The Need for Patient-Centered Key Performance Indicators

Key Performance Indicators (KPIs) in healthcare refer to specific measurable performance metrics assessing the efficiency, effectiveness, and quality of care provided by organizations to understand and optimize hospital-level processes and strategic goals. 

Within the context of clinical care and research, our KPIs typically center around clinically meaningful outcomes such as mortality rates and survival statistics. These metrics are essential for assessing the efficacy of treatments and interventions for individual patients and provide a population-level overview.

However, when considering what drives healthcare innovation, particularly in digital health, the picture becomes more complex; essentially, there are more stakeholders with varying functions in the space to appeal to. 

The modified answer then becomes: Innovation in healthcare is not solely about improving clinical outcomes, it also becomes about enhancing utility for end-users and appeasing strategic decision-makers, incorporating both clinicians and administrators respectively. 

This means that a product may not get translated solely for clinical benefit but has a valid path forward improving administrative inefficiencies, care coordination/navigation, or even volume/efficiency rates, driving cost savings and benefits in non-clinical ways.

This complexity is evident in the rapid advancement of digital health technologies, especially those leveraging artificial intelligence. Many of the KPIs used to evaluate these innovations are surrogate outcomes or incentives that emphasize efficiency and patient throughput. 

This focus calls to the foundational fee-for-service nature of the healthcare system, where volume often takes precedence over value. The introduction of value-based and performance-based KPIs marks a significant shift. 

However, many of these KPIs still prioritize clinical efficiency. For example, pay-for-performance reimbursement models often focus on post-discharge outcomes, such as hospital readmission rates for specific conditions compared to regional competitors. These models may also involve bundled services or a series of steps required in the treatment of a condition. 

Since volume is still at the foundation of these reimbursement models, larger healthcare systems are able to capitalize on the opportunity and rapidly expand while rural and community-based hospitals have struggled to stay open. 

Over half of all rural hospitals in the United States have fewer than 25 beds and also account for the most hospital closures. This can be attributed to unique financial challenges including the lack of patient volume and specialty services resulting in unreliable reimbursement modeling. 

Despite these advancements, the underlying ideology remains centered on service provision and fee-based incentives directed at clinicians, effectively placing the locus of responsibility primarily on healthcare providers. 

Yet, it's well understood that effective healthcare requires active participation from both clinicians and patients. While value-based care represents a step in the right direction, it prompts the question: How can we realistically integrate patient-centered KPIs?

Measuring factors such as patients' understanding of their clinical course, their efficiency in scheduling appointments, or overall satisfaction with care could serve as initial approaches. 

However, until there's a systemic economic incentive for hospital systems to adopt technologies that address patient satisfaction, widespread integration at the systemic level is unlikely. Tangible value or reimbursement models focused on actual patient outcomes and perspectives are necessary to drive this change.

One example of aligning patient incentives with health outcomes is UnitedHealthcare's Rewards program. This initiative offers members the opportunity to earn up to $1,000 annually by engaging in healthy behaviors, such as walking 5,000 steps daily, tracking sleep, completing health surveys, and attending annual checkups. 

These rewards are designed to motivate members to take charge of their health and stay engaged in activities that improve their quality of life, while reducing payer healthcare costs. Therefore, we must rethink how we define innovation in healthcare. Should we prioritize clinical care outcomes or continue to prioritize operational KPIs? 

As researchers, we must reconsider how we report data and collaborate with industry partners to reshape the narrative of healthcare. By developing and implementing patient-centered KPIs, we can ensure that innovation in digital health truly translates into improved patient outcomes and experiences.