Zeroing In on CMS “Meaningful Measures” Targets

Meaningful Measures 2.0 goals are designed to facilitate the ongoing move toward value-based care, which targets issues including person-centered care, safety, chronic conditions, seamless care coordination, equity, affordability and efficiency, wellness and prevention, and behavioral health. 

By Medecision

In every functional area, from clinical to operations to financial and beyond, measurements are the lifeblood of healthcare. How has the patient’s condition progressed since this morning? What is our current readmission rate? Are we meeting our safety goals? To what degree are we providing a positive patient―and clinician―experience? What is the bottom line?

In its quest for alternative payment models (APMs) that successfully incentivize high-quality and cost-efficient care, the Centers for Medicare & Medicaid Services (CMS) has been sharpening its focus on “meaningful” measures. CMS announced its Meaningful Measures 1.0 in 2017 with this vision: “Use impactful quality measures to improve health outcomes and deliver value by empowering patients to make informed care decisions while reducing burden to clinicians.”

Last year, CMS unveiled Meaningful Measures 2.0 as part of its Quality Measurement Action Plan, which aims to assess only “those core issues that are the most critical to providing high-quality care and improving individual outcomes.”

The overarching goals of the plan are:

• Use meaningful measures to streamline and align quality measurement.
• Leverage measures to drive improvement through public reporting and payment programs.
• Improve quality measures efficiency by a transition to digital measures and use of advanced data analytics.
• Empower consumers to make the best healthcare choices through patient-directed quality measures and public transparency.
• Leverage quality measures to promote equity and close gaps in care.

The updated 2.0 goals are designed to facilitate the ongoing move toward value-based care, which targets issues including person-centered care, safety, chronic conditions, seamless care coordination, equity, affordability and efficiency, wellness and prevention, and behavioral health. To succeed under the plan, an organization must demonstrate measurable progress in the relevant areas.

 Fewer Measures, Greater Impact

The Quality Measurement Action Plan puts consumer and caregiver voices front and center in the mix. But it also is intended to reduce the number of measures and their burden on clinicians.

Meaningful Measures 2.0 sets forth these goals:

• Utilize only quality measures of highest value and impact focused on key quality domains.
• Align measures across value-based programs and across partners, including CMS and federal and private entities.
• Prioritize outcome and patient-reported measures.
• Transform measures to fully digital by 2025 and incorporate all-payer data.
• Develop and implement measures that reflect social and economic determinants.

Stakeholder engagement and communications are an essential component of the Quality Measurement Action Plan’s continuing development. CMS collaborated with 30 specialty societies on the first iteration of MIPS Value Pathways (MVPs), which it defines as “a subset of measures and activities, established through rulemaking, that can be used to meet MIPS reporting requirements beginning in the 2023 performance year.”

While seeking to “align and connect measures and activities across the quality, cost, and improvement activities performance categories of MIPS for different specialties or conditions,” the MVP framework also promotes interoperability and population health measures.

Implementation of the MVP framework, part of the Merit-based Incentive Payment System (MIPS), “honors our commitment to keeping the patient at the center of our work,” CMS says. “In addition to achieving better health outcomes and lowering costs for patients, we anticipate that MVPs will result in comparable performance data that helps patients make more informed healthcare decisions.”

CMS seeks Meaningful Measures input and collaboration at MeaningfulMeasures@chs.hhs.gov. All potential MVP candidates must meet multiple criteria relating to meaningfulness to clinicians, value to patients and caregivers, reporting of services provided by multispecialty groups, reducing barriers to participation in APMs, and support for the transition to digital quality measures.

MVP candidates also should include measures and activities from the quality, cost and improvement activities performance categories; be clinically appropriate; and incorporate the patient voice, among other requirements.

The Further Evolution of APMs

For all the time and effort that healthcare invests in measurement, and linking it to appropriate reimbursement, most attempts to make it truly “meaningful” remain works in progress. The fragmented nature of healthcare makes it expensive and difficult to manage―simultaneously increasing both the importance and challenge of meaningful measurement.

“The success of APMs and patient engagement in care more generally is inextricably linked to the quality of the measures that are used in these APMs, and the burden versus benefit of collecting these measures,” Mark B. McClellan, MD, wrote in an August 2018 blog post for Health Affairs. “As CMS seeks to further evolve payment models, it is important for policy makers to consider what kinds of measures we would want to invent that can then be tied to a set of alternative payments.”

Four years later, as APMs continue their evolution in pursuit of the best possible outcomes and experiences at the lowest possible cost, Dr. McClellan’s words remain true. As an industry, we must collaborate and create partnerships that address our clinical, cost, capacity and consumer challenges. We must embrace solutions such as consumer-centric digital care management; high-tech, high-touch consumer engagement; data-driven care coordination; and smarter utilization management.

And we must continue our quest to develop objective and reliable ways to measure what is truly meaningful.