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CMS and AHIP Announce New Core Quality Measures


On February 16, 2016, the Centers for Medicare & Medicaid Services (CMS) and America's Health Insurance Plans (AHIP), as part of a collaborative effort with physician groups, consumers and employers, announced the release of seven uniform clinical quality measures for physician quality programs. The new core measures are intended to improve patient care and streamline the quality improvement reporting requirements across both commercial and government payers. 

The Core Quality Measures Collaborative (the "Collaborative"), which is comprised of healthcare industry participants including CMS, AHIP and its member plans, national physician organizations, employers, and consumers, worked together to reach agreement on the core measures. According to the CMS fact sheet, "[t]he goal of this effort is to establish broadly agreed upon core measure sets that could be harmonized across both commercial and government payers, which will add focus to quality improvement efforts, reduce the reporting burden of quality measures, and offer consumers actionable information for decision-making." 

The new core measures provide a general framework, without significant details, and cover performance reporting in the following areas:

  • Accountable care organizations, patient-centered medical homes, and primary care
  • Cardiology
  • Gastroenterology
  • Providers of HIV and hepatitis C care
  • Medical oncology
  • Orthopedics
  • Obstetrics and gynecology

Several of the core measure sets require clinical data to be extracted from Electronic Health Records (EHR), are self-reported by providers, or rely on registries. In its fact sheet, CMS noted that "a robust infrastructure to collect data on all of the measures in the core set does not exist currently ... Providers and payers will need to work together to create a reporting infrastructure for such measures."

The announcement of the new core measure sets coincides with the growing collaboration between health plans and providers to drive value-based care and better health outcomes as encouraged by the Affordable Care Act. Specifically, some private health plans have entered into accountable care organization (ACO) agreements with providers using a "shared risk" payment model. These arrangements offer providers financial incentives for cost savings and quality performance, but assess financial penalties against them if they exceed spending targets or fail to provide quality care. Other private health plans have entered into "shared savings" contracts with providers which make providers bonus-eligible for containing costs and providing quality care, but do not put them at financial risk. Accordingly, the new core measure sets complement and build upon the collaborative efforts already underway as payment and delivery system reform continues to expand.

The timeline for implementation of the new core measure sets varies. CMS is currently using measures from each of the core sets and will solicit input for implementation of the new core measures in future notice and comment rulemakings. Private payers and providers which choose to adopt the voluntary framework will implement the core measures through contractual negotiations.

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