Key Quality Measures for 2020, How to Select Measures Effectively

The Core Quality Measure Collaborative (CQMC), a partnership between America’s Health Insurance Plans, CMS, and the National Quality Forum (NQF) that establishes quality measures to promote patient-centered, value-based care, has released four new quality measure sets for 2020.

“The release of today’s updated core measure sets is the direct result of collective work across the spectrum of CQMC’s member organizations to create useful tools in paying for value, reducing the data collection burden for health care providers and improving the quality of care for the patients they serve,” said Danielle Lloyd, senior vice president of private market innovations and quality initiatives at AHIP and CQMC Steering Committee Chair.

The new measures seek to identify key quality performance indicators that health plans can use for their advanced payment models while also diminishing the burden on providers.

The new core quality measures cover gastroenterology, HIV and hepatitis C, obstetrics and gynecology, and pediatrics.

The original set of quality measures, which are still in effect, group together accountable care organizations, patient-centered medical homes, and primary care as one category. The other three are cardiology, medical oncology, and orthopedics.

CQMC also has two new core sets that it will release in the future, one on behavioral health and one on neurology.

“Data and accurate information are a critical lever for driving measurable health improvements together,” said Shantanu Agrawal, MD, president and chief executive officer of NQF.  “We have an opportunity to normalize high-value care through the use of aligned measure sets that comprehensively drive improvement in key quality areas essential to value-based programs.”

The CQMC measures can offer insight regarding on which performance areas payers should focus their quality performance data collection efforts.

For example, prior to the coronavirus pandemic, payers were recognizing how key pediatrics is to advancing value-based care.

“Children’s health is the most powerful lever we have to influence the health of the next generation, and, ultimately, to influence the economy of this country,” Larry Moss, MD, Nemours Children’s Health System’s president and chief executive officer, asserted at  Xtelligent Healthcare Media’s Fourth Annual Value-Based Care Summit in 2019.

Under the new core quality measures, payers are encouraged to look at quality performance on childhood immunizations, preventive care screenings for clinical depression, asthma medication ratios, and other metrics. Often, telehealth may be the best format to fulfill these measures, particularly as CMS has been rapidly expanding telehealth opportunities, CQMC noted.

Some of these measures could clearly use the increased attention. Earlier in 2020, a U.S. Preventive Services Task Force (USPSTF) report revealed that hepatitis C cases have quadrupled in the last ten years but just slightly over 17 percent of study participants had been screened for the disease.

In addition to offering guidance on what quality measures may be most effective, CQMC abides by certain principles when establishing these measures which can provide a foundational strategy for payers in determining quality measures.

The quality measures must align stakeholder priorities to meet healthcare improvement goals. They also must be unlikely to produce adverse effects and must be evidence-based. Finally, the measures should balance measurement burden and innovation.

The core measure sets as a whole should be patient-centered and conscious about social determinants of healths. The measures should be diverse but outcomes measures and measures that cover multiple areas of quality performance should take priority. Health plans should be innovative about how they gather performance measure data.

The measures should not overburden the provider. The information that they provide should be substantive for all stakeholders. Finally, amidst the efforts to identify quality measures that can be multi-purposed, the data should reveal quality performance about the patient’s immediate medical condition.

CQMC helps diminish provider burden not only by pushing for a more concise selection of quality measures, but also by integrating private and public payer efforts.

“CMS is prioritizing and aligning quality measurement across its programs to ensure high impact and parsimony,” explained Lee Fleisher, MD, chief medical officer at CMS. “The CQMC core sets are a great vehicle to align measures not only across federal programs but with private payers.”

“Today more than ever, we need to be supporting physician participation in value-based arrangements that provide a steady income, reward high-quality and efficient care, and reduce administrative burden to allow more time with patients,” Lloyd added.