Meaningful Measures Hub
Meaningful Measures Hub
“Meaningful Measures” framework is the Centers for Medicare and Medicaid Services’ new initiative which identifies the highest priorities for quality measurement and improvement. It involves only assessing those core issues that are the most critical to providing high-quality care and improving individual outcomes. The Meaningful Measure Areas serve as the connectors between CMS strategic goals and individual measures/initiatives that demonstrate how high quality outcomes for our beneficiaries are being achieved. They are concrete quality topics, which reflect core issues that are most vital to high quality care and better patient outcomes. Examples of Meaningful Measure Areas include Healthcare-Associated Infections and Prevention and Treatment of Opioid and Substance Use Disorders. Each of these Meaningful Measure Areas helps to make the connection to specific CMS strategic goals such as “Empower patients and doctors to make decision about their health care” and “Support innovative approaches to improve quality, safety, accessibility, and affordability” through depicting core issues that are broader than a given individual measure.
How It Was Developed
The Meaningful Measures Initiative was developed collaboratively with the input from a wide variety of stakeholders. It also draws on prior work performed by the: Health Care Payment Learning and Action Network, other Agencies, the National Quality Forum, and the National Academies of Medicine. It includes perspectives from patient representatives, clinicians and providers, measure developers, and other experts such as the Core Quality Measures Collaborative.
Meaningful Measurement Areas are the connectors between CMS Strategic Goals and individual measures/initiatives that demonstrate how high quality outcomes for patients are being achieved. They are concrete quality topics which reflect core issues that are most vital to high quality care and better patient outcomes (which are not program specific), and can encompass bundles of related measures (in other stakeholder discussions, referred to as “small dots”). Meaningful Measurement Areas can focus everyone’s efforts on the same quality areas and lend specificity, which can help:
- Promote alignment across quality initiatives and programs which will minimize provider burden
- Promote more focused quality measure development towards outcomes that are meaningful to patients, families and their providers
- Identify the big picture quality issues that are the highest priority in improving the health and healthcare of patients and communities
- Communicate how CMS programs and measures improve patients’ health and how we plan to deliver value—better care, smarter spending, healthier communities— to meet the needs of patients
The Meaningful Measures framework contains nineteen Meaningful Measure areas organized into specific, overarching healthcare quality priorities. The following is an illustrative example of how the overarching domains, goals, criteria, and measures are interrelated in the Meaningful Measures framework. The quality priority of “Promote Effective Prevention and Treatment of Chronic Disease” includes five Meaningful Measure areas as listed in the below framework including the Prevention and Treatment of Opioid and Substance Use Disorders. The opioid crisis has been declared a public health emergency and therefore it has been recognized as a high priority focus area for measurement.
On the left of this graphic, the patient is at the center along with the CMS four strategic goals: improve CMS customer experience, state flexibility and local leadership, support innovative approaches, and empower patients and doctors. These goals serve as the foundational principles for everything we do.
The CMS strategic goals connect to the 6 cross-cutting criteria: eliminating disparities, track to measurable outcomes and impact, safeguarding public health, achieving cost savings, improving access for rural communities, and reducing burden. These cross cutting criteria are surrounded by 6 quality priorities. One of these quality priorities is ‘Promote Effective Prevention and Treatment of Chronic Disease. Within this priority are 5 Meaningful Measure Areas: preventive care, management of chronic conditions, prevention, treatment, and management of mental health, prevention and treatment of opioid and substance use disorders, and risk-adjusted mortality.
The right hand side of the graphic shows illustrative measures from our Quality Programs that align with the Meaningful Measure Areas.
See the example below:
This example demonstrates how the alignment of the cross-cutting criteria of safeguarding public health and the overarching quality category of “Promote Effective Prevention and Treatment of Chronic Disease” will function to address this important public health issue. For illustrative purposes two measures among the quality measures that address the Meaningful Measure area of “Prevention and Treatment of Opioid and Substance Use Disorders” in CMS’s programs are demonstrated in this graphic. By focusing on this Meaningful Measure area, CMS can identify existing gaps in measurement and quality improvement efforts, and subsequently target its efforts in partnership with states and communities on combating the Opioid crisis.
