Outcomes Before Interventions, and Other Best Practices for Ensuring Your Measurement Methodology Facilitates Effective Solution Design and Delivery

This four-part series will thoughtfully and thoroughly analyze the current state of outcomes measurement within value-based care. Along the way, we’ll bring in various perspectives for stakeholders across the industry. In this post, we are summarizing an interview between PopHealthCare executives Aaron Wells, PhD and Vice President for Outcomes and Reporting and Janet Calhoun, Chief Product Officer.

In part one of our series, we presented the case for the Coarsened Exact Matching (CEM) Methodology as a preferred technique for reporting financial outcomes in value-based care delivery. For this post, we introduce a conversation between Janet Calhoun and Aaron Wells, focusing on the powerful impact a well-designed measurement approach, anchored by CEM, can have on the solutions you use to improve health and reduce costs. You can listen to that conversation below or download it here.


Outcomes Before Interventions

When designing value-based solutions, you need a firm understanding of the outcomes you’re seeking before you build the interventions. Put simply, you should design with the end in mind. In doing so, you can create greater alignment between the solution and expected results, as well as a logical chain of plausibility for the outcomes you report.

Keeping It Simple

The more complicated the outcome methodology, the more people will question its validity because they are not able to connect the dots. From a solutions perspective, this is important because a simplified approach to methodology diminishes time and energy spent debating ROI. This leaves more space to evaluate how well the solution is performing and to innovate for enhanced results.

Collaboration Is Key

In a value-based environment, it is necessary to have a collaborative, open relationship between the payer and service providers. As an example, partners need full access to available data for the populations they are serving. When this data is shared, the CEM methodology can specifically attribute value creation to individual programs, which allows for the health plan to see the incremental impact of complimentary programs. It also allows for the evaluation of each solution to ensure it is working optimally to support members. In a recent analysis by PopHealthCare, we were able to document and verify a value multiplier when using our services as an extra layer of care for medically complex members. Past measurement approaches have treated each solution as an island. This has limited our understanding of impact across interventions and left payers with ambiguity of where savings originated. After all, you can only save each dollar once.

Building in Flexibility

Historically, many solutions have delivered interventions the same way you would spread peanut butter for a sandwich. Everyone got everything. Interventions were applied across the entire population in roughly equal doses. The right methodology allows for more flexibility, and the ability to effectively respond to the fluidity of healthcare. Whether it’s an environmental shift, such as the COVID-19 pandemic, or changes at the individual level, such as a job loss or a new health diagnosis, your solutions have to be nimble to drive impact. Your chosen measurement tool will dictate your flexibility.

Taking a Holistic View

The measurement methodology you use for value creation will determine whether you have a myopic, or holistic, view of each member. Leveraging all data and incorporating a comprehensive set of inputs that expand into areas such as medication compliance, transportation needs, home life and neighborhood facilitates a holistic understanding of each individual and their needs across physical, emotional, social and financial health.  In other words, you must incorporate all the various facets of wellbeing that impact each member in a value-based setting. 

At PopHealthCare, we have been encouraged by the rapid adoption of the CEM methodology within our client base. We are seeing firsthand how outcomes-based product design, leveraging CEM, can benefit both payer and patient. We hope you will continue to follow along with this blog series, as we introduce additional stakeholder voices who are committed to answering the hard questions to more clearly define the value in value-based care. For the full interview between Wells and Calhoun, please click here. If you missed our previous post on the merits of CEM, you can find it here.