Measuring outcomes: Lessons from the world of public education

The quality and efficiency of American health care are increasingly measured using clinical and financial data with a goal of improving clinical practice. Proponents believe such efforts can improve outcomes, motivate clinicians, and inform the public about quality. Detractors point to problems with the accuracy of these measures and the risk of creating perverse incentives for both physicians and patients. Drawing on lessons from similar performance management policies in public education, we provide guidance about this trend for primary care physicians and health care policy makers. We argue that public school teacher evaluations that use value-added modeling foretell specific pitfalls for the use of similar models to evaluate physician effectiveness, and that unintended consequences of performance management in both education and health care can include the narrowing of purpose, deprofessionalization, and a loss of local/community control.