Meaningful Measures 2.0: Moving from Measure Reduction to Modernization

CMS is building on the success of the Meaningful Measures initiative and needs your input to shape Meaningful Measures 2.0. When first introduced in 2017, Meaningful Measures’ objective was to reduce the number of Medicare quality measures and ease the burden on users. Since the launch of Meaningful Measures, CMS has reduced the number of Medicare quality measures by 18 percent, saving more than 3 million hours of time and a projected $128 million.

Although the original Meaningful Measures initiative accomplished its initial goals, its scope and purpose have evolved to keep pace with a rapidly changing healthcare environment. With Meaningful Measures 2.0, CMS will not only continue to reduce the number of measures in its programs but will further shape the entire ecosystem of quality measures that drive value-based care. Meaningful Measures 2.0 will promote innovation and modernization of all aspects of quality, addressing a wide variety of settings, stakeholders, and measurement requirements.

CMS also plans to update and simplify the Meaningful Measures Framework as part of the broader initiative. As shown in the graphic, the draft Framework is currently structured with fewer priorities, focusing on measures related to person-centered care, equity, safety, affordability and efficiency, chronic conditions, wellness and prevention, seamless care coordination, and behavioral health. With Meaningful Measures 2.0, CMS plans to better address health care priorities and gaps, emphasize digital quality measurement, and promote patient perspectives.

Priorities & Measure Gaps

CMS designed Meaningful Measures 2.0 to address measurement gaps, reduce burden, and increase efficiency by:

• Using only high-value quality measures that impact key quality domains.
• Aligning measures across value-based programs and across partners, including CMS, federal, and private entities.
• Prioritizing outcome and patient-reported measures.
• Transforming measures to be fully digital and incorporating all-payer data.
• Developing and implementing measures that reflect social and economic determinants.

Meaningful Measures 2.0

Meaningful Measures 2.0 supports five interrelated goals. Click the title of each goal for more details. 

Empower consumers to make good health care choices through patient-directed quality measures and public transparency.

Objective: Empower people through transparency of data and public reporting, so they can make well-informed decisions about their health care.

• Expand and prioritize caregiver engagement during the measure development process
• Increase patient-reported outcome-based performance measures
• Continue to modernize Compare Sites
• Advance use of Fast Healthcare Interoperability Resources® (FHIR®) application programming interface (API) technology to allow patients to get their health information electronically

Leverage quality measures to promote health equity and close gaps in care.

Objective: Commit to a patient-centered approach in quality measure and value-based incentives programs to ensure that quality and safety measures address healthcare equity.

• Expand confidential feedback reports stratified by dual eligibility in all CMS value-based incentive programs as appropriate
• Introduce plans to close equity gaps through the pay-for-performance incentive programs
• Ensure equity by supporting development of socioeconomic status (SES) measures and stratifying measures and programs by SES or dual eligibility
• Partner with the Office of Minority Health regarding Health Equity Summary Score measures

Use the Meaningful Measures Initiative to streamline quality measurement.

Objective: Align measures across CMS, federal programs, and private payers to reduce the number and burden of measures.

• Leverage the Initiative to reduce burden and align measures across CMS and the federal government
• Develop, prioritize, and utilize measures for high priority targeted areas, such as SES, maternal mortality, and kidney care
• Align quality measures to quality improvement activities
• Increase the proportion of outcome measures
• Continue work with the Core Quality Measures Collaborative to align measures across all payers

Leverage measures to drive outcome improvement through public reporting and payment programs.

Objective: Accelerate ongoing efforts to streamline and modernize programs, reducing burden and promoting important focus areas.

• Continue to examine programs across CMS for modernization and alignment
• Introduce additional Merit-based Incentive Payment System Value Pathways

Improve quality measure efficiency by transitioning to digital measures and using advanced data analytics.

Objective: Use data and information as essential aspects of a robust healthcare infrastructure to allow for payment and management of accountable, value-based care and to drive insights that help health organizations evolve.

• Transform to all digital quality measures •Accelerate development of and testing electronic clinical quality measures using FHIR API technology for transmitting and receiving quality measurement
• Transform data collection to use FHIR API technology and all CMS data (all-payer data)•Leverage centralized data analytic tools to examine programs and measures
• Evaluate new technologies

Patient Perspectives

The updated Initiative promotes better collection and integration of patient voices across CMS programs by:

• Simplifying how to use patient-reported outcome measures (PROMs) and integrating them into the electronic health record workflow.
• Developing PROMs and embedding into the workflow, allowing access through an API or patient portal, improving ease of use, and reducing reporting burden.
• Using National Institutes of Health-developed Patient-Reported Outcomes Measurement Information System® (PROMIS®) tools.
• Working across CMS to use “Self-Reported Health” as an agency-wide key result that reflects the patient’s voice around quality of care.

Digital Quality Measurement 

Meaningful Measures 2.0 emphasizes digital quality measures, which originate from health information captured and transmitted electronically via interoperable systems. CMS continues to improve our digital strategy by

• Using FHIR-based standards to exchange clinical information through APIs, allowing clinicians to digitally submit quality information one time that can be used in many ways.
• Accelerating the transition to fully electronic measures.
• Working across CMS to use artificial intelligence to identify quality problems and intervene before harm comes to patients.
• Developing more APIs for quality measure data submission and interoperability.
• Harmonizing measures across registries.

Next Steps

Meaningful Measures 2.0 will continue evolving with your help. Email your comments to meaningfulmeasuresqa@cms.hhs.gov.

Not sure where to start? Consider these questions:

• Are there gaps in the updated Meaningful Measures Initiative?
• Are there barriers or challenges to implementing the proposed changes and goals?
• Should Meaningful Measures 2.0 address the COVID-19 pandemic? If so, what should we incorporate and how should we do it?

Downloads

• 2020 CMS Quality Conference: The Future of Quality Measurement, 2020 and Beyond —  February 2020 (PPTX)
• 2021 CMS Quality Conference: CMS Quality Measurement Action Plan – March 2021 (PDF)