Discussants stressed the existence of a significant and growing interest in efficiency measures. At this time, existing efficiency measures reflect measures of relative resource utilization and have not taken into account differences in quality by resource use. Existing efficiency measures have been applied primarily by private sector health plans looking for opportunities for cost savings to reduce the growth in health care trend. Information derived from application of these tools typically has been provided to physicians, integrated health systems, and hospitals as part of internal improvement efforts; the tools are only in their early stages of being validated for use in public reporting and pay for performance.
Discussants noted that both the NQF and the AQA have assembled workgroups to identify and endorse measures of efficiency. The AQA has also proposed a starter set of cost-of-care measures pertaining to seven conditions (diabetes, AMI, CHF and CAD, asthma, depression, and low back pain), but measures have not yet been developed and would need to be linked to quality-of-care measures to assess efficiency (rather than cost alone). The AQA/HQA Steering Committee has convened an Efficiency/Episodes of Care Work Group to develop a comprehensive approach to efficiency measurement, which includes an examination of the overall system, medical group, practice site and individual physicians, and that takes into account episodes of care as well as primary responsibilities for the care provided (AQA, 2007).