General principles for measure development serve as overarching guidelines for measure development that meet the standards and rigor expected of a meaningful, valid, and useful measure.
Measure development should
- Focus on what is best for persons and most meaningful to persons, caregivers, and measured entities.
- Explicitly align with CMS goals and objectives.
- Align across payors, including Medicare, Medicaid, the Health Insurance Exchanges, other federal partners, and private payors, to the extent feasible based on data availability for each payor type, differences in populations served, and level of analysis.
- Address a performance gap where there is known variation in performance, not just a measure gap.
- Use resources efficiently in a rapid-cycle fashion, including using process improvement techniques, such as Lean and human-centered design, and considering respecification instead of de novo measure development.
- Encourage collaboration among measure developers and share best practices/new learnings freely.
- Reorient and align around person-centered outcomes that span clinical settings, which may require different “versions” of the same measure (i.e., different cohorts, but same numerator). Test each of these setting-specific versions for reliability and validity.
- Promote value-based care that produces quality outcomes.
- Focus on outcomes (including patient-reported outcomes), safety, patient experience, care coordination, appropriate use/efficiency, and/or cost.
- Identify disparities and promote health equity in the delivery of care.
- Guard against negative unintended consequences of measure implementation, including overuse and underuse of care.
- Engage stakeholders early and often during the measure development process.
- Strive to reduce clinician and person burden in data collection and reporting measures.
- Ensure measures meet the specific program’s(s) stated intent, goals, and objectives.
- Use digital sources and avoid paper-based sources.