Health Information Management

News: CMS, AHIP Standardize Quality Measures

CDI Strategies, February 25, 2016

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CMS and representatives of the private insurance industry have agreed to use a single set of healthcare quality measures, according to a statement published by CMS.

The group behind the effort, the Core Quality Measures Collaborative, led by America’s Health Insurance Plans (AHIP), CMS, and Chief Medical Officers, consists of purchasers, providers, and consumers. The collaborative represents 70% of all healthcare payers, including Aetna and UnitedHealth Group. The goal is to establish broadly agreed upon core measure sets that could be harmonized across both commercial and government payers, says CMS.

The core measures are divided into seven sets, including:

  • Accountable Care Organizations (ACOs), Patient Centered Medical Homes (PCMHs), and Primary Care
  • Cardiology
  • Gastroenterology
  • HIV and Hepatitis C
  • Medical Oncology
  • Obstetrics and Gynecology
  • Orthopedics

All measures selected were evidence-based, and most but not all, already had been endorsed by the National Quality Forum (NQF), which is in charge of endorsing quality measures and served as the technical advisor for the collaborative, according to an article in the VBPmonitor. Measures were selected based on attributes such as patient benefits, feasibility within existing skill sets and resources, ease of testing, face validity, and implementation effort. 

Every measure selected also relies on evidence-based data to validate patient benefit, which is another major driver for participation not only by providers, says VBPmonitor, but by consumers of the data, patients, and those who might leverage the publicly reported data to make purchase decisions. 

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