The Measure Applications Partnership (MAP), a public-private collaboration established under the auspices of the National Quality Forum (NQF), has submitted to the Department of Health and Human Services (HHS) its second annual round of suggestions with regard to federal performance measures.
MAP's 110 members represent consumers, business and purchasers, labor, health plans, clinicians, hospitals, other providers, communities and states, suppliers, accreditation and certification organizations, and federal agencies.
Its work fulfills a statutory requirement for multi-stakeholder input to HHS on the selection of performance measures for public reporting and performance-based payment programs, while also working to align measures being used for public and private sector programs.
By encouraging the private and public sectors to use the same measurement approaches and measures, officials say, MAP seeks to drive improvement, transparency and value in healthcare, furthering the "triple aim" of the National Quality Strategy: better care for individuals, better population health and lower costs.
"MAP’s recommendations are meant to promote the selection of measures that will drive improvement for those providing care, transparency for those seeking care, and value for those paying for care," said Elizabeth McGlynn, co-chair of the MAP coordinating committee, in a statement.
The partnership reviewed a list of more than 500 measures under consideration for 20 federal programs covering clinician, hospital and post-acute care/long-term care settings.
Of those, the group supported the immediate application of 141 measures in federal programs and supported the direction of another 166 measures, contingent on further development, testing or NQF endorsement.
On the other hand, MAP declined to support 165 measures under consideration and recommended phased removal of 64 current measures. Meanwhile, it recommended six measures that are not on HHS’ list of measures under consideration be added to programs.
"Measurement is an integral step toward achieving care of the highest value," said George Isham, MD, co-chair of the MAP coordinating committee, in a statement. "One of MAP’s priorities is to help identity high-impact measures that work together across settings, prevent unnecessary measurement burden and help assess the value of the healthcare services being provided."
MAP officials say a number of themes emerged during its review, during with 94 stakeholders submitted more than 400 comments on the draft recommendations:
- System-level measurement is crucial for the move toward a patient-centered approach to measurement and a framework for constructing measure sets that address the triple aim.
- The shift from pay-for-reporting to pay-for-performance necessitates that performance measurement should be more rigorous to match increased provider accountability.
- Shared accountability for care delivery and community engagement are needed to address diverse needs and fragmented care, particularly of vulnerable populations.
- Measures of clinical quality, particularly outcomes, should ideally be linked to cost measures.
Health information technology, particularly, electronic health records obviously have a critical role to play.
Among MAP's suggestions was its recommended alignment of the Medicare Shared Savings Program (MSSP) with meaningful use measures. As integrated systems adopt health IT at a rapid clip, they should have aligned incentives across programs, the group argues. Most measures in MSSP are finalized for meaningful use, but some that are not could be revised for electronic reporting and incorporated, officials say.
Another recommendation was to have more proactive outreach to developers, including EHR vendors, to tackle gaps in measurement.
"Regularly convening measure developers for discussions with those who can elucidate the highest priority gaps can provide real-time feedback as measures are identified, developed and implemented," according to the MAP report. "NQF is also exploring ways to heighten collaboration through creation of a virtual 'measure incubator,' which would allow stakeholders interested in addressing measurement gaps to collaborate with measure funders, developers, EHR vendors, healthcare systems with advanced measures and local/regional collaboratives."
The MAP Strategic Plan for 2012-2015 also seeks to set up feedback loops about measure use, in hopes of driving better care through smarter use of health IT.
This year, MAP will establish those loops, to set up "two-way exchange of information about measure implementation, use and impact to inform MAP’s recommendations and to determine how to better meet the measure selection needs of public- and private-sector performance measurement programs."
Pointing to the recent Institute of Medicine report, "Best Care at Lower Cost: The Path to Continuously Learning Health Care in America," MAP cited the creation of feedback loops as essential for system improvement.
"A continuously learning system uses information to change and improve its actions and outputs over time," wrote MAP officials. "Ideally, the exchange of information through feedback loops is systematic, standardized, real-time, two-way, occurs among all levels of the system and takes best advantage of information technology.
The full report (PDF) is available here.