Call to Action

Governance and Oversight

Actions Planned for 2020

1. Establish a transition leadership team responsible for developing a sustainable strategy for governance and oversight of the federal QME and for executing the activities of this Roadmap in parallel with the establishment of the long-term governance structure.
   1. This transition leadership team will be led by the Secretary of HHS or their designee and include representatives from CMS, the Agency for Healthcare Research and Quality (AHRQ), the Centers for Disease Control and Prevention (CDC), IHS, HRSA, DoD, VA and OPM. The transition leadership team will have a formal role for private sector stakeholders in the management of the QME, consistent with statutory and legal requirements. The transition leadership team should strive for transparency by making its proceedings publicly available.
      1. Each participating agency will dedicate appropriate staff resources to support this transition leadership team and its activities and develop a budgeting plan for both the transition and permanent governance structure.
   2. By July 1, 2020, the transition leadership team will develop a plan for establishing a long-term quality measurement governance structure. They will develop this by the following:
      1. Inventory functions and tasks needed to support the federal QME and evaluate whether the entities performing various functions are best suited for those tasks in the future state.
      2. Develop recommendations for authorities and funding that would be required to support the future governance structure in effectively performing oversight. This will include exploring different mechanisms for engaging the private sector and patients suggested by subject matter experts and in the literature (e.g. Financial Accounting Standards Board [FASB]-type entity; use of a Federal Advisory Committee Act [FACA]; or others).
      3. Develop a charter for the permanent governance structure. This charter will specify that the governance structure is accountable to the Secretary of HHS and that the Secretary shall periodically evaluate the utility of the governance structure and decide on whether to renew or terminate the body.
      4. Develop an implementation plan to stand up the long-term governance structure and execute upon the actions outlined in this Roadmap. This implementation plan should appropriately represent the interests of patients, providers, and payers.
   3. The transition leadership team will execute short-term actions outlined in this Roadmap until the permanent governance structure is operational, at which time the permanent governing body will be charged and empowered to implement this Roadmap. Those responsibilities include the following actions:
      1. By April 1, 2020, assess the scope of the federal QME by inventorying federal programs that collect, store, and use quality data. The inventory will include statements of goals and objectives for each program, as well as estimates of federal resources supporting each program, relevant statutory mandates, and the burden imposed by each program on healthcare providers and patients.
      2. By October 1, 2020, develop a strategy for ongoing evaluation of program effectiveness in achieving their stated goals and monitoring for unintended consequences. This strategy should prioritize programs in the initial inventory of relevant federal programs to determine the timeline for evaluation as well as establish clear criteria for evaluation.
      3. Until the permanent governance structure is in place, execute on the actions listed under the Data Reporting and Collection and Quality Measures in Federal Programs sections.
2. By December 31, 2020, establish a long-term governance structure for all government quality management and measurement programs. Key functions of the long-term governance structure will be informed by the findings of the transition leadership team described above and in addition should include the following actions:
   1. Develop priority areas for quality measurement reflecting national healthcare goals identified by federal, state, and private sector stakeholders.
   2. Establish and implement a transparent process to make quality data publicly available, as discussed below.
   3. Establish and implement a transparent, evidence-based process by which quality measures used in federal programs are developed, maintained, evaluated, modified, and retired. This will include specifications for: contracting for measure creation, including engagement with specialty societies; measure validation, including cost-benefit analysis and scientific validity; measure pilot-testing; and ongoing stewardship and maintenance of measures, including timely updating of measures in response to evolving evidence and guidelines.
   4. Ensure the federal government applies acceptable technical standards and impact analysis for all quality measurement activities, to identify those that demonstrably improve health outcomes, address healthcare costs, and meet the measurement needs of patients, providers, and payers.
   5. Develop and implement a plan for incorporating patient and provider input into both the federal QME and the assessment of provider healthcare quality.
   6. Execute the evaluation strategy defined by the transition leadership team. Share insights and recommendations for federal programs that collect, store, and use quality data to better align with the federal QME. In addition, identify programs in need of significant reform or retirement and develop recommendations for operational, regulatory, or legislative changes for review with White House (WH) and Congressional leaders. The process for developing these recommendations should consider public feedback and the impact of the proposed changes on patients.
   7. Oversee the implementation of all other activities defined in this Roadmap.

Data Collection and Reporting

Actions Planned for 2020

1. Improve accessibility and availability of HHS, DoD, and VA datasets related to healthcare quality to a broader audience of stakeholders, while maintaining and safeguarding the public interest.
   1. By Spring 2020, solicit public input on what additional datasets should be released and what other data collection activities would be of interest to stakeholders. Develop recommendations and an implementation plan for review with WH and Congressional leaders.
   2. By July 1, 2020, publish a plan for publicly releasing HHS datasets containing information relevant to assessing quality in healthcare delivery, within the parameters of what the government can legally release.
2. By July 1, 2020, perform a review of CMS processes for ensuring data integrity as part of the survey and certification process for providers, and develop revised standards for auditing data that can be applied across all federal programs to ensure data validity.
3. By December 31, 2020, establish agreements within the federal government to share data across federal programs in order to facilitate quality measurement.
4. By December 31, 2020, gather inputs on infrastructure changes that would reduce provider burden of federal reporting requirements, such as a "report once" structure that reduces the need for providers to submit redundant data via multiple different avenues. This can be conducted in conjunction with RFI activity and responses to be performed by the transition team.

