Last week, a government-led working group/coalition that includes The Centers for Medicare & Medicaid Services (CMS), AHIP (American’s Health Insurance Plans), (the primary insurance industry trade association), and several provider groups, announced a new agreement to standardize quality measures in support of the move towards value-based payment. The number of quality measures has exploded in recent years, with little agreement on which actually serve as effective measures of quality.
This agreement marks a concerted effort by public and private payers to harmonize the disparate, overlapping, and sometimes conflicting quality measures. The group unveiled seven sets of core quality measures for: (1) ACOs, PCMHs, and primary care; (2) cardiology; (3) gastroenterology; (4) HIV and Hepatitis C; (5) medical oncology; (6) obstetrics and gynecology; and (7) orthopedics.
Following from the agreement, the hard work of incorporating the measures into Medicare and Medicaid programs, as well as into private contracts between insurers and providers, must begin. For CMS, that means using the regulatory process to add new measures and remove others deemed unnecessary (much of which is likely to be done through the agency’s upcoming MACRA rulemaking this spring/summer.) Private insurers, meanwhile, will begin to implement the measure sets through individual contract negotiations with providers.
The group’s members also hope to evaluate how well the new measure sets work, adding newly developed measures or removing those that might become less useful in the future.
Impact for NextGen Healthcare clients
While this announcement does not create any immediate legal obligations for private payers or providers, CMS and private payers are likely to incorporate these quality measures into their regulations and value-based payment contracts over the next several years. As a result, performing well on these particular quality measures is likely to become increasingly important for clients. NextGen Healthcare is carefully analyzing these measure and actively searching for the best way to assist clients in adopting them as part of their overall quality programs.