CMS’ National Quality Strategy Emphasizes Equity, Safety, Resilience

During its annual quality meeting on April 13, the Centers for Medicare & Medicaid Services (CMS) hosted a panel, whose members provided ideas for how to put the CMS National Quality Strategy’s enhanced focus on equity and patient safety into practice.

Anita Monteiro, director of the quality improvement and innovation group at CMS, said that the new strategy includes rethinking how we embrace the digital age, including the emerging importance of electronic measures. “While the system isn't quite there yet to be able to do this at full capacity, we need to be working in that direction,” she said. “We have a tremendous opportunity because the U.S. health system has enormous data resources. These data resources can be leveraged by taking advantage of data science and the tools of big data, including artificial intelligence and machine learning, to guide prevention and quality improvement. I want to challenge all of us to bring together our collective intellect, ideas and passion to leverage the incredible advances in modern technology to continue to learn from the pandemic.”

Kedar Mate, M.D., CEO of the Institute for Healthcare Improvement (IHI), said now is the time to fully embrace the reality that there is no healthcare quality without equity. He added that embracing this reality requires three specific actions. First, CMS can lead the way toward decisively adopting equity as an aim to be added to the triple or quadruple aim. “We've all witnessed how CMS’ adoption of the triple aim focused the energies of our nation on this concept,” he said. “Now is the time, I believe, to add equity to this construct. For without it, the triple aim will remain out of reach.”

Second, Mate said, CMS can ensure that race/ethnicity, language, sexual orientation, gender identification and disability data are more reliably collected and documented for every patient and for every outcome. Setting expectations around the collection and use of these data will focus the attention of leadership in a way that only CMS can do, he added.

Finally, CMS can commission demonstration activity that shows how quality improvement and population health initiatives can improve areas where inequities have major population-level health impacts, such as cardiovascular disease, cancer care, diabetes and maternity. “IHI has had the privilege of working with numerous health systems in the past few years on initiatives that have reduced inequities in these areas, and we hope that CMS will be continue to support initiatives through the National Quality Strategy that demonstrably reduce inequities like these in the future.”

The next speaker was Dana Gelb Safran, Sc.D., president and CEO of the National Quality Forum. The NQF has a longstanding history of being the steward for the nation's portfolio of healthcare quality measures. It plays a pivotal role as a consensus-based entity with public/private partnerships on healthcare quality metrics.

In addition to joining Mate in applauding the strong equity focus in the strategy, Safran said it is time to elevate the importance of safety in our measurement and improvement efforts in the quality field. “We have some very strong measures, but they focus almost exclusively in the hospital setting,” she explained. “We need to advance measures and improvements in the ambulatory setting, the post-acute care settings, and everything in between, so I am really delighted to see CMS putting forward this emphasis on safety.”

Another area that Safran liked is the linkage that CMS made between the National Quality Strategy and the National Value Strategy. “We need a next generation of measures in order to really advance and see the success that value-based payment offers,” she said. “That pulls together three of the pillars of the CMS Quality Strategy, the innovation pillar, the patient and family focus pillar, and the digital pillar. All three of those will be critical to the next generation of measures that we need to support a value strategy in healthcare.”

Finally, she said, CMS’ emphasis on alignment couldn't be more timely or important. “We've heard for over a decade that providers are willing and eager to embrace performance improvement, but that the fragmentation across payers and even within payer programs really undercuts their ability to work on those priorities,” Safran said. “NQF has the privilege of working hand in hand with CMS and AHIP in the leadership of the Core Quality Measures Collaborative. I hope all of you will watch as we look to make the CQMC a higher impact enterprise and something through which we can truly drive alignment and make a difference for those who are working not only to measure care, but to improve it.”