The Healthcare X PRIZE will be introducing an new health value measurement framework that will help focus on health care outcomes at a community level.
The Healthcare X PRIZE (HXP) is being designed to create a next generation health system that increases efficiency, reduces costs, and improves health value. In order to drive this transformation, there needs to be a new way to measure, monitor, and improve the health care outcomes across the different interventions in local health delivery systems. There are currently a wide variety of measures and metrics used to evaluate health care, but these measures have not been utilized in a way that drives the delivery system to optimize for health care value at a both population and individual levels.
As part of the breakthrough aspirations of the HXP, we intend to create new measures and metrics that focus on comparing different systems of health care delivery and financing and how they impact Health Care Value (HCV). Measuring the value produced by a health care system remains a difficult challenge which to date has prevented the meaningful comparison between different systems of care. We believe emphasizing health care value is the appropriate point of focus to leverage market competition in allocating resources efficiently and effectively.
Furthermore, focusing on HCV [outcomes /cost] provides a useful framework to direct attention to removing disparities by maximizing improvements at a population health level.
We believe the creation of a Community Health Index (CHI), which would combine broadly accepted and actionable population health measures (each with varying weights based on relative impact) would achieve this objective. It is currently unclear how many measures are required to give us the degree of confidence that we are accurately measuring impact, and we anticipate this will be a vigorous point of discussion among the HXP measurement subcommittee members. We also want to incorporate outcome measures that focus on either desirable health states (independent living status) or elimination of undesirable health events (hospitalization). In addition, where possible, the given metrics should be already available or relatively easy to obtain (to keep audit and tracking costs to a minimum).
Finally, it is our belief that while the CHI is the appropriate measure to assess health system improvements, the actual solutions created by competing teams should improve individual health status. Therefore, the HXP endeavors to create a third measure, called the Individual Vitality Score (IVS), that will measure the degree of health activation, proactive health improvement, and/or health literacy adjusted for age, sex, morbidity, and genetic risk. Given our current systems orientation toward disease care, we believe that reorienting the system toward
improving individual “vitality” would yield dramatic changes in reimbursement methods, prevention focus, and behavorial changes. The IVS will serve as a catalyst to transform our current current perspective of heath (“absence of disease”) to the invigorating and progressive concept of vitality. We believe that creating the IVS can revolutionize the way individuals, providers, and health systems think about managing a “health portfolio” (think health streaming), including the creation of individual health action plans that optimize health assets over time.
Developing these three metrics - HCV, CHI, and IVS - will require careful thought, analytical integrity, and skillful compromise. We believe that the creation of the IVS will encourage teams to develop meaningful innovation in promoting vitality. Measuring HCV and creating a CHI will require detailed analysis, particularly given the role each will play in judging the HXP competition. Given that the CHI is a component of the overall HCV measure, it is logical to begin our measurement conversations around the creation and validation of a new CHI.
We have begun to evaluate traditional measures of community health, including a) functional health pass rate (e.g., fitness test, % ambulatory, % living independently), b) ER visits, c) hospitalizations/ 30 day re-hospitalizations, d) Major morbidity/ disability, e) sick days taken, f) perceived health score, and g) patient experience and will be validating these ideas in an upcoming meeting with our Measurement Subcommittee in New York City on June 9-10.
We are actively seeking input and guidance from our HXP measurement subcommittee and others in the development of these three measure. We look forward to your feedback.
* Much of the CHI concept was based on excellent work by the Dartmouth Health Policy and Clinical Research Team.