CMS announces alignment, simplification of quality measures

The Centers for Medicare & Medicaid Services has partnered with America’s Health Insurance Plans (AHIP), physician groups, and other stakeholders to release seven sets of clinical quality measures that for the first time ever support multi-payer alignment. This will hopefully make “physicians’ lives easier,” especially for those who currently report several quality measures to different entities. “In the U.S. Health care system, where we are moving to measure and pay for quality, patients and care providers deserve a uniform approach to measure quality,” CMS Acting Administrator Andy Slavitt said in a press release. “This agreement today will reduce unnecessary burden for physicians and accelerate the country's movement to better quality.”

CMS, commercial plans, the National Quality Forum, Medicare and Medicaid managed care plans, purchasers, physician and care provider organizations – such as the American Academy of Family Physicians (AAFP) –, and consumer and patient groups collaborated to establish core sets of quality measures that payers have committed to using for reporting as soon as possible. All parties agreed that the core measure sets should be meaningful to patients, consumers, and physicians, as well as reduce variability in measure selection, collection burden, and cost. The goal is to decide on core measure sets that could be reconciled across both commercial and government payers. The core measures are in the following sets:

·         Accountable Care Organizations (ACOs), Patient Centered Medical Homes (PCMHs), and Primary Care.

·         Cardiology.

·         Gastroenterology.

·         HIV and Hepatitis C.

·         Medical Oncology.

·         Obstetrics and Gynecology.

·         Orthopedics.

“The AAFP’s involvement in the Collaborative is aimed at improving the quality of care while making family physicians’ lives easier by simplifying the information they are being asked to provide to payers,” Executive Vice President and Chief Executive Officer of the American Academy of Family Physicians Douglas E. Henley, MD said. “We are acutely aware of the huge amount of administrative complexity and burden that impacts the daily work of our members and diverts time and resources away from direct patient care. A major part of this is the burden of multiple performance measures in quality improvement programs with no standardization or harmonization across payers. This agreement on a set of core measures for primary care and the PCMH represents a big step toward the goal of administrative simplification for family physicians and improved quality of care.”

The implementation of the measures will take place in several stages aimed at “accelerating the shift to value-based payment.” Said stages are:

·         Measures from each of the sets are already in use by the CMS, and more will be implemented across applicable Medicare quality programs.

·         The Health Care Payment Learning and Action Network (HCPLAN) will integrate these quality measures into their efforts to align payment model components with public and private sector partners.

·         CMS is using new tools from the (Medicare Access and CHIP Reauthorization Act of 2015) MACRA to support quality improvement and alignment.

·         CMS is working with federal partners and state Medicaid plans to align quality measures where appropriate.

·         Core sets of measures will be implemented by commercial health plans as and when contracts come up for renewal or if existing contracts allow modification of the performance measure set. 

·         The Core Quality Measures Collaborative sees the upcoming year as a transitional period, as it begins adoption and harmonization of the measures.

“Health Care Service Corporation has long supported efforts such as the Core Quality Measure Collaborative that improve care quality in ways that are sustainable, accessible and equitable for our members and all consumers,” Senior Vice President and Chief Medical Officer, Health Care Service Corporation Dr. Stephen Ondra said. “Today’s announcement by the Core Quality Measure Collaborative is an important step in getting payers, providers, purchasers and consumers on the same page when they measure and compare health care quality. The efforts announced today will make health quality data more easily understood, less burdensome to collect and more relevant to the needs of all stakeholders. This work will ultimately help accelerate the shift toward payment models that are based on the value of care, rather than the volume.”

The Core Quality Measure Collaborative will continue working to track progress and identify further measures and measure sets. “Members of the Collaborative have taken a leadership role in identifying measures that will drive quality improvement and outcomes for patients,” Executive Vice President, America’s Health Insurance Plans Carmella Bocchino said. “This is a first step of an ongoing process to ensure both public programs and the private sector align measures and reporting especially as we advance alternative payment models.” Additionally, the Collaborative will invite wider participation, in particular from patient groups.

“Our health care system urgently needs measurement that drives improvements in quality, supports informed consumer decision-making and ensures we're paying for and incentivizing high-value care. What we released today is a start at achieving consensus on the best measures, but we need to continue pushing for even better ones,” president of the National Partnership for Women & Families Debra L. Ness said. “We need measurement that works for clinicians and helps them improve care, while also providing information that is meaningful and actionable for patients and families. Alignment across payers is key to making sure measurement doesn't waste resources or create unnecessary burden. Ultimately, it plays a foundational role in achieving better health and better health care at lower costs.”

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