[December 03, 2020]

CQMC Releases Additional Core Measure Sets Aimed at Improving Transition to Value-Based Care

As the nation's health care system transforms from one that pays for volume to one that pays for value, there is a growing need for useful performance measures to help assess the quality of care being delivered by physicians in a value-based payment (VBP) arrangements. Today, the Core Quality Measures Collaborative (CQMC) released four revised core measure sets as well as two new core sets tailored to specific specialties and designed to improve patient outcomes, reduce the burden on health care providers, and give consumers and payer information on which to assess physician performance.

"As health care continues to shift to a value-based payment environment, improving patient outcomes is vital to success," said Danielle A. Lloyd, MPH, Senior Vice president of Private Market Innovations and Quality Initiatives at AHIP and CQMC Steering Committee Chair. "The CQMC measures provide physicians, insurers, and others in the health care field with a blueprint on how to ensure patients are receiving high-quality, evidence-based, and coordinated care in key clinical areas."

With rapid growth in the volume to value movement, there has also been an upsurge in the number of performance measures used to determine the success of health care providers in delivering high-value, high-quality patient care within alternative payment models (APM (News - Alert)). These numerous performance measures can be a burden on health care providers and can lead to confusion for patients and providers.

The CQMC core measure sets directly address this barrier to health care. The updated core sets are the culmination of 75+ multi-stakeholder member organizations evaluating hundreds of existing quality measures against the CQMC's rigorous criteria and adopting measures that are evidence-based and aligned across the health care field.

The four updated core measure sets released today cover:

• Medical Oncology
• Orthopedics
• Primary Care/ Patient-Centered Medical Homes/ Accountable Care Organizations
• Cardiology

The CQMC also released two new core sets that cover:

• Behavioral Health
• Neurology

Earlier this year, the CQMC released four updated core measure sets in the following areas:

• Gastroenterology
• HIV and Hepatitis C
• Obstetrics and Gynecology
• Pediatrics

As part of the CQMC process, member organizations also catalogued areas ripe for measure development. The CQMC released the results of that work in an Analysis of Measurement Gap Areas and Measure Alignment report of the core sets, outlining where measure developers should focus their efforts. The group emphasized the need for additional:

• Outcome measures
• Patient-reported outcome-based performance measures (PRO-PMs)
• Cross-cutting measures
• Disparities or social determinants of health (SDOH)
• Electronic clinical quality measures (eCQMs)
• Clinician-level measures
• Telehealth/virtual visits

The CQMC is a diverse coalition of health care leaders representing over 75 consumer groups, medical associations, health insurance providers, purchasers and other quality stakeholders, all working together to develop and recommend core sets of measures by clinical area to assess and improve the quality of health care in America. The coalition was convened in 2015 by America's Health Insurance Plans (AHIP) and the Centers for Medicare & Medicaid Services (CMS) and is housed at the National Quality Forum (NQF).

Please click here for more information on the CQMC core measures. You can also view the CQMC Implementation Guide by clicking here. This guide provides strategies and actions for stakeholders seeking to implement or evolve VBP programs.

About America's Health Insurance Plans
America's Health Insurance Plans (AHIP) is the national association whose members provide coverage for health care and related services to hundreds of millions of Americans every day. Through these offerings, we improve and protect the health and financial security of consumers, families, businesses, communities and the nation. We are committed to market-based solutions and public-private partnerships that improve affordability, value, access, and well-being for consumers. Visit www.ahip.org for more information.

About the Centers for Medicare & Medicaid Services
Established in 1965, the Centers for Medicare & Medicaid Services (CMS) is the largest insurance payer in the United States, covering more than 130 million Americans through programs such as Medicare, Medicaid, and the Children's Health Insurance Program (CHIP). Using a collaborative and human centered design approach, CMS develops and maintains quality measurement programs, the oversight and standards certification program, and determines coverage analysis. CMS sponsors numerous quality improvement and innovation programs, such as the Center for Innovation (CMMI) and the Hospital Improvement and Innovation Networks (HIIN). CMS is leading the country in developing value-based health care to improve the lives of all patients. These programs help set health care standards used by many organizations across health care today. Visit www.cms.gov for more information.

About National Quality Forum
The National Quality Forum (NQF) works with members of the healthcare community to drive measurable health improvements together. NQF is a not-for-profit, membership-based organization that gives all healthcare stakeholders a voice in advancing quality measures and improvement strategies that lead to better outcomes and greater value. Learn more at www.qualityforum.org.

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