Identifying Value in Multi-Payer Reform: The Nuts and Bolts of Quality Measurement

States across the nation are transitioning their health care systems from fee-for-service to payment models that reward quality and positive outcomes. Public and private payers are moving towards paying for value over volume. But, how do states define high quality? What, precisely, are health insurance carriers rewarding? States and federal agencies are developing aligned measure sets across payers, often leveraging programs made possible through the Affordable Care Act, as noted in our last blog post.
In a recent webinar held as part of NASHP’s Achieving Payment Reform to Improve Quality and Integration of Care project, panelists discussed state and national strategies to identify, select, and integrate quality measures into multi-payer payment models. With a plethora of existing and validated measures, where do states start their selection process?

• Consider measures in use. Kevin Larsen, MD, Medical Director of Meaningful Use at the Office of the National Coordinator for HIT (ONC), suggested that states look at measures already in use. For example, the Medicaid core measure set is an important resource as well as measure sets for state employees.
• Set priorities in health system performance improvement and outcomes. Dr. Larsen stated that the federal government prioritized leading causes of death, such as cardiovascular issues, which led to the Million Hearts campaign to report actionable data and measure progress in preventing heart attacks and strokes.
• Leverage helpful resources. The Buying Value Measure Selection Tool, for example, is designed to help states and other stakeholders develop quality measure sets. The tool allows states to prioritize their own quality improvement needs while also maximizing alignment with existing measure sets at the state and federal level.
• Engage stakeholders. In order to achieve alignment across multiple payers, obtaining buy-in from stakeholders is critical. To this end, states often create metric selection committees with broad representation.

Webinar panelists Lori Coyner, Director of Health Analytics at Oregon’s Health Authority, andStefan Gildemeister, Director of the Minnesota Health Department’s Health Economics Program, discussed their states’ strategies for collaborating with key partners to develop and implement aligned metrics:
Minnesota developed a Statewide Quality Reporting Measurement System (SQRMS) to inform multi-payer approaches to measurement and quality improvement. SQRMS, created by the Minnesota 2008 Health Reform law, establishes standards for quality measures, develops an evolving measure set, creates a system for metric risk adjustment, and integrates metrics into financial incentive models. SQRMS builds on years of groundwork laid in the private market and partners with Minnesota Community Measurement and its stakeholders to develop recommendations for measure set changes. MN Community Measurement also educates providers on metric requirements and facilitates data collection and reporting to the state.
Minnesota has integrated its SQRMS metrics into multi-payer payment reform. One example of integration into payment methodology is the Quality Incentive Payment System (QIPS), commonly known as a Pay For Performance incentive program. QIPS is a statewide incentive framework that encourages public and private payers to adopt standard measures, thereby reducing provider reporting burden and enhancing quality improvement in targeted areas. Providers receive payments based upon a comparison of provider performance against specified targets and improvements.
Oregon’s Coordinated Care Organizations (CCOs), which serve the Medicaid population and will soon cover state employees, have a CCO Accountability plan that includes 17 incentive metricsdeveloped by Oregon’s multi-stakeholder Metrics and Scoring Committee. The CCO incentive measures cover multiple domains (e.g., outcomes, patient experience), all CCO services (e.g., prevention, care coordination, dental), and all CCO populations (e.g., children, individuals with disabilities). If CCOs meet the benchmark or an improvement target on 12 of the 17 measures and have 60 percent of their members enrolled in a Patient Centered Primary Care Home, they receive 100 percent of their quality pool funds.
After states develop aligned measure sets and integrate them into payment incentives, how do they ensure that reported metrics become actionable data? Process and outcome reports are only helpful if providers can leverage the data to improve quality. As Dr. Larsen noted, quality improvement often occurs locally, and providers need real-time data to drive change. Rapid feedback allows providers to make immediate enhancements that benefit current patients.
There is no recipe for a perfect quality measure set. Metrics that are aligned across multiple payers, public and private, are important, though, to allow a state to measure its progress and identify areas for improvement at a population level, implement changes based on actionable data, and send a consistent signal to providers who may be overwhelmed by payers’ requirements. States are making strides in integrating measures into payment models and utilizing reported data to make delivery system improvements. Over time, as states forge ahead with transformative efforts, we will see which measurement strategies move the needle to improve quality of care, enhance population health, and lower costs.
Share your state’s efforts to develop and implement aligned quality metrics in a comment below or on our multi-sector payment reform discussion page.