Aligning Quality Measures across Payers
With a growing emphasis on improving the quality of health care, public and private payers are increasingly measuring the performance of providers on a variety of quality metrics. The purpose of gathering these metrics is to evaluate health care providers and drive them to improve their performance, whether directly through pay-for-performance schemes that give providers financial incentives to improve or indirectly through transparency programs that allow health care consumers to compare the performance of providers and seek care from providers that deliver high-quality services.
The result of many payers individually selecting or developing their own quality measures has been a proliferation of many diverse measures. A related issue is that multiple payers may use the same or similar quality measures, but these individual payers may have different reporting requirements (e.g., time period for reporting). The large number of quality measures, with reporting requirements that may vary by payer, can create substantial administrative burden and make it difficult for providers to focus improvement efforts.
To help address these challenges, a number of states have undertaken efforts at aligning quality measures across multiple payers. In addition to the anticipated benefit of enhanced quality, these efforts at quality measure alignment could potentially yield other benefits. For example, if a system were devised for combining the quality measure data across multiple payers, the precision of the measures could be improved by increasing the size of population, and economies of scale could be achieved by reducing duplication in the reporting and analysis of quality measure data.
This paper describes the efforts of several of the SIM states and provides a framework for states interested in pursuing their own efforts at quality measure alignment, and Table 1 provides a comparison of the states’ quality measure alignment efforts.
Appendix A offers states a tool to catalogue existing quality measures and identify current alignment, and to consider how those measures meet states’ goals and evaluation criteria.