Further Actions under Consideration

• Make needed data infrastructure changes to support further dissemination of quality-related information to the public.
• Build an infrastructure that allows providers to "report the data once" in a standard format, permitting federal partners to repurpose that data for multiple programmatic purposes.
• Develop a blueprint to rapidly accelerate the use of measures derived from entirely electronic data sources, with the goal of 80 percent of quality measures based on electronic data sources by 2025. This blueprint will develop a strategy for information exchange, connectivity of data, and leveraging standards such as Fast Healthcare Interoperability Resources (FHIR)-based application programming interfaces (APIs).
• Develop a blueprint to define data standards and datasets to streamline data abstraction, collection, and reporting activities, to ensure the provision of meaningful and timely quality data.
• Support existing public-private partnerships for building the data infrastructure, such as the Virtual Research Data Center, making code and analysis public and linking datasets to provide more robust information on care quality across the continuum of care.

Quality Measures in Federal Programs

Actions Planned for 2020

1. Develop recommendations for streamlining existing quality reporting and value-based purchasing programs, consistent with proposals in the President's Budget for Fiscal Year (FY) 2020.1
   1. By Spring 2020, solicit input on a program that tests the consolidation of hospital inpatient quality reporting programs, consistent with the proposal included in the President's Budget.
   2. By Summer 2020, move forward with the Merit-based Incentive Payment System (MIPS) Value Pathways announced in the Calendar Year 2020 Quality Payment Program Final Rule.2
2. By July 1, 2020, identify specific goals for achieving even more parsimony and alignment of quality measures used in federal programs, including the following actions:
   1. In conjunction with private sector stakeholders, select a limited number of areas of focus for quality improvement across all government agencies, informed by a public convening and RFI.
   2. Develop a unified measures inventory covering all federal programs, including a crosswalk identifying alignment. Characterize each measure by purpose such as payment, research, or quality improvement. Different standards may be needed for each purpose.
   3. In conjunction with private sector stakeholders, identify a parsimonious set of core quality measures considered essential to understanding quality performance and tracking progress in these priority areas. These measures should be meaningful to patients and providers.
   4. Work with federal agencies to realign their quality measure sets with the national priorities and core measures. Identify opportunities to phase out or reduce reliance on measures outside these core sets. Agencies may differ in their measurement needs, but these differences should be purposeful and justifiable, including appropriate adherence to legislative mandates for programs.
3. By July 1, 2020, identify and execute short-term goals for improving management of the measure stewardship process, and implement a plan to achieve these goals. Publish a standards document for the quality measures lifecycle. Explore opportunities to encourage the private sector to develop measures.
4. By July 31, 2020, build on existing, comprehensive review efforts of the CMS Compare sites and Star Ratings, and develop a strategy to reform the way in which CMS shares quality information with patients, to make it more innovative, consumer-friendly, and helpful for patient decision-making. Consider leveraging a different platform and other sources of data not currently made available to the public (e.g., hospital-level procedure volume data).
5. By December 31, 2020, identify opportunities, including private sector partnerships, to improve the timeliness of data shared with providers and investigate sources of delay through rapid-cycle feedback loops, so that providers and organizations can quickly understand their performance and reliably understand future performance.
6. By December 31, 2020, develop actionable recommendations for basing measurement on broader and more generalizable datasets where possible (e.g., leverage all relevant data in CMS programs or all payer data, rather than relying exclusively on Medicare fee-for-service). Leverage and link other types of data not currently used in these programs, such as accreditation, volume, or staffing, to provide a more robust and comprehensive view of quality performance.

Further Actions under Consideration

• Review the use of quality measures in state Medicaid programs, identifying opportunities to help align the use of quality measures across states while still allowing states the flexibility to innovate in how they administer their Medicaid programs.
• Build a user-centric measures repository using newly accessible data (such as de-identified or synthetic) to speed and streamline the measure development process, accelerating the time to market for new quality measures that leverage the most current technologies and address critical national priorities and that can replace existing measures based on legacy data sources.
• Enhance and expand processes for educating providers and patients on federal quality measurement activities and value-based programs, to ensure greater understanding, engagement, and performance. Innovate on the ability to capture the patient voice through Patient Reported Outcomes Measurements (PROM) and develop strategies for PROM to be more available and operational in quality measurement programs, with a focus on measures that demonstrate care is congruent to patient goals.
• Review the use of quality measures in Accountable Care Organization and Alternative Payment Model provider systems, identifying opportunities to help align the use of quality measures across value-based payment models, while still allowing providers the flexibility to innovate in how they administer their care.

• 1. Please see the  HHS FY 2020 Budget in Brief: https://www.hhs.gov/sites/default/files/fy-2020-budget-in-brief.pdf.
• 2. See CY 2020 Physician Fee Schedule Final Rule (84 FR 62568).