Cascade of Meaningful Measures 

The Cascade of Meaningful Measures is a tool to help prioritize existing health care quality measures, align or reduce measures where there are too many, and identify gaps where new measures may need to be developed. The tool starts by utilizing the eight health care priorities of the Meaningful Measures 2.0 Framework (Figure 1), which consists of eight health care priorities: Person-Centered Care, Safety, Chronic Conditions, Seamless Care Coordination, Equity, Affordability and Efficiency, Wellness and Prevention, and Behavioral Health. 

Figure 1. Meaningful Measures 2.0 Framework

Reading from left to right, the Cascade of Meaningful Measures describes, in increased detail of the components of the health care system that are being measured. It moves from the eight Meaningful Measures health care priorities to goals and objectives. Goals and objectives for each health care priority were identified through peer-reviewed and gray literature searches, as well as stakeholder input. We define these terms below.

• Priorities: These are the eight Meaningful Measures 2.0 health care priorities for quality measurement and improvement

• Goals: Key measurable building blocks of quality that support each priority
• Objectives: Measurable indicators used to assess goal performance and comprised of one or more measures

CMS programs leverage the Cascade to identify possibilities for measure alignment and to prioritize areas for additional measure development. As depicted by the right-to-left arrow at the bottom of Figure 2, the Cascade ultimately helps programs move from existing process and outcome measures to the development of more expansive outcome measures and composites at the Objective and Goal levels.

Figure 2. Cascade of Meaningful Measures Schematic

The CMS Measures Inventory Tool now contains information about how each measure and each program-specific version is mapped to the health care priorities and goals of the Cascade of Meaningful Measures 2.0 Framework. A future release will add information about the objectives associated with each measure and program-specific version. Some measures span multiple Meaningful Measures 2.0 priorities and may have a primary priority and goal as well as a secondary priority and goal. When using CMIT, be sure to filter for both the primary and secondary categorizations to get a complete picture of the measures associated with each health care priority of the Meaningful Measures 2.0 Framework.

Click below to understand the types of measures and goals included under each health care priority in the Cascade of Measures.

Person-Centered Care

Measures in this priority promote the principle that care should be delivered with consideration of the needs, values, and goals of the individual, caregiver, and their family. Goals under this priority are: Optimal Patient Experience Optimal Patient Engagement Optimal Functional Outcomes Optimal Home- and Community-Based Services

Safety

The safety health care priority includes assessment of preventable harms to patients as well as organizational and workforce characteristics that support patient safety, and safety for special populations, including mothers, children, individuals with intellectual or developmental disabilities, older adults, individuals receiving HCBS, and for populations disproportionately affected by poor health outcomes. Measures in this priority promote a safety culture within a health care organization draws a connection between patient safety to health care worker safety through management actions, norms, processes, and practices. Goals under this priority are:

• Reduced Preventable Harm
• Safety Culture
• Workforce and Caregiver
• Safety Safety for Special Populations

Chronic Conditions

Measures in this area promote evidence based care for the management of chronic conditions (including prevention and management of complications), improvement in disease specific outcomes, efforts to reduce preventable emergency department usage and admissions, efforts to reduce mortality. Goals under this priority are: Reduced Disease-Specific Mortality Reduced Preventable Admissions Optimal Functional Outcomes Evidence-Based Healthcare Outcomes Improved Disease-Specific Outcomes

Seamless Care Coordination

This health care priority includes measures and efforts that leverage technology, as well as other processes and activities, to ensure successful transitions of care and coordination. Goals under this priority are: Optimal Interoperability and Data Availability/Reconciliation Optimal Transitions of Care Care Coordination

Equity

Measures in this priority advance care quality for underserved and disadvantaged individuals and communities so that everyone has a fair and just opportunity to attain their optimal health.  Goals under this priority are:

• Equitable Care
• Equity Data Collection
• Identification of Social Risk Factors and Mitigation

Affordability and Efficiency

Measures in this priority promote improvements in the effectiveness and efficiency of care, thus improving health care affordability. Goals under this priority are: Reduced Readmissions Including Observation Appropriate Use of Healthcare Services Cost Price Transparency Rebalanced Long-Term Services and Supports

Wellness and Prevention

Measures in this priority promote individual, family, and community wellbeing through preventive care services, public health infrastructure, and consideration of community and national contexts. Goals under this priority are: Immunizations Chronic Conditions Screening Nutrition and Physical Activity Dental Care Contraceptive Care Adherence to Preventive Pediatric Guidelines Adherence to Age-Specific Prevention Guidelines Wellbeing Public Health

Behavioral Health

Measures in this priority promote screening and treatment for mental health and substance use disorders and support integration of physical and behavioral health.  Goals under this priority are: Suicide Prevention Opioid Use and Disorders Prevention and Treatment Mental Health Disorders Screening and Treatment Integrated Physical and Behavioral Healthcare

Downloads

Cascade of Meaningful Measures Framework – March 2023