Why are quality measures so important?

ACOs are reimbursed based on their ability to reduce cost of care and at the same time meet quality measures.  That is, they only get to keep their profit/cost savings when they provide quality care, which is measured very specifically.  What are quality measures?   These range from patient satisfaction (how long did they wait in the waiting room?) to markers of individual patient health like blood pressure and blood glucose.  Below are the working Medicare quality measures.  Private insurance companies utilizing ACO structures have similar lists.  

There is a logic to the system.  When ACO's meet quality measures, costs are kept under control.  For example, if an ACO puts effort into ensuring their patents' blood sugar and blood pressure are in control, they will avoid costly hospitalizations for heart attacks, strokes, and amputations. Costs will be lower not because less care is given to those who need it, but because less care is needed due to a focus on prevention.  Everyone wins.  

The quality measures are in place to avoid the problems with straight capitation.  What we saw with that system was less care provided, period.  The logic behind quality measures is that ACO's will be forced to provide the type of high quality preventive care that leads to reduction in unnecessary hospitalizations.  

As neuropsychologists we need to begin to think about how we can assist ACOs with the project of reducing unnecessary hospitalizations and meeting quality measures.  Any specialist who helps them do this will be a valued person to refer to.  When we do so, we will become cost decreasers within the system.