|Meaningful Measure Areas||Quality Priorities||Description|
|1.||Healthcare Associated Infections||Making Care Safer by Reducing Harm Caused in the Delivery of Care||On any given day, about one in 25 hospital patients has at least one healthcare-associated infection. Prevent healthcare-associated infections that occur in all healthcare settings.|
|2.||Preventable Healthcare Harm||Making Care Safer by Reducing Harm Caused in the Delivery of Care||Each year, 2.8 million people are treated in emergency departments for fall injuries, with associated costs of $31 billion. Avoid non-infectious harms like falls and complications like bed sores; harm that occurs during care is a leading cause of significant morbidity and mortality, and occurs in both inpatient and outpatient settings.|
|3.||Care is Personalized and Aligned with Patient's Goals||Strengthen Person and Family Engagement as Partners in Their Care||“…researchers have been using goal-attainment scaling for decades to measure the effect of treatment for conditions such as dementia and for comprehensive geriatric assessments”. Ensure the care delivered is in concert with individuals goals, aligned with the care plan co-created with their doctor and evidenced by people making informed decisions about their care.|
|4.||End of Life Care According to Preferences||Strengthen Person and Family Engagement as Partners in Their Care||Fewer than 50% of even severely or terminally ill patients have an advance directive in their medical record. Ensure that care delivered at the end of life is in concert with patient/family preferences, which includes knowing those desires and providing aligned care and services.|
|5.||Patient's Experience of Care||Strengthen Person and Family Engagement as Partners in Their Care||Recent average positive reports of healthcare experiences showed variation across a range of factors, for example, from 52% for ‘Care transitions’ to 87% for ‘Discharge information’. Actively engage patients in reporting their experiences including satisfaction with care and staff, and community inclusion.|
|6.||Patient Reported Functional Outcomes||Strengthen Person and Family Engagement as Partners in Their Care||Slightly more than 15% of adults report physical functioning difficulties. Improve or maintain patient’s quality of life by addressing physical functioning that affects their ability to undertake daily activities most important to them.|
|7.||Medication Management||Promote Effective Communication and Coordination of Care||Annual healthcare costs in the U.S. from Adverse Drug Events (ADEs) are estimated at $3.5 billion, resulting in 7,000 deaths annually. Avoid medication errors, drug interactions, and negative side effects by reconciling and tailoring prescriptions to meet the patient’s care needs.|
|8.||Admissions and Readmissions to Hospitals||Promote Effective Communication and Coordination of Care||Nearly 1 in 5 Medicare fee-for-service hospital discharges have previously resulted in a readmission within 30 days, accounting for more than $17 billion in avoidable Medicare expenditures. Prevent unplanned admissions and readmissions to the hospital; unplanned admissions and readmissions have negative impacts on patients, caregivers, and clinical resources, and can be prevented with effective care coordination and communication|
|9.||Transfer of Health Information and Interoperability||Promote Effective Communication and Coordination of Care||Fewer than 10% of physicians have fully functional Electronic medical record/electronic health record (EMR/EHR) systems. Promote interoperability to ensure current and useful information follows the patient and is available across every setting and at each healthcare interaction.|
|10.||Preventive Care||Promote Effective Prevention and Treatment of Chronic Disease||Many screening rates, like those for cancer, are below desired levels and reflect disparities across ethnicity/race. Prevent diseases by providing immunizations and evidence-based screenings, and promoting healthy life style behaviors and addressing maternal and child health.|
|11.||Management of Chronic Conditions||Promote Effective Prevention and Treatment of Chronic Disease||People with multiple chronic conditions account for 93% of total Medicare spending. Promote effective management of chronic conditions, particularly for those with multiple chronic conditions.|
|12.||Prevention, Treatment, and Management of Mental Health||Promote Effective Prevention and Treatment of Chronic Disease||Annually, 1 in 5 or 43.8 million adults in the U.S. experience mental illness. Diagnosis, prevention and treatment of depression and effective management of mental disorders (e.g., schizophrenia, bipolar disorder), and dementia (e.g., Alzheimer’s disease) with emphasis on effective integration with primary care.|
|13.||Prevention and Treatment of Opioid and Substance Use Disorders||Promote Effective Prevention and Treatment of Chronic Disease||Annually, three out of five drug overdose deaths involve an opioid, resulting in over $72 billion in medical costs. Ensure screening for and treatment of substance use disorders, including those co-occurring with mental health disorders.|
|14.||Risk Adjusted Mortality||Promote Effective Prevention and Treatment of Chronic Disease||Heart disease, cancer, and chronic lower respiratory diseases are among the leading causes for death. Reduce mortality rate for patients in all healthcare settings.|
