone. This report is the product of collaboration between American Healthways and Johns Hopkins Outcomes Verification Program, along with a conference of almost 150 physicians and other healthcare professionals. It proposes 64 measures across five disease states, seven financial and utilization measures and survey standards for member and provider satisfaction.

This paper presents a framework for developing and evaluating performance measurement standards based on four components or aspects: purpose, perspective, process and products (‘four Ps’). Purpose refers to the reasons and uses for the measurement. Perspective refers to who will use the measures and what the unit of analysis is. Process is how the standards are developed and chosen and includes the use of explicit criteria for selecting measures and standards, representative participation by all constituencies, the use of subject matter experts as consultants, and transparency. Products are the measures and their descriptions and specifications.

With respect to the ‘four Ps’ framework, the American Healthways and Johns Hopkins paper includes a stated purpose, but is unclear with respect to who the intended users would be. Its perspective is primarily of physicians with lesser consideration given to public, DM purchaser and DM program manager stakeholders. The process by which the measures were selected and defined is not described, nor are the roles of the conference participants. No criteria for selecting measures are provided. The product is a reasonably comprehensive set of process and outcome indicators for the five disease states. No rationales for selecting these measures are provided, however, and the methodologies are not always well defined.

There are many models of performance measurement standards and measures available. The performance measurement standards established by the National Committee for Quality Assurance and the Joint Commission on Accreditation of Healthcare Organizations are used as reference programs. These programs have done better at fulfilling the attributes offered in the framework, recognizing that they have developed through well-funded efforts over many years.

The American Healthways and Johns Hopkins paper is a significant accomplishment and an important step in the establishment of measurement standards for DM. Further work needs to be done to achieve standards that will be useful and acceptable across the industry and among all constituents. A broader-based and broader-funded effort with more formalized or well-documented measure selection is needed, as well as testing, validation and dissemination of measures not commonly used in DM settings.