Performance Measurement for People with Multimorbidity and Complex Health Needs.

This paper reviews approaches to performance measurement in health systems with particular attention to people with multimorbidity and complex health needs. Performance measurement should be informative and used by multiple stakeholders in order to align performance improvement efforts. System performance measures must allow for macro-system and meso-organization and provider-level reporting, and they should be relevant and important to stakeholders at each level, as well as to patients and all potential care recipients. Measures that assess health outcomes and individuals' experiences with providers, including care planning and coordination of care across providers, are essential to assess value for people with multimorbidity and complex health needs. I suggest that performance measurement for this population should be motivated by the Complexity Framework and organized by the Triple Aim. Based on the care needs and appropriate goals for the health system for this population, applicable measures and suggestions for implementing and using performance measurement systems are identified. Particularly in the case of people with multimorbidity and complex health needs, performance measures must move beyond measures specific to individual encounters to track care for people over time and space. Measures must be rooted in individuals' own needs and goals for care. New systems are required to enable collection and reporting of these measures.