Measures that matter

Measures That Matter

The Center’s aim in developing Measures That Matter for primary care practices is to better align assessment and payment policies with what patients and clinicians know to be valuable, to reduce burden, and to reduce burnout.

Measures that matter

Measures That Matter

The Center’s aim in developing Measures That Matter for primary care practices is to better align assessment and payment policies with what patients and clinicians know to be valuable, to reduce burden, and to reduce burnout.

Person-Centered
Primary Care

Continuity
of Care

Comprehensiveness
of Care

Low Value
Care

The Measures That Matter are a suite of four clinical quality measures that the American Board of Family Medicine endorses for simplifying and improving measurement of Primary Care.

A More Meaningful Standard for Primary Care

Whole-person clinical quality measures are the underpinning of what matters in primary care. They are relevant to all communities, in all public health situations, and across all diseases, providing a way to quantify patient-centered quality care.

Measures That Matter focus on more personalized care, taking into account what matters to both patients and clinicians. While current clinical quality measures focused on disease specific care have value, they are not aligned with the foundations of primary care or the needs of patients, communities, and health systems.

Measures That Matter are designed for use across multiple levels of the health care system:

Primary Care Practices
  • Meet patient needs by focusing attention on what matters
  • Reduce burnout and burden by organizing practice around the reason they went into patient care
Employers
  • Assess if the care they are purchasing is doing what patients, clinicians and payers have identified as what matters
  • Require that systems support aspects of primary care that matter
Patients
  • Participate in health care improvement
  • Provide information important for caring for them as a whole person
Insurers and Healthcare Systems
  • Identify where to invest to support those delivering high quality primary care
  • Develop systems that support integrating, personalizing and prioritizing care

Person-Centered Primary Care Measure

Person-Centered Primary Care Measure (PCPCM) is a patient-reported outcome measure (PROM) of exemplary primary care that has been developed by the Larry A. Green Center based on the extensive input of patients, clinicians, and employers. The PCPCM PROM focuses attention and support on the integrating, personalizing, and prioritizing functions that patients and clinicians say are important. The PROM captures facets of continuity and comprehensiveness, as well as elements of advocacy and allegiance. The PCPCM, which won the National Quality Forum’s 2019 Patient-Reported Outcomes Next-Generation Innovator Abstract Award, is available in the PRIME Registry Measure Set and is endorsed by CMS for use in the Merit-Based Incentive Payment System (MIPS) quality payment program.

For more information, please go to the Larry A. Green Center.

Continuity of Care

Continuity of Care is defined as seeing the same primary care clinician over time and it remains one of the pillars of a high functioning health care system. Continuity of Care is shown to improve patient outcomes and clinician wellbeing, decrease hospitalization risk and decrease levels of spending. When continuity is poor, it suggests fragmented care and an associated lack of a trusting relationship in primary care. The Continuity of Care clinical quality measure, developed in collaboration with the Robert Graham Center, is available in the PRIME Registry Measure Set and is endorsed by CMS for use in the MIPS quality payment program.

Comprehensiveness

Comprehensiveness is lauded as one of the five core virtues of primary care, and higher comprehensiveness is associated with lower costs and hospitalization. The Institute of Medicine defined comprehensiveness as “…the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs.” Comprehensiveness is more complex since it overlaps scope of practice and sites of care. The Comprehensiveness clinical quality measure is being developed in collaboration with the Robert Graham Center.

Low-Value Care

Key to the measurement and reporting of total cost of care is our effort to develop a Low Value Care clinical quality measure. The Low Value Care clinical quality measure can help clinicians identify modifiable behaviors as a mechanism to improve primary care’s well documented moderation of total health care spending and sets up capacity for long term evaluation on total cost of care by clinicians. The Low Value Care clinical quality measure is being developed in collaboration with Stanford University and Mount Sinai Health System.

Phase 1: Conceptualization

Information Gathering

Measure development begins with information gathering – the measure developer conducts an environmental scan, develops a business case and requests input from a broad group of stakeholders including patients. The developer then narrows down the concepts to specific measures.

Phase 2: Specification

Draft Specifications

After the information gathering phase, we begin to draft the measure specifications. Measure specifications provide the comprehensive details that allow the measure to be collected and implemented consistently, reliably, and effectively. The specifications identify the population, the recommended practice, the expected outcome and determine how it will be measured. They also may include age ranges, performance time period and allowable values for medical conditions or procedures, code systems, descriptions.

Measure technical specifications will address the following questions: How will the measure be named? Does the name mean anything to people when they read it? Do they understand what that measure is about? What would the setting of the measure be (e.g., ambulatory office)? How will the data be collected? These questions have to be answered before testing begins.

Harmonization is all about reducing burden. Look at measures currently in practice and determine if there are places where our measure could be harmonized with the existing measure(s).

Phase 3: Testing

Measure Testing

Measure testing assesses the suitability of the quality measure’s technical specifications and acquires empirical evidence to help assess the strengths and weaknesses of a measure. Measure testing involves testing the components of the quality measure such as the data elements, the scales (and items in the scales if applicable), and the performance score.

There are two parts to measure testing: alpha and the beta testing.

Alpha testing helps identify early issues and often begins as early as the conceptualization step and is repeated during the development of the measure specifications.

