The Opportunity for Change
This Roadmap contains three mechanisms to improve the federal QME:
- Establishment of coordinated governance and oversight
- Modernize approach to data collection, reporting, and sharing
- Reform how measures are used in federal quality programs
Governance and Oversight
Existing federal measurement initiatives are siloed within independent healthcare programs and agencies. No governance structure exists to ensure alignment of quality efforts, to assess effectiveness of programs and measures in achieving their stated objectives, to assess utility and duplication of effort across programs, or to assess overall value in light of the burden programs impose on providers and patients. A new governance structure is required to achieve the goals of the executive order.
HHS, DoD, and VA will, in conjunction with private sector stakeholders, establish an enduring, integrated, and transparent governance and oversight structure to oversee the administration of government healthcare quality programs, quality measures and standards, core data sets, and quality data collection, while respecting the legislative mandate of each program. While agencies will continue to have the statutory responsibility to issue their own regulations, this governance body will be empowered with the authority to establish processes to (1) coordinate quality and payment programs and associated quality measures; (2) comprehensively assess the impacts, positive and negative, of the federal QME; (3) align data collection, storage, and access approaches in support of health quality decision-making; and (4) implement processes for the development, validation and retirement of quality measurements. In addition, the governance structure will engage private sector stakeholders—particularly patients and providers—as equal partners with an equal voice in the management and oversight of the federal QME.
Data Collection and Reporting
The systems for data collection, data availability, analysis, and reporting supporting the federal QME, much like the approach to governance, have developed over the past two decades in response to various legislative and regulatory mandates. As a result, federal data are housed in isolated datasets on systems limited in their ability to share and receive information. There is typically an 18-month lag between the time that patients receive care and the time providers and the public receive information on the quality of that care. Many of these systems have been modified to perform expanded functions and have been stretched beyond the capacities of their intended use.
Leveraging the governance body described above, the federal government will reevaluate its approach to data collection and reporting, with the goal of empowering the intended users of the data—patients, providers, policymakers, and payers—with access to timely and transparent information about the quality of care and with appropriate safeguards for privacy and security. This will include expanding accessibility and availability of federal datasets to a larger audience of public and private stakeholders. This also means ensuring that data are available at a level of analysis meaningful for decision-making by patients, providers, policymakers, and payers.
The governing body will also identify opportunities to leverage newer technologies to minimize the burden on those who collect or report data. It will also identify opportunities to ensure timely and rapid feedback to stakeholders to support decision-making and continuous improvement of care and processes. Better data will allow for better and more meaningful measures in the future and will allow for a system agile enough to respond to shifts in the nation's health needs and health care delivery.
Quality Measures in Federal Programs
Over the past decade, the federal government has implemented numerous quality reporting and value-based payment programs, spanning the continuum of ambulatory, inpatient, and post-acute care. These programs are intended to provide information about the quality of healthcare providers so that patients may make informed decisions. The programs have used public reporting and payment incentives to incentivize healthcare providers to engage in continuous quality improvement. The programs have also facilitated a transition to value-based healthcare purchasing, which continues to be a top priority for the HHS Secretary.1 Patients are often unaware of, or do not fully understand, these programs, and the proliferation and increasing scope of quality measurements has resulted in burden and confusion for providers. Recent agency reform programs, such as CMS's Meaningful Measures Initiative, have been effective in addressing these issues and improving the QME. However, the potential of agency-specific reform efforts is limited by agency resources and authorities. A broader reform effort that incorporates and supports existing efforts is necessary. In partnership with state and private sector programs, measure programs can be coordinated, combined, and simplified, reducing burden on those who provide care and freeing resources to focus on improving care rather than reporting care.
Leveraging the governance body described above, the federal government will undertake a systematic review of its quality reporting and value-based payment programs, to identify opportunities to reduce burden, promote efficiency and effectiveness, and accelerate the shift to value, in alignment with the principles outlined in this Roadmap. This assessment will include actionable recommendations for (1) aligning and streamlining the use of measures in federal programs, (2) ensuring programs improve health outcomes by supporting patient and provider decision-making, and (3) reforming or retiring the measures or incentives for which the costs outweigh the benefits.
Learn more about the National Health Quality Roadmap
National Health Quality Roadmap
Get a big picture understanding of the Roadmap
Read about the unified approach and the key principles driving the Roadmap
Call to Action
Find out what actions are planned for 2020 to move forward with the Roadmap