Hospitals and health systems are increasingly collecting and monitoring health care quality and outcome data by patient demographics, which many health care leaders agree improves quality of care. But existing metrics often fail to include patient perspectives, and only limited research has explored which metrics matter for patient outcomes or whether accountability mechanisms exist to ensure data collection contributes to meaningful improvements in quality of care.

To fill these research gaps, my colleagues at the Urban Institute and I designed a study collecting health care leaders’ perspectives on health system performance measurement, approaches to identifying and addressing differences in care, and opportunities for improving transparency and accountability. The leaders we talked with for this study and in an associated convening include health researchers, health system administrators, clinicians, patients, consumer advocates, policymakers, regulators, insurers, and plan purchasers.

Through this work, we found that leaders across the health ecosystem believe data collection and accountability efforts should improve health system outcomes for all, and particularly for patients from groups who have historically faced barriers to accessing high-quality care. Leaders believed these efforts should be framed as closing performance gaps, which our study defined as measurable differences in health system access, quality, experience, and outcome between patient demographic groups.

Below, we outline several strategies health care leaders can employ to reduce or eliminate health care performance gaps.

1. Create comprehensive approaches to performance measurement

Health systems should adopt a comprehensive, balanced approach to performance measurement that includes clinical, process, and patient-reported measures, as well as social determinants of health. This approach will allow health leaders to design more-effective interventions and assess and share progress toward closing performance gaps. To create these comprehensive approaches, health systems should engage their stakeholders—including state regulators, clinicians, consumers, and the communities they serve—to identify measurement tools.

2. Promote stakeholder engagement and buy-in

Actively engaging a wide range of stakeholders—including patients, community organizations, clinicians, and policymakers—when developing and implementing new performance metrics can foster greater acceptance and ownership of the approach. In particular, health systems should engage patients and communities early and substantively in metric development and accountability processes.  

3. Standardize and validate measurements across health systems

Even as health systems develop approaches that work best for their specific contexts, leaders should develop national, standardized, and validated performance measures that can be consistently applied across health systems to drive wider acceptance and comparability.    

4. Align incentives and benchmarks

Health care payers and regulators should work to align incentives and benchmarks to ensure comparability and accountability across health systems. Study participants saw promise in value-based payment models and other financial incentives that reward progress on performance metrics, while properly accounting for and supporting efforts to mitigate social risk factors.   

5. Promote transparency

Study participants also wrestled with the concept of health system accountability. Participants referred to the obligation of health systems, as well as entities that finance and regulate those systems, to take responsibility for performance gaps, commit to eliminating them, and be transparent about actions to address them and the outcomes of these actions. Doing so builds trust, improves performance, and promotes ethical conduct.

To accomplish these goals, participants believed performance data should be publicized with context to avoid misinterpretation. Further, they suggested that health system stakeholders should continuously evaluate and refine metrics to ensure they are actionable, relevant, resistant to manipulation, and don’t unjustly penalize providers who serve high-need populations.  

6. Increase funding and resource support

Ultimately, participants felt that the power and resources needed to scale measurement efforts are primarily at the federal level. Still, state and local governments and philanthropic organizations have significant opportunities to invest in and scale measurement to eliminate performance gaps. Participants believed these entities should provide dedicated funding and resources to providers, especially those serving high-need populations, to build the necessary capacity and infrastructure to collect, analyze, and act on performance metrics.

7. Build capacity and offer technical assistance

Providing training, education, and ongoing technical support to health systems and providers can help organizations build the necessary capabilities to effectively collect, analyze, and use performance data.

8. Align regulatory and policy guidance

Shifting federal and state-level guidance and requirements around health system performance reporting has created many barriers to performance measurement. Establishing clear, consistent, and long-term policy frameworks for performance metrics could provide necessary stability and alignment. Such frameworks, several participants noted, should be informed by community perspectives and feedback collected through performance reporting.