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CMS Stresses Informed Decision-Making in Performance Reports

Consumer engagement and putting the patients at the heart of the matter is a priority for CMS as it continues to push toward informed decision-making among its stakeholders.

By Vera Gruessner

- Since the Affordable Care Act was initially created, the Centers for Medicare & Medicaid Services (CMS) have been focused on improving informed decision-making among payers, providers, the patient community, and other stakeholders. CMS announced that it is committed to strengthening data transparency within the healthcare system.

Qualified Entity Program

Some methods in which CMS has moved ahead in its goals include establishing data on geographic differences in Medicare use and quality along with information on how healthcare providers use Medicare and their general medicine prescribing patterns.

“We have released data on geographic variation in Medicare utilization and quality, as well as data on provider level utilization,” CMS reported. “A commitment to making such resources available puts engaged and empowered individuals at the center of their care, which is essential to transforming our system to one that delivers better care, smarter spending, and healthier people.”

Consumer engagement and putting the patients at the heart of the matter is a priority for CMS as it continues to push toward informed decision-making among its stakeholders. The Affordable Care Act led to the creation of the Qualified Entity program, which pushes healthcare transparency further.

The Qualified Entity program manages the development of performance reports and information to assist healthcare providers in improving quality of care as well as improve healthcare performance transparency by making data available to the public. Employers, patients, caregivers, and consumer groups benefit by having access to this important data and having informed decision-making facilitated through greater transparency.

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There are a number of qualified entities that are participating in the Medicare Data Sharing for Performance Measurement Program and some of these include the Oregon Health Care Quality Corporation, the Maine Health Management Coalition Foundation, the California Healthcare Performance Information System, and the Pittsburgh Regional Health Initiative.

A section of the Affordable Care Act requires that Medicare claims data extracts are freely accessed among eligible, qualified entities. The qualified entities then use the data to study provider performance, quality, and cost as well as create reports for general public access.

Qualified entities also have the opportunity to select the geographic areas they wish to serve. CMS hopes that this method of provider performance reporting to the general public will lead to better quality and lower costs in the Medicare program as well as throughout the healthcare industry. Additionally, it is expected to improve both transparency and informed decision-making among the patient community.

CMS announced that there are 12 certified QEs – 11 QEs established to report regionally and one QE that will be reporting for the entire nation. After the launch of this particular program, two qualified entities have released a performance report to the public and, yesterday, CMS announced the expansion of the Qualified Entity program with the introduction of a second nationwide QE called Amino. 

Using Medicare data, Amino will be able to help ensure American citizens have the capability to incorporate informed decision-making in their healthcare choices including deciding which medical providers will best meet their needs.

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Before the Patient Protection and Affordable Care Act was passed and took effect in 2014, a comprehensive system for addressing healthcare transparency was lacking. Consumers, payers, and caregivers were unable to determine which providers had the best quality care and were most cost effective when accessing performance reports. Essentially, healthcare transparency was fragmented at the time.

The Qualified Entity program allows for the development of more effective performance reporting and really show an overall assessment of provider quality and cost of care by looking at both Medicare data and the information gathered from various health plans.

In August 2014, the first public report from a qualified entity about provider performance was released. The Oregon Health Care Quality Corporation (Q Corp) released the Medicare-driven report, according to a company press release. This made a large impact on improving the type of information consumers had access to regarding the quality of care in the state of Oregon.

“Our organization is dedicated to improving the quality and affordability of health care in Oregon by leading community collaborations and producing unbiased information,” Mylia Christensen, Executive Director at Q Corp, stated in the press release. “We are delighted that the Centers for Medicare & Medicaid Services has joined our longstanding collaborative efforts so that we can now provide information on the care received by over 2.6 million Oregonians.”

“The first public report using Medicare data comes from the Oregon Health Care Quality Corporation (Q-Corp), an organization that produces data and analytics about the quality and utilization of health care in Oregon,” CMS announced last year.

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“Q-Corp was one of the first entities to be certified for Medicare data sharing. The addition of Medicare data has allowed Q-Corp to offer providers and consumers more complete information about the quality of care across the state of Oregon. The Medicare data has also allowed Q-Corp to publish quality measures for clinics that did not have a large enough patient population for reporting using only commercial and Medicaid data.”

CMS also announced in their release that the future Notice of Proposed Rulemaking will contain an augment to the Qualified Entity program. These changes to the program are part of the Congressional passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

These changes are expected to expand the healthcare transparency and public disclosures of the Qualified Entity program. CMS will be seeking public and stakeholder feedback when the new Notice of Proposed Rulemaking is released.


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