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Core Measures

Overview

There is a great demand today for accurate, useful information on health care quality that can inform the decisions of consumers, employers, physicians and other clinicians, and policymakers. This is increasingly important as the health care system moves towards value-based reimbursement models.

It is difficult to have actionable and useful information because physicians and other clinicians must currently report multiple quality measures to different entities.  Measure requirements are often not aligned among payers, which has resulted in confusion and complexity for reporting providers.

To address this problem, the Centers for Medicare & Medicaid Services (CMS), commercial plans, Medicare and Medicaid managed care plans, purchasers, physician and other care provider organizations, and consumers worked together through the Core Quality Measures Collaborative to identify core sets of quality measures that payers have committed to using for reporting as soon as feasible.  The guiding principles used by the Collaborative in developing the core measure sets are that they be meaningful to patients, consumers, and physicians, while reducing variability in measure selection, collection burden, and cost. The goal is to establish broadly agreed upon core measure sets that could be harmonized across both commercial and government payers.

Core Quality Measures

The Core Quality Measure Collaborative, led by the America’s Health Insurance Plans (AHIP) and its member plans’ Chief Medical Officers, leaders from CMS and the National Quality Forum (NQF), as well as national physician organizations, employers and consumers, worked hard to reach consensus on core performance measures. Through the use of a multi-stakeholder process, the Collaborative promotes alignment and harmonization of measure use and collection across payers in both the public and private sectors. 

Designed to be meaningful to patients, consumers, and physicians, the alignment of these core measure sets will aid in:

  • promotion of measurement that is evidence-based and generates valuable information for quality improvement,
  • consumer decision-making,
  • value-based payment and purchasing,
  • reduction in the variability in measure selection, and
  • decreased provider’s collection burden and cost.

CMS believes that by reducing burden on providers and focusing quality improvement on key areas across payers, quality of care can be improved for patients more effectively and efficiently.

To develop the core measure sets the Collaborative split into workgroups and reviewed measures currently in use by CMS and health plans as well as measures endorsed by NQF for the individual measure sets. Based on this review and discussion the workgroups identified a consensus core set for the selected clinical areas. This consensus core set was further discussed by all Collaborative members before being finalized. Additionally, the Collaborative developed a framework of aims and principles that informed the selection of core measure sets.

The core measures are in the following eight sets:

  • Accountable Care Organizations (ACOs), Patient Centered Medical Homes (PCMH), and Primary Care
  • Cardiology
  • Gastroenterology
  • HIV and Hepatitis C
  • Medical Oncology
  • Obstetrics and Gynecology
  • Orthopedics
  • Pediatric

CMS is already using measures from the each of the core sets. Using the notice and public comment rule-making process, CMS also intends to implement new core measures across applicable Medicare quality programs as appropriate, while eliminating redundant measures that are not part of the core set.  Commercial health plans are rolling out the core measures as part of their contract cycle.

The Core Quality Measures Collaborative views the upcoming year as a transitional period, as it begins adoption and harmonization of the measures. Ongoing monitoring by the Collaborative of the use of these measures will enable modifications of measure sets, as needed and based on lessons learned, including minimizing unintended consequences and selection of new measures as better measures become available.

NEW: The Core Quality Measure Collaborative’ s pediatric measure set is intended for measurement at the health care provider and group practice levels. Because sever of the nine measures in the Core Quality Measure Collaborative (CQMC) pediatric set are also in the Medicaid and CHIP Child Core Set , reporting on these measures at the provider and practice levels may also help to encourage reporting on the state-level Child Core Set measures.

Get Involved!

CMS will go through a public notice and comment rule-making for implementation of these core sets and looks forward to public input on the measures included in these core measure sets.  As comment periods open, this page will be updated.

These seven core measure sets are a major step forward for alignment of quality measures between public and private payers and provides a framework upon which future efforts can be based.

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