|15.||Equity of Care||Work with Communities to Promote Best Practices of Healthy Living||In 2015 compared to 1996 children and adults were more likely to visit a health provider. Ensure high quality and timely care with equal access for all patients and consumers, including those with social risk factors, for all health episodes in all settings of care.|
|16.||Community Engagement||Work with Communities to Promote Best Practices of Healthy Living||It is estimated that a $10 per person per year investment in community-based programs could save $16 billion in medical cost savings per year reflective of improved health. Increase the use and quality of home and community-based services (HCBS) to promote public health including a focus on health literacy.|
|17.||Appropriate Use of Healthcare||Make Care Affordable||Overuse of services is estimated to account for nearly $300 billion a year in expenditures. Ensure patients receive the care they need while avoiding unnecessary tests and procedures.|
|18.||Patient Focused Episode of Care||Make Care Affordable||Approximately 30% of healthcare spending is for services without health benefits to patients. Improve care by optimizing health outcomes and resource use associated with treating acute clinical conditions or procedures.|
|19.||Risk Adjusted Total Cost of Care||Make Care Affordable||In 2015, Medicaid spent $545.1 billion and Medicare spent $646.2 billion, with over 400 Medicare ACOs contributing more than $466 million in total program savings. Hold healthcare providers accountable for the total costs of care to mitigate out of pocket costs to the patient, lower costs to the Medicare program, ensure efficient use of high value services, improve the quality of care, and safeguard the future of services and programs, with a focus on price transparency and continual improvements in quality.|
- Connecting to Patients
Meaningful Measures focus health care quality efforts on what is really important to patients, families and caregivers including making informed decisions about their care, aligning care with the patient’s goals and preferences and improving quality of life and patient outcomes. It is intended to highlight that the patient- the patient’s needs, values, preferences and health outcomes- is fundamental to the Meaningful Measures areas and quality domains. For example, in addition to identifying distinct Meaningful Measure areas including Patient’s Experience of Care and Patient Functional Status to focus on the quality domain of Strengthening Person and Family Engagement as Partners in Their Care, all other Meaningful Measure areas have central goals surrounding the patient as well. It is also intended to promote understanding by individuals and caregivers of the importance of health care quality measurement to improve patient outcomes. With everyone’s efforts focusing on the same high impact quality areas, there will be less burden of reporting for clinicians and providers and in turn, an even better ability to focus on patients and providing appropriate care that is meaningful to them.
- Connecting to Clinicians and Providers
The Meaningful Measures framework applies a series of cross-cutting criteria (as displayed in diagram above) that will apply to every quality measure and help guide the removal of lower value quality measures across CMS programs while keeping measures that have less burden and are most meaningful with the greatest impact on patient outcomes. This will allow clinicians and providers the ability to focus on patients and improve quality of care in ways that are meaningful to them instead of reporting and paperwork. CMS is prioritizing the use of outcome measures though high priority process measures will continue to be considered in cases where outcome measures might not be possible.
- Connecting to Specialists
Meaningful Measures are intended to capture the most impactful and highest priority quality improvement areas for all clinicians, including specialists. For example, functional outcomes and health care associated infections are cross-cutting areas for measurement across all settings of care. Taking orthopedic surgeons as an example, we have heard from patients and surgeons that the patient’s functional outcomes after surgery are important to them. Measuring patient-reported functional outcomes data can help illuminate whether the surgery has been effective in improving or maintaining patients’ quality of life. In addition, for specialists such as surgeons and clinicians performing procedures, we know that prevention of complications such as infections is an important outcome. It is applicable from birth to death throughout the lifespan of a patient across care settings.
- How the Meaningful Measure Areas Impact Existing CMS Programs
Meaningful Measures is not intended to replace any existing programs, but will help programs identify and select individual measures. Meaningful Measure areas are intended to increase measure alignment across CMS programs and other public and private initiatives. Additionally, it will point to high priority areas where there may be gaps in available quality measures while helping guide CMS’s effort to develop and implement quality measures to fill those gaps.
- Page last Modified: 10/25/2018 9:21 AM
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