What They’re Watching: Dr. Gordon Moore, 3M

Dr. Gordon Moore is Senior Medical Director at 3M Health Information Systems. He joins us in this edition of “What They’re Watching” to discuss micro and macro measurements.

I’ve been thinking a lot recently about the difference between macro and micro measurements in healthcare, and why they’re both important and we have to think about them differently. Macro measurement being thinks like risk-adjusted total cost of care, hospitalization rate, emergency room utilization rate. Micro measurement being things like a person with diabetes and their hemoglobin A1c, or prevention needs for colorectal cancer screening.

They’re both important but they have very different places. So micro measurement for instance is essential at the point of care when I as a clinician am working with somebody and want to review their gaps in care, want to make sure that I am following evidence and using good tools that enable me to identity gaps and pursue those. Macro being the measures for system performance. How is our system of care working for the population to whom we’re responsible? Are we able to reduce unnecessary use over time?

The two don’t necessarily speak to each other so there’s a lot of conflation right now. This is one of the things that keeps me up at night the idea that we somehow interpret micro measures as speaking to system performance. The reason that keeps me up is that there’s some pretty good evidence that when you take complex behavior of professionals like doctors and say “Focus on a handful of metrics,” that they’ll focus on those things being goals and results driven, but that can sometimes unintentionally be at the detriment of other things that are not being measured. And so we’ll focus on, “You want me to pursue hemography, you want me to do hemoglobin A1c improvement, I can do that.” But that might come at the cost of something else.

We need system improvement. We also need good care for hemography and hemoglobin A1c, so we have to think about those two different measure sets and the different sorts of data we would use to speak to that and different methodologies and then figure out how we can combine those both and present them in a way that’s meaningful to clinicians and health systems so they can see the opportunities to improve outcomes.