Quality Measure Development Plan (MDP)

On May 2, 2016, CMS finalized the MDP, mandated under the Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act (MACRA), to support the new Merit-based Incentive Payment System and Advanced Alternative Payment Models. MACRA supports a transition to value-based payment incentives for physicians and other clinicians to be based on quality, rather than quantity, of care.

The MDP is an essential resource in this transition, as it provides the foundation and a strategic framework for building and implementing a measure portfolio to support quality payment programs under MACRA. The MDP highlights known clinical and specialty measurement and performance gaps and recommends prioritized approaches to close these gaps through the development, adoption, and refinement of quality measures.

Through the application of the principles included in the MDP and the quality measure development funded by MACRA, CMS is committed to increased transparency and partnerships with persons and families, clinicians, and professional societies to develop measures that are meaningful, applicable, and useful across payors and health care settings. These quality measures are essential to address critical performance gaps, facilitate alignment across settings and payors, and promote efficient data collection. CMS intends for the MDP and related quality measures to be key levers of delivery system reform, promoting movement toward paying for value rather than volume and improved national health care delivery.

For more information, including the MDP, MDP Annual Reports, and MDP Environmental Scan and Gap Analysis Reports, view the Quality Payment Program measure development website. 

Measure Monitoring and Maintenance 

Once a measure is in use, it requires ongoing monitoring and maintenance in addition to formal periodic reevaluations to determine whether it remains appropriate for continued use. The measure developer conducts measure trend analyses, evaluates barriers, and identifies unintended consequences associated with specific measures in their purview.

Measure maintenance yields information CMS leadership may find valuable for setting priorities. This information may include barriers to implementation of measures, unintended consequences, lessons learned, measure impact on measured entities, care disparities, and gaps in care. Measure maintenance includes assessment of the performance of the measure, including trend analyses, and comparison to the initial projected performance found in the business case. CMS uses this input to decide whether to remove, retire, modify, suspend, or retain a measure in a specific CMS program.

In addition to measure maintenance, CMS conducts various evaluations and assessments of its measures and programs to determine the effectiveness of its programs. Many of these programs use quality measures, and these analyses evaluate the usefulness of the measures as used in the programs.

The triennial National Impact Assessment of the CMS Quality Measures Reports, required by section 1890A(a)(6) of the Social Security Act, aim to contribute to the overall, cross-cutting evaluation of CMS quality measures. The intent of the analyses in these reports is not to replace or duplicate program-specific assessments nor to replace the analyses individual measures must undergo as part of ongoing measure maintenance. Rather, the intent is to help the federal government and the public understand the overall impact of the government’s investments in quality measurement and reflect on future needs.

Other Reports

Several organizations analyze the performance of CMS-implemented quality measures, and these studies provide valuable input into CMS measure priority planning. These reports and studies may provide information on disparities, gaps in care, and other findings related to measurement policies. Examples of these entities and their associated reports include

• Medicare Payment Advisory Committee (MedPAC) and Medicaid and CHIP Payment and Access Commission (MACPAC) quality reports
• CMS Office of Minority Health Mapping Medicare Disparities
• CMS Office of Enterprise Data and Analytics – Chronic Conditions among Medicare Beneficiaries
• Universities, researchers, and health care facilities, including their journal articles and conference presentations

Together, these inputs influence CMS planning for future measure development, implementation, and maintenance activities.