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The Universal Foundation and dQMs are part of an overall strategy to reduce burden and maximize the power of digital measures to improve patient outcomes. The Universal Foundation establishes a high-priority, standardized set of quality measures to promote alignment across CMS’s payment and quality programs, and focus the nation’s health system on key areas for improvement. Universal Foundation measures also emphasize building a modern health data exchange infrastructure to deliver the highest-quality care to patients—wherever they receive care.

Health plans are implementing “gold carding,” which lessens or removes some administrative work related to prior authorization. Eligibility for gold carding can depend on a provider’s quality ratings, which incentivizes high-quality care. According to an AHIP 2022 survey, 58% of plans use gold carding for medical services—a more than 80% increase from 2019. dQMs can help providers qualify for gold carding with plans.

Most quality measures are based on claims and administrative data that are used for billing, limiting the ability to measure many aspects of health care quality. Replacing the current manual approach to quality measurement with digital quality measures (dQM) can increase the precision of measurement and the relevance of quality reports for clinicians seeking to improve care. They can also increase the validity of reported results and reduce the burden and costs associated with manual data collection and management.

Yes. After initially announcing that all quality measures would be converted to digital by 2025, CMS has moved this date to 2030. CMS recognizes that transitioning to dQMs will produce better insights about the health of populations and will increase the timeliness and relevance of information available to a “learning health system.” Together with ONC, CMS continues the push to standardize and harmonize health data through USCDI and USCDI+. With these data categories, FHIR (a uniform health data language) and APIs—the backbone of today’s internet economy—lay the groundwork for efficient exchange of health data.

As Congress continues to advance price transparency and value-based care, dQMs can revolutionize consumer choice. Through combined price and quality outcomes, consumers can get a true picture of the value of their care. Publicly available quality measurement information is about 2 years out of date; dQMs allow providers to view patient outcomes and needed interventions in real time.

dQMs pull data from certified health technology, which adheres to patient privacy and protections mandated in the 21st Century Cure Act. Additionally, health information will reside with HIPAA covered entities that safeguard the information and comply with federal and state regulations and standards for handling PHI.