The Centers for Medicare and Medicaid Services (CMS), with Americas Health Insurance Plans (AHIP), last month announced seven sets of core measures that represent an attempt to achieve alignment across practice settings and multiple payers. This comes after 18 months of collaboration with other stakeholders to develop the measure sets. There are separate measure sets for Primary Care (and ACO/PCMH), Cardiology, Medical Oncology, Gastroenterology, HIV/hepatitis C, Obstetrics and Gynecology, and Orthopedics. The measures can be seen at https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/Core-Measures.html.
Meanwhile, for the last 18 months, the Quality Council of the Connecticut State Healthcare Innovation Model has been engaged in a similar process. The state has a grant to support payment reform for the Medicaid program and the development of core measures is key to establishing a value-based payment initiative. The council consists of physicians, healthcare advocates, and insurance company representatives; this group developed a preliminary set of core measures, focusing on things relevant to the Medicaid population including oft-ignored issues like behavioral health. With the announcement of the CMS-AHIP measure set, the state Quality Council will be looking to align the set they have developed as much as possible.
Both of these endeavors rely heavily on existing measures. This is one of the major criticisms of the CMS-AHIP set. The current state of quality measurement doesn’t seem to be capturing the most important aspects of care. McGlynn and colleagues suggested 3 guiding principles for measurement: integration with care delivery; acknowledgement of clinical challenges such as multi-comorbidity and uncertainty; and reflection of patient preferences, goals of treatment and heterogeneity of care related to this (1).
ACP has commented on the broader CMS draft proposal that preceded the announcement of the measure set [CMS Quality Measure Development Plan: Supporting the Transition to the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs)], as required by MACRA (the Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act of 2015). The letter to CMS is a thoughtful, thorough document (albeit a significant read at 42 pages!) and was the work of the Medical Practice and Quality Committee (MQPC), chaired by former CT Chapter Governor and current Board of Regents member Dr. Robert McLean. The letter asks CMS to use the MACRA as an opportunity to “build a learning health and healthcare system” which reflects learning from prior programs and emphasizes “the need to constantly monitor the evolving measurement system to identify and mitigate any potential unintended consequences.” Like McGlynn, ACP recommends a patient-centered approach that recognizes the patient-physician relationship. The College also “strongly recommends that CMS collaborate with specialty societies, frontline clinicians, and EHR vendors in the development, testing, and implementation of measures with a focus on decreasing clinician burden and integrating the measurement of and reporting on performance with quality improvement and care delivery.” I invite you to review the entire document.
- McGlynn EA, Schneider EC, Kerr EA. Reimagining quality measurement. N Engl J Med. 2014 Dec 4;371(23):2150-3.