Putting Patients Back at the Center of Healthcare: How CMS Measures Prioritize Patient-Centered Outcomes
This report is based on a 2019 Healthcare Analytics Summit presentation given by Kimberly Rawlings, MPP, Measures Management System Lead, CMS, titled, “Meaningful Measures: Prioritizing Patients Over Paperwork.”
Two themes dominate patient and clinician experience today: drastically increased clinician screen time in the exam room and increased regulatory burdens on clinicians and health systems. A primary side effect of these contemporary trends is a loss of patient engagement. Clinicians and organizations become so taxed with reports and measures that what should be their number one priority—the patient—gets lost in the shuffle. Without patients at the center, healthcare organizations can miss information about care delivery or outcomes, and thus fail to properly align goals and resources around patient-centered outcomes improvements and lowered costs.
To move the patient back to the center of care, CMS launched its Meaningful Measures framework, including the Patients over Paperwork initiative, in 2017. The patient-centered effort aims to evaluate the current regulatory practices that hinder a productive patient-clinician relationship and establish CMS strategies that put patients first across all programs (Medicare, Medicaid, and the exchanges). Meaningful Measures works to empower patients and clinicians in key ways: getting patients the right care, at the right time, in the right place and ensuring both patients and clinicians have the data they need to realize these goals.
Interoperability: The Foundation for Innovation in Patient-Centered Care
Achieving CMS’s patient-centered goals will require innovation across all payment models, including interoperability—the ability to share data across disparate systems for seamless data sharing among patients, clinicians, payer, and providers. Health systems must have effective, open data sharing practices to keep patients healthy, while payers need shared data to tie payments to outcomes. As the lynchpin of patient-centered care and Meaningful Measures objectives, interoperability also gives clinicians the timely information they need to make decisions at the point of care, versus waiting days or weeks for critical information. Data sharing across patients and clinicians enables coordinated care, better outcomes, and reduced costs, as providers have insights to avoid drivers of cost and poor outcomes, such as repeats of costly tests and adverse drug interactions.
From Aligning and Reducing Measures to Incentivizing Sound Decision Making
CMS introduced Meaningful Measures to address the problem of too many disparate measures and a subsequent unsustainable administrative reporting and provider cost burden. The framework aims to simplify processes by focusing on critical areas that matter most for clinicians and patients and promoting alignment and stimulating innovation for new types of measures to better serve patients, clinicians, and providers.
Meaningful Measures focus industry efforts on quality areas that fulfill certain criteria:
- Address high-impact measure areas that safeguard public health.
- Are patient-centered and meaningful to patients, clinicians, and providers.
- Are outcome-based where possible.
- Fulfill requirements in CMS statutes.
- Minimize level of burden for providers.
- Identify significant opportunity for improvement.
- Address measure needs for population-based payment through alternative payment
- Align across programs and/or with other payers.
The framework’s introduction allowed CMS to pause from the fast pace of measure development and implementation to reflect on what’s meaningful to patients, resolve disparate measures and reporting burdens, and promote measurement alignment with four strategic goals (Figure 1):
- Introduce more flexibility and local leadership.
- Support innovation.
- Empowering patients and clinicians.
- Improving the customer experience.
Figure 1: Four strategic goals for the CMS Meaningful Measures program.
Meaningful Measures promotes patient-centered healthcare improvement in eight areas—each with accompanying measures to support improved outcomes:
- Preventive care.
- Management of chronic conditions.
- Prevention, treatment, and management of mental health.
- Prevention, treatment, and management of opioid and substance use disorders.
- Risk-adjusted mortality.
- Medication management.
- Admissions and readmissions to hospitals.
- Transfer of health information and interoperability.
Meaningful Measures aligns with existing quality-reporting programs and helps those programs identify and select individual measures. It also allows clinicians and other providers to focus on patients and improve care in meaningful ways, capturing the most-impactful and highest-priority quality improvement areas for all clinicians including specialists. The initiative guides rulemaking, measures-under-construction lists, and impact assessments.
The Next Steps for CMS Quality Measures
In the coming years, Meaningful Measures will continue to focus on engaging stakeholders in the development of measures that matter most to clinicians and patients. Clinicians don’t want to report on what they feel doesn’t matter (i.e., doesn’t improve outcomes or reduce costs). To that end and based on stakeholder input, priorities moving forward will include patient-reported outcomes, electronic clinical quality measures, appropriate use of opioids and avoidance of harm, nursing home safety, maternal mortality, and sepsis.
A Framework for Patient-Centered Care
Meaningful Measures established a vision and a practical strategy for getting patients back at the center of healthcare. Importantly, CMS is listening to stakeholders on the frontlines of care delivery—including patients, clinicians, and providers—to ensure that quality measures work for, not against, better care and lower costs. As more advanced electronic infrastructure promises to support more data interoperability, CMS will have further insights into ways to remove obstacles to patient engagement while also advancing quality goals.
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- DSRIP in 2018: Continuing Efforts for Medicaid Reform