The Opportunity
In 2015, healthcare spending in the United States reached
$3.2 trillion or approximately $9,990 per person.1 This represented a 5.8 percent increase over
2014 spending levels, and expenditures related to private health insurance,
hospital care, physician services, and clinical services were the primary
contributors.2 Despite this high level of spending, the U.S.
continues to rank below other developed countries for health outcomes including
lower life expectancy and greater prevalence of chronic diseases.3 Healthcare quality is also an issue with the
U.S. falling behind other developed countries in the quality domains of
effective care, safe care, coordinated care, and patient-centered care.4 The factors contributing to these concerning
trends are as complex as the healthcare system itself and include physician
practice patterns, regional market influences, and access to care. Improving
efficiency has the potential to simultaneously reduce the rate of cost growth
and improve the quality of care provided.
As reducing costs continues
to be a focus of healthcare reform, it is important to understand the current
use of resources in the healthcare system as it relates to quality—especially
how resource use relates to health outcomes. Recent legislation—including the
Improving Medicare Post-Acute Care Transformation Act (IMPACT) of 2014, and the
Medicare Access & CHIP Reauthorization Act of 2015 (MACRA)—requires the use
of resource use measures to support payment reform efforts. Resource use measures
will also be included on the physician compare website, and will ultimately be
included in the Merit-Based Incentive Payment System (MIPS) for physicians.
Identifying and providing incentives for providers to deliver efficient care
(i.e., high quality, lower cost) require quality measures as well as cost and
resource use measures. Such measures position the healthcare system to evaluate
the efficiency of care and stimulate changes in practice to improve efficiency.
NQF Related Work
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For more information, please contact efficiency@qualityforum.org.
1 Martin AB, Hartman M, Washington B, et al. National
health spending: faster growth in 2015 as coverage expands and utilization
increases. Health Aff (Millwood). 2017;36(1):166-176.
2 Martin AB, Hartman M, Washington B, et al. National
health spending: faster growth in 2015 as coverage expands and utilization
increases. Health Aff (Millwood). 2017;36(1):166-176.
3 Squires D, Anderson C. U.S. Health Care from a
Global Perspective: Spending, Use of Services, Prices, and Health in 13
Countries. Issues in International Health Policy. New York: The
Commonwealth Fund; 2015. Available at http://www.commonwealthfund.org/~/media/files/publications/issue-brief/2015/oct/1819_squires_us_hlt_care_global_perspective_oecd_intl_brief_v3.pdf.
Last accessed March 2017.
4 Davis
K, Stremikis K, Squires D, et al. Mirror, Mirror on the Wall, How the
Performance of the U.S. Health Care System Compares Internationally. New
York: The Commonwealth Fund; 2014. Available at
http://www.commonwealthfund.org/~/media/files/publications/fund-report/2014/jun/1755_davis_mirror_mirror_2014.pdf.
Last accessed March 2017.