Measuring Healthcare Resources Using Episodes of Care

The past several years have brought intensive scrutiny to all aspects of our healthcare system’s performance. While other industries have widely deployed continuous improvement cycles and adopted waste-reducing lean production methods, the U. S. healthcare sector lags far behind. The growing cost of healthcare in the U.S. in the face of increasingly documented lackluster quality and daily harmful and preventable errors have other industries asking, “Where is the healthcare sector’s commitment to continuous quality improvement?” In addition, given the impact of resource waste on the affordability of and access to healthcare, monitoring the use and appropriateness of health care services is essential. Private and governmental payers of healthcare are demanding that health plans and healthcare providers address variation in quality and in the use of care resources in systematic ways. This means measuring what is important, identifying significant, actionable variation, and motivating improvement. Motivation includes providers’ professionalism, (a component of which is the desire to improve when credible, actionable information is available), differential pay for differential performance, and increased transparency of measurement results.