CMS Seeks To Make Quality Measures More ‘Universal’ In Rollout Of New Program

Top Medicare and Medicaid officials want to create a “universal foundation” of quality measures aligned across all programs in a bid to ease reporting burdens and confusion.

Officials with the Centers for Medicare & Medicaid Services called for aligning quality measures across more than 20 agency programs in a letter in The New England Journal of Medicine Thursday. CMS’ Universal Foundation aims to focus provider attention on the quality measures which affect the largest segments of a patient population and advance health equity.

“Our intention is that the Universal Foundation will eventually include selected measures for assessing quality along a person’s care journey—from infancy to adulthood—and for important care events, such as pregnancy and end-of-life care,” according to the NEJM letter.

The letter lays out the initial preliminary measures as part of the foundation, which will eventually be used across all CMS programs to the extent they are applicable.

Some of the measures for adults focus on prevention such as screenings for breast and colon cancer as well as immunizations. Others focus on chronic conditions like controlling high blood pressure or behavioral health such as screenings for depression and treating substance use disorder.

For health equity, the foundation will include screenings for social risk factors and drivers of health. Equity has become a major priority for the Biden administration and CMS has sought to instill equity measures in both provider and payer programs for Medicare.

The foundation will include other specific measures for pediatric patients, such as measures for wellness and immunization visits. It also includes measures for person-centered care and behavioral health.

“Additional measures will be necessary for assessing care provided to specific populations or in certain settings, such as hospital-based care, maternity care, diabetes care and long-term and community services,” the letter said. “CMS will identify add-on measures that could be implemented consistently across programs.”

Director of Medicare Meena Seshamani and Center for Medicare and Medicaid Innovation Director Liz Fowler were among the officials who signed the letter.

The initial foundation measures are meant to address diseases or conditions that have high morbidity and mortality in the U.S., such as diabetes and high blood pressure.

CMS didn’t give an exact timeline on when this alignment will finish. The agency said it intends to align such measures while also getting feedback from stakeholders and the general public.

It will also work with outside groups to talk about the broader alignment of quality measures outside of CMS. This can include participation with groups such as the Health Care Payment Learning and Action Network. CMS hinted that the measures may change depending on the program though.

For example, CMMI will still “test new quality measures in models when such measures are appropriate given a particular model’s quality aims while leveraging the Universal Foundation where possible,” the officials wrote.

Any changes to Medicaid measures must also be done in concert with states.


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