CQMC Finds Quality Measurement Gaps, Supports Digital Measures

March 28, 2022 - Members of the Core Quality Measures Collaborative (CQMC), including AHIP, have identified multiple quality measurement gaps and recommended new digital quality measures and health equity quality measures.

“As we expand performance measurement, it is critical that we move to digital measurement to reduce the resources required and get the information in front of the physicians when it counts,” Danielle A. Lloyd, senior vice president of private market innovations and quality initiatives at AHIP and CQMC steering committee chair, said in the AHIP press release. 

“Moreover, we need to get physicians information on not only clinical gaps in care, but also social barriers patients may be facing contributing to disparities in outcomes.”

CQMC is a partnership between AHIP and the Centers for Medicare & Medicaid Services (CMS) with involvement from the National Quality Forum (NQF). More than 75 stakeholders comprise CQMC, including health insurers, medical associations, consumer groups, and others. These organizations convened to change the CQMC quality measures and identify quality measure gaps.

“Gaps refer to areas that are not yet measured or adequately covered by measurement, as identified by the CQMC Workgroups within the clinical domains of current core sets,” the report assessing quality measurement gaps explained.

Ultimately, the report found seven quality measurement gaps.

First, CQMC workgroups found that outcome measurements were not aligned and perpetuated measurement gaps. CMS has identified member outcomes measures as crucial for assessing the quality of care across care sites, including home healthcare quality measurement.

“While both process and outcome measures are important, outcome measures provide vital information on the healthcare results that matter most to patients,” the report stated. “The use of outcome measures supports a holistic, patient-centered approach to quality measurement.”

Second, CQMC supported patient-reported outcome performance measures (PRO-PMs). According to separate supplemental materials from CMS, several PRO-PMs are already in existence, including measures for specific and total knee replacement surgery conditions post-surgery. Such measures may amplify members’ voices.

However, CQMC noted that while these measures exist, there is limited evidence surrounding their implementation.

Third, CQMC found that it may be beneficial to institute cross-cutting measures — quality measures that can apply across various specialties. In response, the coalition established a workgroup that set a definition for “cross-cutting measures” and outlined the five domains of such quality measures.

Cross-cutting quality measures assess the quality of fundamental healthcare components in conditions and diseases, disease prevention, episodes of care, multiple populations, and various provider types. The five domains of cross-cutting quality measures are patient safety, patient and family engagement, care coordination, equity, and population health.

Fourteen specific measures are currently under review as cross-cutting quality measures.

Fourth, the report identified gaps in health equity and care disparity quality measures. CQMC suggested two paths for addressing these gaps: design new health equity measures or stratify current measures to include health equity data. Incorporating social determinants of health quality measures could be one step toward advancing health equity quality measurement.

Fifth, CQMC promoted the use of digital quality measures to better assess quality of care. CQMC members found that digital quality measures could reduce reporting burden, improve quality measurement, and introduce new quality of care data sources. 

The National Committee for Quality Assurance has also supported digital quality measures and has argued that a shift to this form of assessing quality of care could empower value-based care initiatives.

Sixth, the collaborative outlined the different levels of quality measurement—namely, clinician-level and facility-level—and how CQMC might expand these quality measures.

Finally, CQMC addressed telehealth and virtual visit quality measures.

“Future efforts in measurement specifications, measure review, and selection for future core sets should account for the use of innovative technologies for healthcare delivery and its impact on health outcomes,” the report concluded for this measure. “Additionally, measures in future core sets could address access to healthcare and quality via telehealth.”

In order to improve virtual care quality measures, payers may have to partner with policymakers and providers and refine their data gathering techniques for these avenues of care, a CitiusTech survey found.

The CQMC report highlighted various ways in which payers and their partners can improve quality measurements and hinted at future reports that may address the solutions that could empower that change.