A year ago, officials from the Center for Medicare and Medicaid Services unveiled a National Quality Strategy. In a May 1 update on the strategy, CMS officials discussed several goals, including annually increasing the percentage of digital measures used in CMS quality programs. CMS officials also said the organization would build one or more quality data systems that can receive data using the FHIR data standard by 2027.
Speaking during the annual CMS Quality Conference, Aditi Mallick, M.D., chief medical officer for Medicaid and CHIP, spoke about the way that the National Quality Strategy supports the agency's efforts to ensure equitable access, quality and outcomes for all individuals served by CMS programs. “We are addressing the ways in which Medicare, Medicaid and CHIP and Marketplace meet the needs of those we serve, particularly individuals and communities that have been historically marginalized and underserved,” she said.
CMS is incorporating equity into the measurement strategy of every quality and value-based program possible, Mallick added. “That will help us to continue to reward high-quality care for underserved populations.” For example, she explained, CMS will collect social drivers and determinants of health data across programs and healthcare settings. This improvement of data completeness will allow for additional views on health equity. “These data improvement practices further enable us to assess and analyze equity within our different programs and care settings,” she said.
Where possible, CMS is using health equity scores and equity-specific measures. “We plan to use all the levers available to us to continue to support health equity throughout the healthcare system. That includes regulations, standards, oversight, conditions of participation and quality improvement assistance and activities to move forward with this goal,” Mallick said.
In terms of building a person-centered approach to care, CMS is planning to increase the use of person-reported measures so that over time a minimum of 25 percent of the overall score calculation weighting comes directly from individuals served by CMS programs. “With the critical need to include diverse populations in CMS strategy and policy, we are expanding our outreach efforts to both individuals and communities so that we obtain this meaningful bi-directional engagement and feedback,” Mallick added. “We also acknowledge how important it is for people to have access to their own data to promote informed and collaborative decision-making. In this goal area we also plan to increase access to and utilization of resources like patient portals to improve that engagement.
Regarding efforts to improve patient safety, CMS is using all the levers at its disposal, including expanded and improved measures of safety performance, increased transparency and strong payment incentives to promote improved safety outcomes, Mallick said. “The pandemic and the challenges that cause presents both an opportunity and an obligation to re-evaluate healthcare safety with an eye toward building a more resilient healthcare system capable not only of achieving safer routine care, but also maintaining high levels of safety in times of crisis,” she said. “Our success target reflects a return to pre-pandemic levels by 2025 and an additional 25 percent reduction in harm by the year 2030. CMS is engaged in a number of initiatives to promote patient safety across our programs, including incentivizing meaningful improvements and issuing guidance for facilities to implement an effective, data-driven quality assessment and performance improvement program, including tracking and monitoring medical errors.”
Focus on use of digital data
Susannah Bernheim, M.D., chief quality officer/senior advisor for the Center for Medicare & Medicaid Innovation, spoke about the agency’s efforts to drive interoperability to accelerate and support the transition to digital and data-driven healthcare and its importance for quality and safety. “The key objective of this work focuses on the use of digital data. We want to support the ongoing advancement in technology and standards to drive interoperability of healthcare data. As a part of this, we set a target to transition to all digital quality measures in the future. This is critical to help us build a learning healthcare system, which supports improved data analysis,” she explained. “Rapid-cycle feedback and alignment and the ability to use all-payer data will aid in continuous improvement in person-centered care. CMS will annually increase the percentage of digital quality measures used in CMS quality programs and will also build one or more quality data systems that can receive data using the FHIR with application programming interface delivery by 2027. This will allow CMS to receive needed data through a seamless and secure exchange format,” Bernheim said.
“We will continue to collaborate with other federal partners, such as the Office of the National Coordinator for Health Information Technology, to ensure that digital data elements for quality measures are being standardized through USCDI,” she added.
Another objective is to improve quality on an aligned and foundational set of high-priority clinical areas and support services, such as maternal health, behavioral health, equity and safety. CMS will deploy comprehensive quality improvement approaches that leverage evidence-based interventions and will continue to build on its analytics capabilities to develop dashboards that help to inform quality improvement and policy decisions. “These can help us use data that we have in real time to continue to deliver the best care,” Bernheim said.
CMS is focused on increasing alignment across quality reporting and value-based payment programs, she added. “We've been working across the agency, across our center, to increase alignment, which we believe will accelerate improvement on the path toward higher value and person-centered care. This goal will use a universal set of quality measures, addressing high-priority clinical areas and support services.”
One action CMS is highlighting involves implementing relevant measures from the Universal Foundation in applicable quality programs across the care journey by 2026. “We'll also be pursuing greater program alignment among Medicare, Medicaid and CHIP, Marketplace, and Innovation Center models through how we standardize our data collection and reporting and through measure stratification,” Bernheim said. “All of this will help us to move forward by increasing our ability to promote cross-agency, standardized approaches to quality metrics improvement initiatives, and quality and value-based programs.”
The Universal Foundation
Doug Jacobs, M.D., the chief transformation officer in the Center for Medicare at CMS, spoke about the concepts behind the creation of a Universal Foundation of quality metrics across as many CMS programs as possible.
“Our intended impact with the Universal Foundation is trying to improve health outcomes by focusing provider attention on high-priority areas and measures,” he explained. “The intent is that these measures are meaningful — meaning high burden of disease or morbidity and mortality across the country on measures that are broadly applicable across different programs and settings, measures that are digitally reported or capable of becoming digitally reported, making sure we can get to that seamless pulling of information from the electronic health records over time.”
Also, these measures are capable of being stratified to identify and track disparities as part of CMS’ equity goals, Jacobs noted. “The intent here is that having an aligned set of measures across as many programs as applicable in the Universal Foundation would reduce provider burden by streamlining and alignment, and it would also improve the comparability that we have across our quality programs,” he said. “Is there something working in one program that's not working in another program? Can we compare equity across our programs? This will help us determine what's working and what's not as we think about how to move forward, and also to promote interoperability by prioritizing measures in the transition to interoperable digital data.”
