Core Measures

Introduction

The Core Quality Measures Collaborative (CQMC) is a diverse coalition of health care leaders representing over 75 consumer groups, medical associations, health insurance providers, purchasers and other quality stakeholders, all working together to develop and recommend core sets of measures by clinical area to assess and improve the quality of health care in America.  The coalition was established in 2015 by America’s Health Insurance Providers (AHIP) and the Centers for Medicare & Medicaid Services (CMS) and is convened by Battelle’s Partnership for Quality Measurement (PQM) in its role as the Consensus-Based Entity (CBE).  Please go to  https://p4qm.org/CQMC for more information.

Overview

There is a great demand today for accurate, useful information on health care quality that can inform the decisions of consumers, employers, clinicians, and policymakers. This is increasingly important as the health care system moves towards value-based reimbursement models.

It is difficult to have actionable and useful information because clinicians must currently report multiple quality measures to different entities.  Measure requirements are often not aligned among payers, which has resulted in confusion and complexity for reporting health care providers.

To address this problem, CMS, commercial plans, Medicare and Medicaid managed care plans, purchasers, clinicians and other care provider organizations, and consumers worked together through the CQMC to identify core sets of quality measures that payers have committed to using for reporting as soon as feasible.  The guiding principles used by the CQMC in developing the core measure sets are that they be meaningful to patients, consumers, and clinicians, while reducing variability in measure selection, collection burden, and cost. The goal is to establish broadly agreed upon core measure sets that could be harmonized across both commercial and government payers.

Core Quality Measures

Using a multi-stakeholder, consensus-driven process, the CQMC, led by AHIP and its member plans, Chief Medical Officers, leaders from CMS, as well as national physician organizations, employers, and consumers, recommend core performance measure sets that promote alignment and harmonization of measure use and collection across payers in both the public and private sectors. 

Designed to be meaningful to patients, consumers, and clinicians, the alignment of these core measure sets will aid in:

• promotion of measurement that is evidence-based and generates valuable information for quality improvement,
• consumer decision-making,
• value-based payment and purchasing,
• reduction in the variability in measure selection, and
• decreased provider’s collection burden and cost.

CMS believes that by reducing burden on providers and focusing quality improvement on key areas across payers, quality of care can be improved for patients more effectively and efficiently.

To develop the core measure sets, the CQMC is split into workgroups and reviews measures currently in use by CMS and health plans as well as measures endorsed by the CBE for the individual measure sets. Based on this review and discussion, the workgroups identified a consensus core set for the selected clinical areas. This consensus core set was further discussed by all CQMC members before being finalized. Additionally, the CQMC developed a framework of aims and principles that informed the selection of core measure sets.

The core measures can be found at: https://p4qm.org/CQMC.

CMS is already using measures from each of the core sets. Using the notice and public comment rulemaking process, CMS also intends to implement new core measures across applicable Medicare and Medicaid quality programs as appropriate, while eliminating redundant measures that are not part of the core set.  Commercial health plans are rolling out the core measures as part of their contract cycle.

Ongoing monitoring by the CQMC of the use of these measures will enable modifications of measure sets, as needed, and based on lessons learned, including minimizing unintended consequences and selection of new measures as better measures become available.

Get Involved!

CMS looks forward to public input and comments on the measures included in these core measure sets when going through the public notice and rulemaking for implementation. 

Visit the PQM Website for more information about how to get involved in the CQMC.