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Measure Conceptualization

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.

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 Example

An example of a positive cost outcome resulting from a measure may include reduced expenditures for payors, measured entities, or individuals, which may occur indirectly, e.g., as when increased spending on preventive care reduces spending on subsequent healthcare needs.

Considerations for Costs, Benefits, & Savings

In making the business case, the measure developer should qualify and quantify the pros and cons 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.

Patient

Considerations

  • Health outcomes
  • Length of stay
  • Readmissions
  • Patient satisfaction
  • Adverse events
  • Medical errors
  • Trust in the healthcare 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 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
    • More affordable care through cost savings
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    Last Updated: Nov 2022