Core Quality Measures Collaborative Release
Background
Over the past three years, the Centers for Medicare and Medicaid Services (CMS) has worked to align quality measures across public programs in order to support consistent high quality care for patients and reduce complexity and burden for clinicians in how they report on quality improvements. For example, CMS has aligned quality measures across acute care hospital programs, such as the Inpatient Quality Reporting Program, Hospital Value Based Purchasing, and the Hospital-Acquired Condition Reduction Program. Hospitals report quality measures once, which are then used for these multiple programs.
Now, CMS and Americas Health Insurance Plans (AHIP), as part of a broad collaborative of health care system participants, is releasing seven sets of clinical quality measures (https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/Core-Measures.html) that support multi-payer alignment, for the first time, on core measures for physician quality programs. The core measure sets are intended to promote alignment of quality measures for the practitioner community (e.g., physician) or group practice level accountability and are in the following areas:
- Accountable Care Organizations (ACOs), Patient Centered Medical Homes (PCMH), and Primary Care
- Cardiology
- Gastroenterology
- HIV and Hepatitis C
- Medical Oncology
- Obstetrics and Gynecology
- Orthopedics
CMS is already using measures from the each of the core sets. Using the notice and public comment rule-making process, CMS also intends to implement new core measures across applicable Medicare quality programs as appropriate, while eliminating redundant measures that are not part of the core set.
CMS worked with AHIP and commercial payers, as well as other stakeholders, over the past 18 months as part of the Core Quality Measures Collaborative to gain consensus around the measures for inclusion in these sets. The goal of this effort is to establish broadly agreed upon core measure sets that could be harmonized across both commercial and government payers, which will add focus to quality improvement efforts, reduce the reporting burden of quality measures, and offer consumers actionable information for decision-making. CMS believes that this process and its implementation should be an open and transparent one that allows for input from all stakeholders. Using our notice and public comment rule-making process, we intend to implement these measures across applicable Medicare quality programs as appropriate.
Approach and Criteria to Achieving a Core Measure Set
AHIP convened leaders from health plans, CMS, the National Quality Forum (NQF), physician specialty societies, employers, and consumers with the goal of collaborating on the establishment of a core set of measures in selected clinical areas. The Core Quality Measures Collaborative was split into workgroups for each of the identified core measure sets. Each workgroup reviewed measures currently in use by CMS and health plans, as well as measures that are endorsed by NQF. Based on this review and discussion, a consensus core set was identified by the workgroups for the selected clinical areas. This consensus core set was further discussed by all Collaborative members before being finalized. Additionally, the Collaborative developed a framework of aims and principles that informed the selection of core measure sets.
Implementation of Core Measure Sets
CMS has been working to align measures across public programs. It intends to include, for solicitation of broad input, the agreed upon measure sets for public comment in future proposed rules when and as appropriate.
Private payers will use a phased-in approach to implementation. Contracts between physicians and private payers are individually negotiated and therefore come up for renewal at different times depending on the duration of the contract. Private payers will therefore, implement these core sets of measures as contracts come up for renewal or if existing contracts allow modification of the performance measure set.
Several of the measures included in the core set require clinical data extracted from electronic health records (EHRs), are self-reported by providers, or rely on registries. While some plans and providers may be able to collect certain clinical data, a robust infrastructure to collect data on all the measures in the core set does not exist currently. The implementation of some measures in the core set will depend on availability of such clinical data either from EHRs or registries. Providers and payers will need to work together to create a reporting infrastructure for such measures.
Given ongoing local and regional efforts at quality improvement, provider performance on some of the measures in the core sets may be topped out in particular areas of the country or within a particular provider's patient population. Private payer -provider collaboration will help determine the appropriate subset of core measures that should be implemented.
Finally, there are specific markets in the U.S. that have made great progress towards measurement, and in such markets payers will continue to work in collaboration with providers to implement new and innovative measures. Such an approach can help advance quality measurement and improvement.
Other Department Work To Support Quality Measures
Across the Department, we will continue our work to align measures across the public and private sectors, building off the work of the Core Quality Measures Collaborative.
Learning and Action Network: CMS established the Health Care Payment Learning and Action Network (HCPLAN), in March 2015, to provide a forum for public-private partnerships to help the U.S. health care payment system meet or exceed recently established Medicare goals for value-based payments and alternative payment models (APMs). The HCPLAN will integrate these quality measures into their efforts to align payment model components with public and private sector partners. The work of the Core Quality Measures Collaborative is an important advance that will contribute to the alignment of quality measures across payment models. HCPLAN workgroups will use the measure sets as the expected starting point for quality measures in these areas. Where there is need for testing of new quality measures in selected markets, the HCPLAN can help to identify multipayer approaches so that the tests are most effective for patients, clinicians, and payers. CMS will continue to encourage robust collaboration between the Collaborative and the HCPLAN as both efforts are synergistic to achieve the goals of delivery system reform.
Medicare Access and CHIP Reauthorization Act of 2015: CMS will use new tools from the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 to support quality improvement and alignment. For example, MACRA provided additional funding provided to create and implement new measures where gaps exist and align measures with the private sector. As required under MACRA, CMS has developed a draft Quality Measure Development plan which is currently out for public comment: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs.html.
Other Partners: CMS continues to work with other federal partners including the Office of Personnel Management, Department of Defense, and Department of Veterans Affairs, as well as state Medicaid plans to align quality measures where appropriate.
Today marks a major step forward for alignment of quality measures between public and private payers and provides a framework upon which future efforts can be based.
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