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"The two words ‘information’ and ‘communication’ are often used interchangeably, but they signify quite different things. Information is giving out; communication is getting through." -- Sydney J. Harris

Will Medicare Core Measures Make MNCM Obsolete?

By Jim Chase
President, MN Community Measurement

Jim_ChaseAfter the Centers for Medicare & Medicaid Services (CMS) and America’s Health Insurance Plans (AHIP) announced their core measure sets, several people asked if this will make MN Community Measurement (MNCM) obsolete.

After all, if Medicare and the largest payers can align around a single set of measures, why do we need a local measurement organization like MNCM?

Last month, CMS and AHIP, as part of a broad Core Quality Measures Collaborative of health care system participants, announced seven sets of clinical quality measures. Both Jasmine Larson, Manager of Measure Development at MNCM, and I participated in the steering committee and some workgroups for this collaborative.

CMS has announced that the core measures will support multi-payer alignment for the first time, primarily for physician quality programs. This work will inform the implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) through its measure development plan. It is also part of CMS’s effort to ensure the programs work for providers while keeping the focus on improved quality of care for patients.

Given the size of Medicare, there is no doubt that MACRA will have a major impact on the measurement and value based purchasing landscape across the country. CMS will still need to go through a rule making process to determine how to use the core measures across all of their programs. Similarly, each health plan that participated in the Core Measures Collaborative will need to evaluate when and how they might implement these measures in their programs.

While this is an important step to align measures on a national level, there is a long way to go for adoption in ways that will optimize the potential to improve our health care system. As this implementation of the national measures rolls forward, MNCM’s community benefits remain clear.

MNCM’s Community Benefits

  • Align measures across payers

  • Promote standard data collection and reporting methods

  • Develop and test new measures that fill gaps for the future

  • Use our leadership and expertise to influence how future national measures are adopted

Align measures across payers

MNCM can continue to facilitate consistent measure implementation between Medicare, Medicaid and health plans in Minnesota, to reduce measurement burden wherever possible. Our community will need to make hard choices about how we align with the national measure sets. In the CMS-AHIP core measure set, there are measures that we don’t currently use, such as medication reconciliation.

These measures will have increased financial impacts on our health care organizations: When and where should we adopt them? Similarly, the components of our composite diabetes and vascular care measures have different specifications from the national measure set. When and where do we align our specifications to reduce burden and help our health care organizations get credit for their high performance?

There are other measures, such as our Optimal Asthma Control measure, that have not been included in the national measure set at this time, but we may want to continue to use them since they are leading the way for future adoption into the national set. (Note: this measure is currently in consideration for endorsement by the National Quality Forum and a draft recommendation will soon be available for public comment. Please refer to http://www.qualityforum.org/Pulmonary_and_Critical_Care_Project.aspx )

And finally, which measures should we retire in order to reduce unnecessary burden and make room for the new, more impactful measures. I believe the multi-stakeholder process we have at MNCM will be the best way to work though these choices in order to maximize the benefit for patients and reduce duplication and data burden.

Promote standard data collection and reporting methods

The CMS-AHIP report also notes that “Clinicians and payers will need to work together to create a reporting infrastructure for such measures.” The role MNCM plays in standardizing data collection and reporting will become more important as demand for use of these measures by multiple parties grows. We may need help from all of our stakeholders to advocate for data reporting methods that avoid duplication and build on our existing infrastructure.

Develop and test new measures that fill gaps for the future

The report of the Core Quality Measurement Collaborative, consistent with the Institute Of Medicine’s Vital Signs report, also notes that there are significant gaps in the type of measures that are needed for the future value based purchasing system. The participants acknowledged that the lists they developed are an important starting point, but recognize that a core measure set needs to be dynamic to address the future needs of the health care system and the variation in readiness in regions across the country.

MNCM has already started to help. The MNCM depression measures have been included in this proposed core set even though very few regions in the country have experience using this type of measure. This measure is also being touted as an example of the kind of high value, patient reported outcome measure that can serve as a blueprint for getting to a higher impact measure set that is needed for future value based purchasing programs.

The National Quality Forum recently asked MNCM to begin developing other patient reported outcome performance measures that can help fill these measurement gaps. This new project focuses on the development and testing of a performance measure using an appropriate COPD patient-reported outcome as a measure of physician practice outcomes. The rest of the country looks to Minnesota for these innovations and we need to continue to lead the way in developing and testing high impact measures that drive improvement in care.

I hope you agree that there is still plenty for all of us to do to make sure measurement and reporting achieves its potential to drive improvement in the health care system as new national payment reform efforts continue. Please let me know if you have thoughts on this, and I look forward to working with you as the measure implementation for Medicare unfolds.

Jim Chase
President, MN Community Measurement