Life Science Compliance Update

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April 18, 2016

Quality Measure Core Set Implementation Plan

For the past three years, the Centers for Medicare and Medicaid Services (CMS) has worked to align quality measures across different public programs in an attempt to support consistent high quality care for patients and to reduce complexity and burden for clinicians in how they report on quality improvements. CMS has already 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 their quality measures once, which are then used for multiple programs.

CMS recently announced the release of seven sets of core clinical quality measures intended for use in multi-payer settings. These measures were selected to support multi-payer alignment on core measures primarily for physician quality measurement program, as measure requirements are often not aligned among payers, which often results in confusion and complexity for reporting providers.

The guiding principles used to develop the core measure sets are that they be meaningful to patients, consumers, and physicians, while reducing variability in measure selection, collection burden, and cost. The goal is to establish broadly agreed upon core measure sets that can be harmonized across commercial and government payers.

The seven core measure sets focus on 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; and Orthopedics.

The seven measures were selected as a part of a collaboration between CMS, America's Health Insurance Plans (AHIP), private payers, and other stakeholders, known as Core Quality Measures Collaborative, to establish "broadly agreed upon core measure sets that could be harmonized across both commercial and government payers." Current measures acted as a model for the new measure sets, and CMS plans to use the rulemaking process to introduce additional measures from the new sets into public reporting programs.

According to CMS Acting Administrator Andy Slavitt, "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. This agreement … will reduce unnecessary burden for physicians and accelerate the country's movement to better quality."

Implementation

Implementation will occur in several stages. When it comes to private payers, the measure sets will be phased in over time as contracts between providers and payers are renewed and renegotiated. The implementation of certain measures will depend on the provider's ability to collect and report data through their Electronic Health Record (EHR). 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 currently exist, and further infrastructure may be required for certain measures.

The Health Care Payment Learning and Action Network (HCPLAN), a public-private collaboration established by CMS, will integrate these quality measure into their efforts to align payment model components with public and private sector partners. In addition, CMS is working with federal partners (i.e., the Office of Personnel Management, Department of Defense, and Department of Veterans Affairs) and state Medicaid programs to further align quality 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 to determine the appropriate subset of core measures that should be implemented.

The Core Quality Measures Collaborative will use the upcoming year as a transitional period, as it begins to adopt and harmonize the measures. The Collaborative will continually monitor the use of these measures to modify them as needed, based on lessons learned. In addition to monitoring progress, the Collaborative will invite broader participation and add additional measures and measure sets.

Debra L. Ness, president of the National Partnership for Women & Families, believes that "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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