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The Core Quality Measures Collaborative
The American Academy of Family Physicians Academy has participated in the Core Measures Collaborative (the Collaborative) convened by America’s Health Insurance Plans (AHIP) since August 2014. The Collaborative is a multi-stakeholder effort working to define core measure sets of various specialties promoting alignment and harmonization of measure use and collection across both public and private payers.
Participants in the Collaborative included Centers for Medicare and Medicaid Services (CMS), the National Quality Forum (NQF), private payers, provider organizations, employers, and patient and consumer groups. This effort exists to decrease physician burden by reducing variability in measure selection, specifications and implementation– making quality measurement more useful and meaningful for consumers, employers, as well as public and private clinicians.
The Collaborative seeks to promote evidence-based measures and generate valuable information for quality improvement, decision-making, and value-based payment and purchasing. The core measure sets are designed to be meaningful to patients, consumers, and physicians, while maintaining parsimony and reducing the collection burden and cost.
Reducing Administrative Burden on Family Medicine
In the current payment environment, 61% of family physicians have contracts with seven or more payers, and are responsible for numerous different quality measure sets as required by each payer. Often these measures do not align and use different specifications for the same measure topic. This leads to administrative burden, measurement fatigue, complexity, and frustration.
Over 70 percent of family physicians indicate the lack of alignment among payers is a significant barrier to value-based care delivery. Developing a core set of measures will reduce variation among measure selection, specifications, and implantation among payers, which will reduce the burden on family physicians related to quality measurement.
Primary Care Core Measure Set
With significant AAFP input, a PCMH/ACO/Primary Care Core Measure Set has been developed for primary care. The goal of this set is to decrease burden and allow for more congruence between payer reporting programs.
Clinical topics included in the core set are:
- Care coordination
- Prevention and wellness
- Behavioral health
- Overuse and utilization
- Patient experience
Implementation and Adoption by Payers
CMS and private health plans have committed to phasing in the core measure sets. CMS plans to adopt measures not currently included in their programs, such as PQRS, and will engage the rule-making process to solicit stakeholder and public input before adoption. Private health plans will use a phased-in approach to implementation. Such a phase-in will be determined by certain specific factors, such as contracts.