NQF-Convened Group Provides Third Annual Recommendations on Measures for More Than 20 Federal Healthcare Programs 

Washington, DC - Identification of measures that fill acknowledged gaps and increase measure alignment were two major areas of progress highlighted in the Measure Applications Partnership’s (MAP) third annual round of input to the Department of Health and Human Services (HHS). MAP recommends performance measures for use in more than 20 federal programs, and focuses on enhancing alignment or use of the same measures across these federal programs and between the public and private sectors.

A public-private partnership convened by the National Quality Forum (NQF), MAP fulfills a statutory requirement for multi-stakeholder input to HHS on the selection of performance measures for public reporting and performance-based payment programs. MAP represents several major stakeholder groups, including consumers, purchasers, health plans, clinicians and providers, suppliers, accreditation and certification entities, communities and states, and the federal government, as well as subject matter experts for areas such as health IT and healthcare disparities.

“MAP recommended measures that will drive the healthcare system to higher performance in key priority areas,” said George Isham, MD, MS, co-chair of the MAP Coordinating Committee. “In tandem with payment and delivery system changes, such measures will make care more affordable, provide better public information about healthcare acquired conditions, and reduce the burden on providers to report on multiple measures that are often similar.”

On December 1, 2013, MAP received and began review of more than 230 measures under consideration for use in federal programs covering clinician, hospital, and post-acute care/long-term care settings. MAP ultimately supported or conditionally supported more than 80% of measures being evaluated for potential use in “gateway” pay-for-reporting programs that serve as a starting place for engaging providers in reporting and for gaining experience with new measures. MAP was more selective in recommending measures for use in “higher stakes” public reporting and pay-for-performance programs, supporting or conditionally supporting fewer than half of the measures being considered for those programs.

MAP works in a transparent manner with a carefully balanced composition of members representing all areas of healthcare. In total, more than 140 experts who regularly use measures and measurement information participated in MAP discussions. For the first time, NQF provided the list of measures under consideration to the public for their comment prior to MAP review, which resulted in 314 comments from 60 organizations that informed committee deliberations. MAP received an additional 354 comments from 53 organizations on MAP’s draft recommendations, which were included in the final report.

“MAP has taken important steps to engage end users and to enhance its transparency – inviting public comments before committee review and posting all comments on NQF’s website,” said Dr. Christine Cassel, NQF president and CEO. “The input we received from the early public commenting process was invaluable to MAP’s review. Several public commenters commended MAP for creating an earlier opportunity for stakeholders not on MAP committees to offer upstream input on measures under consideration.”

The report promotes alignment, or use of the same or related measures, as a critical strategy for accelerating improvement in priority areas, reducing duplicative data collection, and enhancing comparability and transparency of healthcare information. To date, at least 285 measures are in use across three or more HHS programs. MAP relied on its families of related measures and information about current measure use in various public and private sector programs to inform selection of measures that promote alignment. MAP also began work to identify a core set of measures for individual clinician reporting that would be applicable across clinician programs.

“Coordinating measure use across multiple programs, settings of care, and points of time will allow us to effectively reduce the data reporting burden that care providers experience on a daily basis,” said Elizabeth McGlynn, PhD, co-chair of the MAP Coordinating Committee. “This will allow providers to focus on what really matters most – the well-being of their patients.”

MAP and NQF will be undertaking additional activities during 2014 that will build on its first three years of work and enhance its recommendations for future pre-rulemaking cycles. These include:

• Building on the families of measures concept to identify the best available measures and measure gaps for the topics of person- and family-centered care, population health, and affordability;
• Holding a lean (kaizen) event aimed at improving MAP’s processes and better integrating the measure endorsement and selection functions;
• Exploring methodologies for appropriately adjusting measures for socioeconomic status to ensure fair comparisons; and
• Holding a design meeting to further conceptualize a “measure incubator” to support measure development through technical support and matchmaking with funders, test beds, and end-users.

Taken together, these activities will accelerate filling the current gaps in performance measurement programs with the measures we need to improve the value of health care for patients and our nation as a whole.

The final report is now available online. To learn more about MAP, please visit www.qualityforum.org/MAP.

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