Documenting Outcomes, Benefits, & Costs

When developing the business case, the measure developer should evaluate and report on all potential positive and negative impacts resulting from a measure, such as clinical or cost outcomes. See the Business Case Form & Instructions.

Clinical Outcome Examples

  • Preservation of healthy lifestyles for individuals receiving care
  • Lives saved
  • Complications prevented
  • Clinical practice improved
  • Enhanced experience for those receiving care

Cost Outcome Examples

  • Reduced payor expenditure per beneficiary
  • Lower facility-level payment associated with a condition-specific episode of care
  • Reduced loss of work/wages for patient due to illness or injury
  • Lower total out-of-pocket payment for health care services

Considerations for Costs, Benefits, & Savings

In making the business case, the measure developer should qualify and quantify the advantages and disadvantages of implementing the measure, including hard and soft benefits. For example, a measure intended to reduce long-term mortality through early detection and treatment may cause increased short-term costs and potential complications from screening tests.

ConsiderationsExamples
Patient Considerations
  • Health outcomes
  • Length of stay
  • Readmissions
  • Patient satisfaction
  • Adverse events
  • Medical errors
  • Trust in the health care system
Employee and Organizational Considerations
  • Workplace safety
  • Staff time
  • Staff turnover
  • Sick time
  • Training
  • Turnover hiring costs
  • Staff supervision costs
Liability Considerations
  • Worker’s compensation claims
  • Liability insurance premiums
  • Litigation and judgment costs
  • Fines
Material Considerations
  • Product purchase
  • Maintenance
  • Storage
  • Disposal

Quality Improvements

By documenting the potential improvement anticipated from implementing a specific measure, the measure developer can make a strong case for why the organization should invest resources in development (or continued use) of the specific measure in its quality initiatives. At a minimum, the business case for a measure should state explicitly, in economic and societal terms, the expected costs and benefits of the measure.

Examples of Direct Quality Improvement Benefits

  • Better care through reduction of harm and positive influence on patients’ perception of their care
  • Better health through reduction in mortality and morbidity and improvements in quality of life

Examples of Indirect Quality Improvement Benefits

  • More affordable care through cost savings
  • Increased availability of specialist appointments as the schedule is not unnecessarily overloaded
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