The Four Highways of CMS’s dQM Strategic Roadmap

In 1956, President Eisenhower signed legislation funding the construction of the U.S. Interstate Highway System. 

Stick with me here, I promise this has to do with healthcare.

Up until that year we had cars, roads, speed limits, and a few laws, but it was highly variable between states. There was no comprehensive interstate plan that allowed Americans to easily and safely travel our country.

Has anybody guessed where I'm going with this?

Over the last decade the healthcare industry adopted the EHR system, developed eCQMs, worked on common value sets and specifications, and established submission procedures. It's as if we have preliminary roads, speed limit signs and a few laws, but no comprehensive way of sending and receiving patient clinical data between all of the places it lives. That is what the CMS dQM strategy is hoping to achieve.

As I read through the CMS dQM Strategic Roadmap and talked with experts and attended CMS webinars, I couldn't help drawing this analogy. CMS wants to create a highway system for the transmission of data between all the different places that patient data lives.

We put together an infographic below summarizing the four main strategies CMS is employing to get them to their end goal. 

CMS's Overall Goal for dQMs

CMS wants to make patient data in all the places it lives easy to access, report and analyze to allow for rapid improvement to patient care.

They intend to achieve this monumental task with four major initiatives which I've called highways.

• Highway 1 Improve Data Quality
  • Create a standardized set of data elements and get all EHRs using the FHIR API so data can be easily transmitted using one standard.

• Highway 2 Advance Technology
  • Develop Measure Calculation Tools (MCTs) that can be installed separately from the EHR so reporting can happen regardless of which EHR the healthcare organization has.

• Highway 3 Optimize Data Aggregation
  • Work with data aggregators to figure out who has what and how everyone can and should share.

• Highway 4 Align Measures
  • Create one comprehensive set of dQMs used across all payers, for all programs in all healthcare settings.

In each highway, I've given you the current state we are in and the ideal state CMS wants us to get to. I've also given you the in-between state. This in-between state is what you should pay close attention to. This is the most likely thing to affect your organization in the near future. At the end of each highway page, I put the keys to success for achieving that highway goal and the biggest barriers to success.

This is a highly-designed summary (because we just can't help ourselves), but I also created a simple document summary that you can have for reference below. 👇