AHIP, CMS, NQF formalize collaborative to align quality measures across payers

Stethoscope on top of bundles of money
The eight core measure sets available so far include primary care and seven specialties. (Getty Images/Wavebreakmedia)

The great irony of quality measures in their current state is that they exist to make care better, but they create inefficiencies at the same time.

To that end, the Core Quality Measures Collaborative (CQMC) was formalized on Tuesday by America’s Health Insurance Plans (AHIP), the Centers for Medicare & Medicaid Services (CMS) and the National Quality Forum (NQF) to align quality measures.

According to its website, CQMC “is a multi-stakeholder, voluntary effort created to promote measure alignment and harmonization across public and private payers.” The group has developed eight core measure sets that cover primary care and seven medical specialties: cardiology, gastroenterology, HIV/hepatitis C, medical oncology, orthopedics, obstetrics and gynecology, and pediatrics.

FREE WEBINAR | DECEMBER 13, 2018

Employer-Based Insurance: Top Priorities for 2019

Join Blue Health Intelligence (BHI) and Midwest Business Group on Health (MBGH) to hear how key descriptive, predictive and prescriptive analytics capabilities can drive new cost and quality insights for health plans, employers and benefit consultants.

RELATED: CMMI’s Adam Boehler wants to ‘blow up’ fee for service

Aligning these measures with input from multiple stakeholders creates a system that works best for providers and, by extension, patients, said Kate Goodrich, director of the Center for Clinical Standards and Quality and chief medical officer at CMS, in a press release.

“We believe this is the beginning of a new era in patient care and empowerment, and we celebrate the advancement of alignment to promote more actionable and useful quality information,” she added.

Each set is rooted in science and aims to improve care, reduce clinician burden and improve transparency for consumers.

It’s important to note that CQMC has not developed any payer’s exact measures, but rather a “parsimonious set of measures” that they can use as a springboard within their individual quality improvement programs, explained Danielle Lloyd, AHIP’s senior vice president of clinical affairs.

RELATED: The magic number? AMGA wants to reduce quality measures from hundreds to 14

In doing so, payers can customize their measures toward patient groups with different medical service needs. For instance, CMS removed a low back pain measure in its latest Medicare physician fee schedule because that wasn’t a concern for most Medicare patients, Lloyd said.

“It’s not to say every payer’s set has to be exactly the same, but that there’s broad alignment,” said Chinwe Nwosu, director of clinical affairs at AHIP.

Lloyd described the work as “public and private partnership at its best.”

Going forward, CQMC would like to expand the use of these measures, including by solving implementation barriers.

The group hopes to create measures that address health disparities, include behavioral health factors and can be automatically harvested from EHRs.