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Measure Harmonization

Measure Harmonization and Alignment

The definition of measure harmonization is standardizing specifications for related measures when they

  • have the same measure focus (i.e., numerator criteria)
  • have the same target population (i.e., denominator criteria)
  • have elements that apply to many measures (e.g., age designation for children)

Measure developers should harmonize measures unless there is a compelling reason for not doing so that would justify keeping two or more similar appearing measures separate (e.g., significant risk variation by age, comorbidity, race). The measure developer should harmonize and standardize measure specifications so they are uniform or compatible unless the measure developer can justify differences as dictated by the evidence.

The dimensions of harmonization can include numerator, denominator, numerator and denominator exclusions, denominator exceptions, calculation, and data source and collection instructions. The extent of harmonization depends on the relationship of the measures, evidence for the specific measure focus, and differences in data sources.

The measure developer must ensure harmonization of the risk adjustment methodology of the harmonized measure with the risk adjustment methodology of the related measure or justify any differences. Measure developers should use the Blueprint content on the CMS MMS Hub as a guide to understand some of the concepts to explore during the development and assessment of the risk adjustment model. Because of the complexity of risk adjustment models, the measure developer should provide sufficient information to facilitate the understanding of the measure when vetted through CMS and its measure development partners, e.g., other federal agencies, or CMS consensus-based entity (CBE) for endorsement. For more information on risk adjustment, see the Risk Adjustment in Quality Measurement  supplemental material.

The Blueprint content defines measure alignment as encouraging the use of similar standardized quality measures among government and private sector efforts. Harmonization is related to measure alignment because multiple programs and care settings may use harmonized measures of similar concepts. CMS seeks to align measures across programs, with other federal programs, and with private sector initiatives as much as is reasonable.

Alignment of quality initiatives across programs and with other federal partners and insurers helps to ensure clear information for patients and other consumers. A core set of measures increases signal for public and private recognition and payment programs (Conway, Mostashari, & Clancy, 2013). When selecting harmonized measures across programs, it becomes possible to compare the provision of care in different settings. For example, if the calculation method of the influenza immunization rate measure is the same in hospitals, nursing homes, and other settings, it is possible to compare the achievement for population health across the multiple settings. If there is harmonization of functional status measurement and alignment of measure use across programs, it would be possible to compare gains across the continuum of care. Consumers and payers are enabled to choose measures based on similar calculations. In these and other ways, harmonization promotes

  • comparisons of population health outcomes
  • coordination across settings in the continuum of care
  • clearer choices for consumers and payers
Core Quality Measures Collaborative

The Core Quality Measures Collaborative (CQMC) is a public-private partnership between America’s Health Insurance Plans and CMS. The membership is comprised of more than 70 organizations, including health insurance providers, primary care and specialty societies, consumer and employer groups, and other quality collaboratives. The aims of the CQMC are to 

  • Identify high-value, high-impact, evidenced-based measures promoting better patient outcomes and providing useful information for improvement, decision-making, and payment.
  • Align measures across public and private payers to achieve congruence in the measures used for quality improvement, transparency, and payment purposes.
  • Reduce the burden of quality measurement by eliminating low-value metrics, redundancies, and inconsistencies in measure specifications and quality measure reporting requirements across payors.
    The CQMC has core sets of quality measures in multiple categories.
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