IF the Merit-based Incentive Payment System (MIPS) contemplated by the Medicare Access and CHIP Reauthorization Act of 2015 (HR 2) and discussed by Averall et al is implemented correctly, perhaps there will be relief from the "tyranny of measurement." As Averill et al point out, for far too long, the focus has been on process measures that are only tangentially related to outcomes and that are generally unsuitable for affecting a decision on value. Typically, in the world of process measures, the emphasis is on collection of data rather than acting on outcomes. The sheer number of process measures limits effectiveness in improving performance of the health system.

When Texas transitioned to an outcomes-based model in managed care that considered performance on 3 potentially preventable events, admissions, readmissions, and emergency department visits, there were near immediate system responses to the measures. Health plans began to measure the source of potentially preventable admissions and emergency department visits and take constructive action in the management of the provider network to reduce the occurrence. Similarly, with readmissions, innovative contract mechanisms emerged to encourage reductions in readmissions. Such a response would not have been possible with process measures. As Averill et al point out, states have demonstrated a wide range of success in using outcome measures tied to potentially preventable events for Medicaid as well as commercial populations. The results have been impressive.

If the health care system is to evolve into a sustainable model, then the process pointed to by Averill et al is the pathway to success. According to an Institute of Medicine study, up to 30% of health care services delivered in the United States are either not necessary or could be avoided. The unnecessary services are directly related to admissions to the hospital that should not occur, complications as a result of a hospital stay, being readmitted to a hospital when that readmission is avoidable, visiting the emergency department for a condition that could be treated in a primary care setting, or use of unnecessary diagnostic procedures. Until and unless the financial incentives are put into place to better align outcomes and efficiency with compensation, it is not likely these conditions will change.