Stakeholder Engagement

Stakeholder Engagement

Measure developers and other groups seeking advice request input from a diverse group of stakeholders when undertaking quality measurement projects, especially when developing quality measures. This engagement helps them balance a variety of perspectives and interests and lead to better clinical outcomes. As a result, stakeholder engagement is a critically important task to support Centers for Medicare & Medicaid Services’ (CMS) aims to gather information about future measurement needs and to conduct its measurement activities transparently.

Who is involved?

Stakeholders are individuals or organizations with an interest in or who are impacted by quality measures. Examples of stakeholders include patients, caregivers, clinicians, measure developers, and healthcare facility representatives.

Select the role that best describes you to see why and how you can get involved.

Patient, Caregiver, or Patient Representative / Family Member

This stakeholder group represents people receiving medical care. Across CMS, the terms “persons” and “family” are used when referencing these types of stakeholders. The term “family” applies to participants in a person’s healthcare support team including informal caregivers. Patient advocates and advocacy groups can also provide patient insights but are not a substitute for person and family engagement.

Why You Should Get Involved:

  • You can help identify important healthcare issues.
  • You can shape resources and information needed to make informed healthcare decisions.
  • You can help measure developers and CMS produce easily understood, relevant, and quality measures. 

Ways to Get Involved:

Measure Developers

It is a measure developer’s responsibility to engage stakeholders, including other measure developers, throughout the Measure Lifecycle to get feedback, exchange ideas, and gain new insights.

Why You Should Get Involved: 

  • You can share best practices to continuously improve the measure development and maintenance process.
  • You can help advance measure portfolios across CMS programs.
  • You can gain valuable insights that you can apply in your own work.

Ways to Get Involved: 

  • Join a Technical Expert Panel (TEP). You could provide a fresh perspective or new ideas on how to approach technical aspects of measure development based on your professional experience.
  • Respond to a request for public comments.
  • Stay informed. Subscribe to our email updates to receive the monthly MMS Newsletter which features current opportunities to get involved, upcoming educational events such as MMS Information Sessions, and recent measure development updates. Attend an MMS Information Session. Previous sessions are posted on the Resources page
  • Review measures currently in use, under development, or under consideration on the CMS Measures Inventory Tool (CMIT). Being familiar with these measures promotes measure harmonization activities. 
  • Educate stakeholders when conducting your own engagement activities. There are several downloadable resources designed for patients, families, providers, and advocates on the Resources page.
Other Stakeholders, e.g., Clinicians, Facility Representatives, Health Information Technology Professionals, etc.

Other stakeholder groups such as clinicians and facility representatives (collectively known as “measured entities”), health plan representatives, commercial payors, academic researchers, and local, state, and federal government agencies provide critical insights to measure developers. Facilities include hospitals, skilled nursing facilities, home health agencies, outpatient physical therapy offices, comprehensive outpatient and inpatient rehabilitation facilities, end-stage renal disease facilities, hospices, group practices, laboratories, and suppliers.

Why You Should Get Involved:

  • You have unique insights into workflows, data processes, and level of burden required to collect quality measurement data.
  • You can help identify potential positive and negative payment effects due to quality reporting and performance. 

Ways to Get Involved:

  • Join a Technical Expert Panel (TEP). You can share potential real-world consequences or benefits to implementing a measure.

  • Participate in the public comment period for a proposed measure.

  • Subscribe to MMS email updates. You will receive the monthly MMS Newsletter that features opportunities to get involved, policy updates, and upcoming educational opportunities such as the MMS Information Session.

  • Attend an MMS Information Session. Previous sessions are posted on the Resources page.

When and How Are Stakeholders Involved?

Valuable stakeholder input informs quality measurement projects at each stage of the Measure Lifecycle as well as outside that framework. For example, stakeholders may provide input into how Hospital Quality Star Ratings or other publicly reported metrics are calculated and presented. Stakeholder input may inform the shape and structure of CMS resources, such as Care Compare, or help inform CMS needs and priorities. Click here to download Stakeholder Engagement in the Measure Lifecycle (PDF)

To learn more about forms of stakeholder engagement during the Measure Lifecycle, click each stage below.

Measure Conceptualization
  • Interviews: The measure developer may contact and interview measure experts, subject matter experts (SMEs) (including vendors and electronic health record system implementers), relevant stakeholders, and other measure developers to identify any measures in use or in development that are relevant to the topic of interest or to offer suggestions regarding appropriate topics for measure development. Measure developers may ask these or other experts to provide feedback about feasibility, importance, usability, and face validity before measure specification begins.
  • Technical Expert Panel (TEP): The measure developer assembles a TEP to provide input on the suggested concepts. The TEP may help narrow a list of potential concepts for development, provide insights on the importance of proposed concepts, or respond to other key questions identified by the measure developer.
Measure Specification
  • Public Comments: This is a key time to get additional public comments. Although it is advisable to get public comments at several points during measure development, getting public comments at this stage help the measure developer find potential issues, which can cut down on necessary revisions later in the process. The measure developer, TEP, and CMS review and consider comments received during the public comment period. This often results in revisions to the measure specifications.
  • Technical Expert Panel (TEP): During this stage, the TEP should be very involved in reviewing the initial specifications and providing several rounds of feedback.
Measure Testing
  • Qualitative Feedback: After testing is complete, measure developers may follow up with some of the stakeholders who commented on the measure specification stage and discuss the testing results with them. The measure developer will consult with statisticians to interpret testing data and ways to act on it.
  • Technical Expert Panel (TEP): At this stage, the TEP reviews and provides feedback on the testing plan and results from the alpha and beta testing. The TEP provides feedback to the measure developer in an iterative process.
Measure Implementation
  • Public Comments: This stage is completely transparent and open to the public for comments and questions. Measures under consideration for implementation are submitted for public comment either through the formal federal rulemaking process or through a specific public comment process (for measures that are not subject to rulemaking).
  • Stakeholder Meetings: Measure developers also convene stakeholder meetings regarding the implementation of considered measures, and their questions about the measures are resolved iteratively as the measure remains under consideration.
  • Technical Expert Panel (TEP): The TEP is available to help respond to questions from stakeholders, the public, and the National Quality Forum (NQF) steering committee.
Measure Use, Continuing Evaluation, and Maintenance
  • Public Comments: Public comments are requested for the annual update, comprehensive reevaluation, and ad hoc reviews of the measure. Results and progress from each of these review processes are reported publicly.
  • Technical Expert Panel (TEP): Stakeholders may participate in a formal TEP review, such as during a comprehensive reevaluation.


The following resources have been developed to support measure developers in stakeholder engagement:

Page Last Modified:
12/01/2021 08:00 PM