Value-Based Care Metrics

Value-based care metrics

This is a sample checklist of metrics determined using evidence-based guidelines that you may choose to use as part of your value-based care payment model.You may not cover all of these metrics in your agreement or may need to add metrics, so consider modifying the list to meet your practice’s needs.

It is important to consider realistic measurement windows and outcomes targets that your practice can meet when negotiating these terms.Performance metric intervals should be extended beyond the clinical practice guideline interval to accommodate the lives and schedules of patients. This also reduces pressure on providers to over test patients to ensure that tests fall within the measurement window. For example, if a clinical practice guideline recommends an item be performed yearly, the performance metric interval could be set at 15 months. As a general rule we recommend that performance measurement intervals be set at 130 percent of the clinical practice guideline interval. Your practice should also negotiate the target number of patients to be evaluated.

Please note that practice guidelines frequently change. This is only an example and may not include the latest recommendations.

Blood pressure
Adult (age >20 years) screening: at every regular visit or at least once every two years* if blood pressure (BP) is 120/80 mm Hg
Hypertension management (evidence-based range): appropriate pharmacologic treatment is initiated for patients age ≥60 years
Diabetes management
Retinopathy screening
Nephropathy screening
Daily aspirin for disease management and ischemic vascular disease
HbA1Ctesting: done within the measurement year*; target should be <7.0% in nonpregnant adults
Immunizations
Tdap vaccine: administer Tdap once for patients age >19 years; boost with Td every 10 years*
Influenza vaccine: annually for patientsage >6 months
Shingles vaccine: for patients age >60 years (optional if >50 years)
Lipid management
Drug therapy for lowering LDL
Cholesterol screening for cardiovascular care
Preventive screening
PAP: for patientsage 21 to 65 years every 3 years* if no history of abnormal PAP test (or every 5 years* if age >30 years and most recent PAP negative and HPV-negative)
Mammogram: for patientsage 50 to 75 years every 1 to 2 years* (screening is optionalif age 40 to 50 years or >75 years)
Colonoscopy: for patients age 50 to 75 years every 10 years* (more frequent if history of colon polyp or family history of colon cancer)

*Consider increasing this clinical practice guideline interval when negotiating performance metrics

Source: AMA. Practice transformation series: prepare your practice for value-based payment. 2016.

References

American Heart Association. Heart-health screenings. Accessed January 18, 2016.
James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507-520. Accessed January 18, 2016.
American Diabetes Association. Standards of medical care in diabetes—2016 abridged for primary care providers. Diabetes Care. 2016;39(Suppl. 1):S1-S112. Accessed January 18, 2016.
National Diabetes Education Initiative. Diabetes management guidelines. Accessed January 18, 2016.
Stone NJ, Robinson JG, Lichtenstein AH, et al. Circulation. 2013;1259(25 Suppl 2):S1-S45. Accessed January 18, 2016.