Today, Centers for Medicare and Medicaid Services (CMS) is announcing the release of a Pediatric measure set as part of the Core Quality Measures Collaborative (CQMC). This set of nine measures is intended for use at the provider level for individual or groups of clinicians and is intended to add focus to quality improvement efforts, reduce the burden of reporting of quality measures, and offer consumers actionable information for decision-making.
This release marks the next step forward for alignment of quality measures between public and private payers. Seven of the nine measures in this Pediatric set of quality measures are harmonized with existing state-level measures in the Medicaid and CHIP Child Core Set.
The CMS has worked for several years to align quality measures across public programs in order to support consistent high quality care for patients and reduce complexity and burden for clinicians in how they report on quality improvements. For example, quality measures are aligned across Medicare’s acute care hospital programs, such as the Inpatient Quality Reporting Program, Hospital Value Based Purchasing, and the Hospital-Acquired Condition Reduction Program. Hospitals report quality measures once, which are then used for these multiple programs.
In 2016, CMS and America’s Health Insurance Plans (AHIP), as part of a broad collaborative of healthcare system participants, released seven sets of clinical quality measures that supported multi-payer alignment, for the first time, on core measures for clinician quality programs. The core measure sets are intended to promote alignment of quality measures for clinicians at the individual or group practice level. These measure sets were in the following areas:
- ACOs, PCMH, and Primary Care
- HIV and Hepatitis C
- Medical Oncology
- Obstetrics and Gynecology
CMS is already using measures from the each of the core sets. Using the notice and public comment rule-making process, CMS made significant progress in implementing these core measures in the Quality Payment Program and the Medicare Shared Savings Program, while eliminating redundant measures that were not part of the core sets.
These initial seven sets of measures were targeted primarily towards practitioners and group practices that serve adult patient populations. CMS is now releasing a set of measures targeted towards practitioners and group practices that serve pediatric patient populations.
CMS worked with AHIP and commercial payers, as well as physicians and consumers, as part of the CQMC 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 decision-making. CMS believes that this process and its implementation should be an open and transparent one that allows for input from all stakeholders.
Harmonization between Medicaid and CHIP Child Core Set and the Pediatric Measure Set
Together, Medicaid and the Children’s Health Insurance Program (CHIP) serve more than 45 million children, representing more than 1 in 3 children in the United States. CMS, through the Center for Medicaid and CHIP, partners with states to share best practices and provide technical assistance to improve quality of care.
Starting in 2010, and in partnership with states and a variety of stakeholders, CMS has annually reviewed and published the Medicaid and CHIP Child Core Set, a set of children’s healthcare access and quality measures for voluntary use by State Medicaid and CHIP programs. It includes a range of children’s quality measures encompassing physical, behavioral, and oral health and is intended for measurement at the state-level. By contrast, the CQMC pediatric set is intended for measurement at the healthcare provider and group practice levels.
Because seven of the nine measures in the CQMC pediatric set are also in the Medicaid and CHIP Child Core Set, reporting on these measures at the provider and practice levels may also help to encourage reporting on the state-level Child Core Set measures. Alignment between these multiple levels of measurement may also help to facilitate quality improvement efforts by allowing states to understand how variation in performance at the provider-level drives performance at the state-level.
Approach and Criteria to Achieving Core Measure Sets
The CQMC launched in 2014 when leaders from CMS, health plans, the National Quality Forum (NQF), physician specialty societies, employers, and consumers were convened with the goal of collaborating on the establishment of a core set of measures in selected clinical areas. The CQMC was split into workgroups for each of the identified core measure sets. Each workgroup reviewed measures currently in use by CMS and health plans, as well as measures that are endorsed by NQF. Based on this review and discussion, a consensus core set was identified by the workgroups for the selected clinical areas. This consensus core set was further discussed by all Collaborative members before being finalized. Additionally, the Collaborative developed a framework of aims and principles that informed the selection of core measure sets. Since the initial release of the first seven measure sets in 2016, CMS has been actively participating in the collaborative on the development of the new CQMC Pediatric Measure Set.
The Medicaid and CHIP Child Core Set is also developed through extensive stakeholder engagement. CMS works with the NQF to convene healthcare stakeholders and measurement experts to provide input into the annual revision of the Medicaid and CHIP Child Core Set measures through the Measure Applications Partnership (MAP). The MAP Medicaid and CHIP Child Taskforce is comprised of members representing health plans, state Medicaid agencies, pediatric providers, and consumer advocates.
Other Department Work To Support Quality Measures
Across the Department, we will continue our work to align measures across the public and private sectors, building off the work of the Core Quality Measures Collaborative.
Other Partners: CMS continues to work with other federal partners including, the Agency for Healthcare Quality and Research, Office of Personnel Management, Department of Defense, and Department of Veterans Affairs, as well as state Medicaid plans, to align quality measures where appropriate.