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New Summary Measures of Population Health and Well-Being for Implementation by Health Plans and Accountable Care Organizations

Thomas E. Kottke, MD, MSPH; Jason M. Gallagher, MBA; Sachin Rauri, MS; Juliana O. Tillema, MPA; Nicolaas P. Pronk, PhD, FACSM; Susan M. Knudson, MA

Abstract Health plans and accountable care organizations measure many indicators of patient health, with standard metrics that track factors such as patient experience and cost. They lack, however, a summary measure of the third leg of the Triple Aim, population health. In response, HealthPartners has developed summary measures that align with the recommendations of the For the Public’s Health series of reports from the Institute of Medicine. (The series comprises the following 3 reports: For the Public’s Health: Investing in a Healthier Future, For the Public’s Health: Revitalizing Law and Policy to Meet New Challenges, and For the Public’s Health: The Role of Measurement in Action and Accountability.) The summary measures comprise 3 components: current health, sustainability of health, and well-being. The measure of current health is disability-adjusted life years (DALYs) calculated from health care claims and death records. The sustainability of health measure comprises member reporting of 6 behaviors associated with health plus a clinical preventive services index that indicates adherence to evidence-based preventive care guidelines. Life satisfaction represents the summary measure of subjective well-being.

HealthPartners will use the summary measures to identify and address conditions and factors that have the greatest impact on the health and well-being of its patients, members, and community. The method could easily be implemented by other institutions and organizations in the United States, helping to address a persistent need in population health measurement for improvement.

Introduction In 2008 Berwick, Nolan, and Whittington described pursuit of the Triple Aim as a strategy to improve the US health care system (1), and in 2011 the US Department of Health and Human Services adopted the National Quality Strategy as a driver for better, more affordable care for individuals and the community (2). Also in 2011, the Institute of Medicine (IOM), in a report on the role of measurement in action and accountability, stated that, “Because a summary measure of population health . . . would serve as a marker of the progress of the nation and its communities in improving health, it is important that it be implemented in data collection and public communication efforts at the federal, state, and local levels” (3). If individual health plans were to collect and report a uniform set of summary measures of health and well-being, they would make a significant contribution to implementing the recommendations made in the 2011 report For the Public’s Health: The Role of Measurement in Action and Accountability. When aggregated across health plans, the measures would be applicable regionally and nationally, because nearly 90% of Americans are now registered with a health plan (4). In pursuit of efforts to measure progress toward mission achievement, HealthPartners has aligned its efforts with the challenge of the 2011 IOM report on measurement and developed summary measures of health and well-being that can be implemented by any health plan or accountable care organization much in the way that any plan can measure cost of care using HealthPartners’ total cost of care metric (5).

About HealthPartners Founded in 1957, HealthPartners is the largest consumer-governed, nonprofit health care organization in the nation. It has a mission of improving health and well-being in partnership with its members, patients, and community. HealthPartners provides a full range of health services including insurance, care delivery, and health and well-being programs. The HealthPartners care system includes a multispecialty group practice of more than 1,700 physicians, 7 hospitals, 52 primary care clinics, 22 urgent care locations, 22 dental clinics, and many specialty practices in Minnesota and western Wisconsin. HealthPartners employs more than 22,500 people, all working together to pursue the HealthPartners mission.

HealthPartners Summary Measures Framework It is impossible to create a single measure that comprises both current health and sustainability of health, and health is not the same construct as well-being (6). Therefore, HealthPartners summary measures framework comprises 3 components: a measure of current health, a measure of likelihood of sustainability of health, and a measure of well-being.