Payer Perspectives on the Role and Impact of QOPI Certification

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Although the healthcare industry values what it tends to measure, what is measured is not necessarily what should have the most value, according to John Fox, MD, senior medical director and associate vice president of medical affairs at Priority Health.

During his session, he discussed measuring value in cancer care and the current systems out there, such as the Quality Oncology Practice Initiative (QOPI) from the American Society of Clinical Oncology. The key takeaways were that payers and providers need to measure what is important to patients; not everything that has value can be measured by providers alone; and there needs to be an agreement on what is important to measure.

“Just like there’s a proliferation of pathways, there’s also a proliferation of measurement programs, and a proliferation of incentive programs,” he said.

The challenge with measurements sets, such as QOPI, and the reason why payers don’t pay for them, is because it is difficult to measure their impact. There are almost 200 QOPI measures and many of them are process-related.

“We don’t have patient-centered metrics, we don’t have patient safety metrics, or effectiveness metrics,” Dr Fox said.

More valuable measures would include a clear demonstration of whether or not the patient understood they were receiving palliative care and what that meant, and documenting a discussion with patients about their advanced directives, he said.