Measures That Matter

PRIME Registry is a part of the Measures that Matter initiative, collaborating with the ABFM Foundation, The Center for Professionalism and Value in Health Care, the Larry A Green Center and others. PRIME Registry provides a platform for testing, developing and evaluating measures in the clinical environment.

We are pleased to announce that, as a part of this initiative, a new Patient Reported Outcome (PRO) measure is being added to the PRIME Quality Dashboard.

INTRODUCING PRIME 133:

A Person-centered Primary Care Measure

What is PRIME 133?

PRIME 133 is a patient-reported measure of exemplary primary care that has been developed by the Larry A. Green Center, based on extensive development work with patients, clinicians and health care payers. The measure is the winner in the Patient-Reported Outcomes category of the National Quality Forum (NQF) Next-Generation Innovator Abstract Award.

The Person-Centered Primary Care Measure (PCPCM) focuses attention and support on the integrating, personalizing, and prioritizing functions that patients and clinicians say are important. A measure based on these principles may reduce both the de-personalization experienced by patients, and the measurement burden, burnout and crisis of meaning experienced by clinicians.

The PCPCM uses a survey to ask patients to assess 11 distinct yet highly interrelated items regarding their assessment of the care they receive. The 11 items were developed with input from hundreds of patients and physicians, and are associated with better personal and population health, equity, quality and costs.

The work that participating practices do will help support efforts to gain NQF and CMS endorsement for use of the PCPCM in payment, certification and regulatory programs.

Interested in implementing this measure?

Practices who are already enrolled in PRIME are invited to implement the PCPCM in your practice. Implementing this measure is an opportunity to implement a means of measuring what is more meaningful to you and your patients.

More About Measures That Matter

Situation

Well-designed and supported primary care is an important source of improved outcomes in high performing health systems even though it may produce lower disease-based quality measures. This has been called the Paradox of Primary Care. The United Kingdom went down a similar disease measurement path with the Quality Outcome Framework 15 years ago and have since largely abandoned it due to burnout and lack of population health improvement. This does not mean that measures or payment schemes that use them are bad, but it does suggest a need for better alignment between measures that matter and providing sufficient resources to address them.

Background

Well-designed and supported primary care is an important source of improved outcomes in high performing health systems even though it may produce lower disease-based quality measures. This has been called the Paradox of Primary Care. The United Kingdom went down a similar disease measurement path with the Quality Outcome Framework 15 years ago and have since largely abandoned it due to burnout and lack of population health improvement. This does not mean that measures or payment schemes that use them are bad, but it does suggest a need for better alignment between measures that matter and providing sufficient resources to address them.

Resources

Assessment

The Center for Professionalism & Value in Health Care aims to assess and promote the most meaningful measures in several health care sectors starting with primary care. The Center aims to produce comprehensiveness measures (highest quartile has 15% lower total costs and 25% lower hospitalization rates), continuity measures (highest quartile have 25% lower total costs and 25% lower hospitalization rates), as well as total cost of care and low-value care measures. Based on this research, CMS has approved the latter for use in our QCDR as a MIPS measure. The American Board of Family Medicine Foundation funded research with the Larry A. Green Center that produced the Patient Centered Primary Care Measure, a PRO which won the National Quality Forum’s (NQF) 2019 Patient-Reported Outcomes Abstract Award and has been fast-tracked for NQF and CMS endorsement. The research underpinning this PRO demonstrated close association with continuity and comprehensiveness, and strong endorsement by both patients and providers. The Center will continue to develop and study these measures using the PRIME Registry as a testbed, and using claims data to assess them across most family physicians, training programs, and health systems. JAMA and Annals of Family Medicine published our studies done in collaboration with the Robert Graham Center showing that physicians’ cost-related behaviors are highly correlated with where they trained and last for 15+ years after training. These measures not only have utility for clinicians, but for identifying training programs and health systems that are not supporting high-functioning primary care.

The Center’s aims in developing Measures That Matter for primary care practices is to better align assessment and payment policies with what patients and clinicians know to be valuable, to reduce burden, and to reduce burnout.

Learn more about the Center for Professionalism and Value in Health Care