Developing Measures that Matter

I want to repeat something I said in my last post:

"The best measures will generate timely and actionable guidance for clinicians and their teams to help develop care plans with their patients, identify the best treatment options and address gaps in care." 

So… how do we get there? Well, the good news about developing “measures that matter” is that data sources and accessibility are evolving quickly; there are standards to help make information even more usable and shareable.

It wasn’t too long ago that health care was paper-based and searching for charts and paper reports was part of every clinician’s day. And until recently, HEDIS measures were primarily based on chart reviews, claims data and paper surveys, supplemented with data from other sources such as EHRs. Electronic clinical quality measures (eCQM), such as those currently used in the Medicare Quality Payment Program, rely almost exclusively on EHR-generated data. But CMS and others, including NCQA, introduced a new term earlier this year: digital quality measures (dQM). dQMs are designed to use data from many sources, including EHRs, claims, registries, health information exchanges and case management systems.

Using digital sources of information is half the equation. The other half is moving from paper-based specifications, which require interpretation and significant programming, to digitally specified measures, which are downloadable, executable and require little additional programming. NCQA now publishes a growing subset of HEDIS® measures as dQMs. This year, we will release digital measures for HEDIS reporting using the Quality Data Model (QDM) and Clinical Quality Language (CQL). We will also release a small subset of measures based on Fast Healthcare Interoperable Resources (FHIR) and CQL. In 2021 we will begin releasing digital HEDIS measures in FHIR-CQL only.

In addition to reducing programming burden and variability in interpreting measures, the logic expressions available in CQL and an expanding number of data sources provide opportunities to develop measures that are more clinically relevant, fit into workflows, generate insights to drive improvement and align with value-based payment objectives; for example, measures that look at treatment intensification or deintensification based on person-specific information (e.g., blood pressure or diabetes control).

We can also develop measures that might not be appropriate to link to payment but that drive important and clinically relevant aspects of care; for example, measures that depend on setting goals with patients based on unique care plans. Because goals are person-specific by design, it’s difficult to develop benchmarks or comparisons—and yet, conversations about setting goals and engagement between clinical teams and patients/families are crucial, especially for people with complex chronic conditions.

What could the future of dQMs look like?

DQMs will be based on clinical guidelines written with a digital format in mind and in tandem with clinical decision support. They will be machine readable and updated automatically through application programming interfaces (API). When guidelines change, value sets are modified or new therapeutics are introduced, measure specifications will be updated in the same way smartphone apps are updated.

Measures will be harmonized across health plans, networks, practices and clinicians for reporting —there will be one definition that does not depend on the health plan or payment model for which they are reported. And, there will flexibility for health systems and others to adjust measures to meet unique, quality improvement needs such as through NCQA’s Allowable Adjustments for HEDIS. Measure results (and/or the data to support measure output) will be aggregated at the person-centered level to produce comprehensive insights about the quality of care received.

In conclusion, measures that matter, and that are built, distributed and maintained as described here, will help drive improvements in care, translate evidence into practice, deliver high-value care and highlight where we need to provide more resources, push harder or incentivize differently.

Do you agree with this vision?

What would you change?

What are the barriers to achieving such a future (policy, technology, cultural, economic and others)?

Share your thoughts in the community forum.  

_{HEDIS® is a registered trademark of the National Committee for Quality Assurance.}