How Patient-Reported Outcomes Improve Employee Care

Most surgeries look successful on paper. The surgeon follows protocol, there are no immediate complications and the claim is processed without issue. Bytraditional outcomes metrics, the case is closed.

But for some, the real story begins well after they leave the operating room. A patient may undergo knee replacement surgery with no complications, only to struggle with persistent pain months after the expected recovery period. Another may technically recover from a procedure, but still find it difficult to climb stairs or enjoy everyday activities.

These outcomes rarely appear in claims data, yet they define whether care truly improves a patient’s life.

Benefits leaders often hear vendors claim they deliver “high-quality care,” but those claims can be difficult to qualify on the human level. Traditional metrics, such as complication rates and readmissions, reveal only part of the picture. They capture a small part of what happened clinically, but not many of the things that matter most to patients.

“There’s no single claims-based solution that can give you red, yellow, green, or one number score to paint the whole picture of quality,” says Jason Tibbels, MD, FAAFP, Chief Medical Officer at Lantern. “When someone says quality is in the top 10%, you should say, ‘Of what? As measured how and by whom?’”

An important element of how Lantern answers this question is by measuring outcomes directly from the people who matter most: patients themselves.

What Are Patient-Reported Outcomes?

Patient-Reported Outcomes (PROs) are health outcomes reported directly by patients, without interpretation by clinicians or coders. They reflect how patients describe their own pain levels, physical functioning and quality of life after treatment.

To gather that information consistently, Lantern uses Patient-Reported Outcome Measures (PROMs), which are simple surveys that ask patients how they feel after treatment, including their pain levels, mobility and ability to do everyday activities.

Developed by the Hospital for Special Surgery (HSS) and well validated through rigorous research, these tools help show whether surgery actually improved a patient’s daily life, not just whether the procedure was technically successful.

For example:

• HOOS JR measures outcomes for hip replacement patients
• KOOS JR measures outcomes for knee replacement patients

PROMs are widely recognized across healthcare. Lantern now integrates PRO collection across all procedures and cancer care.

Why PROs Reveal What Traditional Metrics Miss

Complication rates tell you when something seriously went wrong. PROs tell you how patients really feel.

A surgery can produce zero “complications” and still fail to restore meaningful quality of life. Under conventional measurement systems, the case appears successful. PRO data may tell a different story.

Claims data also has limitations. Billers code claims for reimbursement, not for measuring functional recovery. Claims can show that a surgery happened, but they cannot reveal whether the patient regained mobility, reduced pain or returned to normal life.

“The vast majority of surgical patients avoid major complications, yet their functional and wellbeing outcomes often go unmeasured,” Tibbels explains.

That missing data matters because patients judge success differently than health systems do. For many, success means being able to walk without pain, play with grandchildren, dance at a wedding or simply move through daily life comfortably again. PROs make those outcomes visible.

A More Complete View of Physician Quality

Measuring physician quality requires more than reviewing complication rates alone.

True provider performance is multifaceted. To paint a complete picture, Lantern integrates patient-reported outcomes for all doctors in its Network of Excellence:

• Procedure volume and experience
• Appropriateness of care metrics
• Complication and readmission outcomes
• Malpractice and board sanction history

This broader approach helps Lantern identify quality signals that traditional metrics miss.

It matters in a healthcare system where financial incentives don’t always align with patient outcomes. Fee-for-service models often reward higher procedure volume rather than better recovery experiences, which can contribute to unnecessary procedures or overuse of costly interventions.PRO data helps counterbalance those distortions by focusing attention on what ultimately matters: whether patients actually get better.

How PROs Benefit Members

For members, PROs validate recovery in their own words.

Lantern goes beyond clinical benchmarks by asking patients directly how they feel at different intervals following treatment. When recovery falls behind expectations, Lantern’s clinical team steps in before problems lead to complications, avoidable readmissions or prolonged suffering.

It creates a more responsive care experience, one built around real patient needs rather than assumptions based solely on claims data.

How PROs Benefit Plan Sponsors

For employers and plan sponsors, PROs provide stronger evidence of Centers of Excellence quality.

Cost savings and utilization data remain important, but they don’t fully demonstrate whether care improves health outcomes. PROs add a deeper layer of accountability by showing measurable quality-of-life improvements alongside financial performance.

They also support:

• National Committee for Quality Assurance (NCQA) accreditation alignment
• Centers for Medicare & Medicaid Services quality incentive benchmarks
• Stronger plan performance reporting
• More transparent evaluation of specialty care partners

With PRO data, plan sponsors gain evidence that their healthcare investments are delivering meaningful results, not simply reducing claims spend.

Strengthening Lantern’s Network Quality

PROs also improve Lantern’s ability to maintain a high-performing specialist network.

Claims data can miss underperforming physicians entirely. A surgeon may have no recorded complications, yet still generate consistently poor patient recovery outcomes. Only PRO data can uncover that gap.

Lantern benchmarks every surgeon in its network against published clinical standards and compares patient-reported recovery outcomes across providers. That data feeds directly into Lantern’s continuous network improvement process, helping to identify which physicians consistently deliver better real-world results.

“It’s estimated that somewhere between 5 and 20% of physicians account for between 70 and 80% of adverse outcomes,” Tibbels says.

By surfacing those patterns earlier, Lantern can refine its network based not just on procedural success, but on actual patient recovery.

Measuring What Matters Most

Healthcare quality improves when providers measure outcomes that reflect real patient experiences.

A successful surgery not only avoids complications, but restores mobility, reduces pain and helps people return to their lives. By integrating patient-reported outcomes into every layer of our care model, Lantern captures what traditional systems overlook.