outcome measures for ACO

What Outcomes should we set for an ACO 

I keep getting asked this question. 
Here’s my stock answer.


I’d written a bunch of stuff on this before.


 This goes though how this is done in the states, especially the CMS data set.
The Solomon article references is especially interesting, and I often refer to it. There’s some sound advice in it.


I’d keep such a venture simple, using what data is readily available rather than relying on asking busy folk to collect new datasets. We’re already awash with data that we don’t use. However the obvious trade off in this is the issue of what’s already measured vs what’s important etc. 

Outcome wise 

Multiple outcome frameworks already available obviously – NHS, PHOF. ASCOF. Mostly these are very fit for the purpose expected of them.

There’s a creep towards ootcomes relevant to “old folk” and the like (don’t get me started on that one…..you’ve seen my previous blogs). The outcome set has got to focus on whole population and stratified pop groups, not just frail elderly and bed days etc

Cost wise 

for me I’d chase after cost / patient month – needs more sophisticated data than we currently have, and needs to be done in segmented pops 

It does boil down to knowing:-

  • What outcomes and other things you want to achieve. Being really this. You’ve got to think hard, there are no shortcuts.
  • what data is collected, readily (and sometimes less readily, but needs a bit of work) available
  • What raw data can be turned into indicators
  • Knowing – in detail, real detail, how the datasets are derived from raw data, and what can / can’t be concluded.

Of course, given that was always completely over focus on cost and under focus on outcomes, maybe there’s a valid case to ageee a position of

            “until yuove told us a compelling story about how you’re going to improve patient outcomes and at population level, we aren’t going to move on to discuss the cash”


What others have written


a) Kings Fund

Pick and mix – Slide set from 2012 is excellent- https://www.kingsfund.org.uk/sites/files/kf/field/field_document/Outcomes-choosing-and-using-indicators-the-king’s-fund-aug-20121.pdf

As is the overview – https://www.kingsfund.org.uk/topics/commissioning/how-measure-improving-outcomes-guide-commissioners

More recently there’s this from the Kings Fund in 2015

Measuring the performance of local health systems | The King’s Fund


b) This paper from CDC is ace.

Kottke et al – https://www.ncbi.nlm.nih.gov/pubmed/27390075

New Summary Measures of Population Health and Well-Being for Implementation by Health Plans and Accountable Care Organizations

The summary measures comprise 3 components: current health, sustainability of health, and well-being. 

  • The measure of current health is disability-adjusted life years (DALYs) calculated from health care claims and death records. 
  • The sustainability of health measure comprises member reporting of 6 behaviors associated with health plus a clinical preventive services index that indicates adherence to evidence-based preventive care guidelines. 
  • Life satisfaction represents the summary measure of subjective well-being.

I do (really) like it, but fear it’s a bit like trying to define the indicator of power (“one indicator to rule them all, One indicator to find them, One indicator to bring them all and in the darkness bind them”)

c) These IHI papers are also mega useful

Institute for Healthcare Improvement: Whole System Measures 2.0: A Compass for Health System Leaders

Earlier paper


Others have been at this also. There’s some amazing stuff on the Nuffield Trust website – mostly but not exclusively on the issue of smart use of HES data for indicator construction and monitoring.

Of course all the above is health and care system oriented. Not health and well being oriented. A health and well being outcome or indicator framework might look very different. Ours is below. We are considering revising this.














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