CMS Execs Describe ‘Universal Foundation’ to Align Quality Measures

Feb. 2, 2023
In a New England Journal of Medicine article, CMS leaders say goal is to focus providers’ attention on measures that are meaningful for the health of broad segments of the population and reduce provider burden

Acknowledging that a lack of alignment across the Centers for Medicare & Medicaid Services’ quality programs has contributed to challenges for clinicians and health insurers, the leaders of several CMS centers are proposing a “Universal Foundation” of quality measures that will apply to as many CMS quality-rating and value-based care programs as possible.

Published Feb. 1 in the New England Journal of Medicine, the essay’s authors include Douglas B. Jacobs, M.D., M.P.H.; Michelle Schreiber, M.D.; Meena Seshamani, M.D., Ph.D.; Daniel Tsai, B.A.; Elizabeth Fowler, Ph.D., J.D.; and Lee A. Fleisher, M.D.

The authors note that across 20 quality programs, although some of its quality measures are consistent, many are not. They note that other insurers often use the same quality measures as CMS to adjust clinician reimbursement as part of value-based arrangements — although some insurers use different or modified measures, which has also contributed to measure proliferation.

The Universal Foundation “is intended to focus providers’ attention on measures that are meaningful for the health of broad segments of the population; reduce provider burden by streamlining and aligning measures; advance equity with the use of measures that will help CMS recognize and track disparities in care among and within populations; aid the transition from manual reporting of quality measures to seamless, automatic digital reporting; and permit comparisons among various quality and value-based care programs, to help the agency better understand what drives quality improvement and what does not.”

CMS has created a cross-center working group focused on coordination of these processes and on development and implementation of aligned measures to support a consistent approach under the Universal Foundation. One goal, they say, is for the Universal Foundation to eventually include selected measures for assessing quality along a person’s care journey — from infancy to adulthood — and for important care events, such as pregnancy and end-of-life care.

The New England Journal of Medicine article includes a table of preliminary measures. Under adult care, the domains are wellness and prevention, chronic conditions, behavioral health, seamless care coordination, person-centered care and equity, with two or three measures listed under each.

The CMS executives note that the streamlined measures “would be used across CMS programs and populations, to the extent that they are applicable and in keeping with legislative statutes. Additional measures will be necessary for assessing care provided to specific populations or in certain settings, such as hospital-based care, maternity care, dialysis care, and long-term and community services. CMS will identify add-on measures that could be implemented consistently across programs.”

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