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.
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