Centers for Medicare and Medicaid Services and America’s Health Insurance Plans: Core Quality Measure Sets

The Centers for Medicare and Medicaid Services (CMS) and America’s Health Insurance Plans (AHIP), as part of a broad collaborative of health care system participants, has released seven sets of clinical quality measures that support multi-payer alignment on core measures for physician quality programs. The core measure sets are intended to promote alignment of quality measures for the physician or group practice level accountability. The Core Quality Measures Collaborative has worked for the past 18 months to gain consensus around the measures for inclusion in these sets. The 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 decisionmaking. Core measure sets have been proposed for the following clinical practice areas:

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

CMS is already using measures from the each of the core sets. Using the notice and public comment rulemaking process, CMS intends to implement these core measure sets across applicable Medicare quality programs as appropriate, while eliminating redundant measures that are not part of the core set.  CMS also will continue to work with other federal partners including the Office of Personnel Management, Department of Defense, and Department of Veterans Affairs, as well as state Medicaid plans to align quality measures where appropriate.

Private payers will use a phased-in approach to implementation. Contracts between physicians and private payers are individually negotiated and therefore come up for renewal at different times depending on the duration of the contract. Private payers will therefore, implement these core sets of measures as contracts come up for renewal or if existing contracts allow modification of the performance measure set.

Here is the core measure set for ACOs, PCMH, and Primary Care:

Link to Original Source

This entry was posted in Health Care Reform, Health Care Reform: Accountable Care Organizations, Health Care Reform: Medical Homes, Health Care Reform: Payment Reform, Health Care Reform: Quality Improvement. Bookmark the permalink.

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