Beta testing, which is also referred to as field testing, generally occurs after the initial specifications have been developed, and strives for representative sample sizes – multiple sites/settings. The primary purpose for beta testing is to understand the usability of the measure and to test the scientific acceptability of the measure.

After the testing ends, the results are analyzed with a return to the specification phase, or even the conceptualization phase, to rework the measure before testing again.

The PRIME registry is ABFM’s Qualified Clinical Data Registry (QCDR) and serves as our measure testing bed.

Phase 4: Implementation

Measure Implementation

The measure is then submitted for NQF endorsement (not a requirement for use by CMS) and for use in the 18 CMS quality reporting and payment programs.

What’s the difference between submitting to CMS versus submitting to NQF?

The National Quality Forum (NQF) submission is about the endorsement process where a consensus-based entity reviews the measure using five evaluation criteria to assess the measure on its own merit and independent of a CMS program. It essentially gives it that stamp of approval, and so endorsement/NQF submission is separate from CMS implementation. NQF endorsement is valued for measures in CMS programs, but it is not a requirement.

The CMS implementation process takes the measure from being in development to being actively used in 18 of the CMS quality payment programs (QPP).

Phase 5: Use, Continuing Evaluation, and Maintenance

Re-evaluation

This step ensures that the measure continues to add value to quality reporting measurement programs and that its construction continues to be sound. The regular reevaluation of measures is vital as the science and other factors are always changing (e.g., development of new clinical guidelines, new technologies for data collection, discovering a better way to calculate measure results). Continually reviewing the measure will ensure it remains relevant and meaningful. Measures that stop being useful are retired.

Interaction Among Measure Lifecycle Phases

The Measure development lifecycle is not a linear process. Once the measure is conceptualized, it can move throughout the various phases in the measure development lifecycle.

Decision Criteria

The following decision criteria throughout the measure development cycle ensures a measure meets the applicable standards before moving to the next phase:

Importance to measure and report—including analysis of opportunities for improvement such as reducing variability in comparison groups or disparities in healthcare related to race, ethnicity, age, or other classifications.

Scientific acceptability—including analysis of reliability, validity, and exclusion appropriateness.

Feasibility—including evaluation of reported costs or perceived burden, frequency of missing data, and description of data availability.

Usability—including planned analyses to demonstrate that the measure is meaningful and useful to the target audience. This may be accomplished by the Technical Expert Panel (TEP) reviewing the measure results such as means and detectable differences, dispersion of comparison groups, etc. More formal testing, if requested by CMS, may require assessment via structured surveys or focus groups to evaluate the usability of the measure (e.g., clinical impact of detectable differences, evaluation of the variability among groups).

  • Person-Centered Primary Care

  • Continuity of Care

  • Comprehensiveness of Care

  • Low Value Care

The Measures That Matter are a suite of four clinical quality measures that the American Board of Family Medicine endorses for simplifying and improving measurement of Primary Care.

A More Meaningful Standard for Primary Care

Whole-person clinical quality measures are the underpinning of what matters in primary care. They are relevant to all communities, in all public health situations, and across all diseases, providing a way to quantify patient-centered quality care.

Measures That Matter focus on more personalized care, taking into account what matters to both patients and clinicians. While current clinical quality measures focused on disease specific care have value, they are not aligned with the foundations of primary care or the needs of patients, communities, and health systems.

Measures That Matter are designed for use across multiple levels of the health care system:

Primary Care Practices
  • Meet patient needs by focusing attention on what matters
  • Reduce burnout and burden by organizing practice around the reason they went into patient care
Employers
  • Assess if the care they are purchasing is doing what patients, clinicians and payers have identified as what matters
  • Require that systems support aspects of primary care that matter
Patients
  • Participate in health care improvement
  • Provide information important for caring for them as a whole person
Insurers and Healthcare Systems
  • Identify where to invest to support those delivering high quality primary care
  • Develop systems that support integrating, personalizing and prioritizing care

Person-Centered Primary Care Measure

Person-Centered Primary Care Measure (PCPCM) is a patient-reported outcome measure (PROM) of exemplary primary care that has been developed by the Larry A. Green Center based on the extensive input of patients, clinicians, and employers. The PCPCM PROM focuses attention and support on the integrating, personalizing, and prioritizing functions that patients and clinicians say are important. The PROM captures facets of continuity and comprehensiveness, as well as elements of advocacy and allegiance. The PCPCM, which won the National Quality Forum’s 2019 Patient-Reported Outcomes Next-Generation Innovator Abstract Award, is available in the PRIME Registry Measure Set and is endorsed by CMS for use in the Merit-Based Incentive Payment System (MIPS) quality payment program.

For more information, please go to the Larry A. Green Center.

Continuity of Care

Continuity of Care is defined as seeing the same primary care clinician over time and it remains one of the pillars of a high functioning health care system. Continuity of Care is shown to improve patient outcomes and clinician wellbeing, decrease hospitalization risk and decrease levels of spending. When continuity is poor, it suggests fragmented care and an associated lack of a trusting relationship in primary care. The Continuity of Care clinical quality measure, developed in collaboration with the Robert Graham Center, is available in the PRIME Registry Measure Set and is endorsed by CMS for use in the MIPS quality payment program.

Comprehensiveness

Comprehensiveness is lauded as one of the five core virtues of primary care, and higher comprehensiveness is associated with lower costs and hospitalization. The Institute of Medicine defined comprehensiveness as “…the provision of in