A Note from Our CEO: Preparing for the Evolution of Quality Improvement in 2023 & Beyond

After a tumultuous three years, what does 2023 hold for the future of healthcare quality measurement and improvement? A lot of changes—some big and some even bigger—but mostly necessary for the sake of better patient outcomes and the promise of value-based care. Our CEO, Dr. Zahid Butt, shares his insights on what we can expect (and how you can prepare!) for the journey ahead.

The Industry is Adapting to a Post-Pandemic World

Let’s start by addressing the obvious: while COVID-19 is not entirely behind us, we are certainly learning to live with it—and more importantly adapting to a post-pandemic world. This includes rapid adoption, and in some cases acceleration, of further development of things that may have existed previously but not at scale.

For example, MRNA vaccines were in development for years, but were unable to break through because the traditional, glacial approach to vaccine development was so entrenched in our healthcare system. Then the sledgehammer of COVID came down, pushing forth this new way of developing vaccines within six to nine months.

We embraced virtual care and Telehealth at a scale unimagined prior to the pandemic. It took a confluence of events—not just the pandemic lockdowns, but also the general availability and maturing of video tools like Zoom—to allow Telehealth to truly flourish at scale so quickly. The industry is now adjusting again to rightsize the appropriate mix of Telehealth and in-person visits that best balance quality and patient satisfaction. This will inevitably require new ways to measure quality for care delivered and managed outside a provider’s physical location. In addition to new quality measures designed for virtual care, many existing standardized quality measures (e.g., Controlling High Blood Pressure) will be impacted by the “hybrid care model.“ Perhaps this could be the catalyst needed for broader adoption of Patient Reported Outcomes Performance Measures (PRO-PMs).

Health Equity is Finally a Priority 

It shouldn’t surprise anyone that health equity is the issue on everyone’s minds right now. We saw this reflected in our own 2022 State of Inpatient Quality Reporting survey when it was voted the #1 most important new CMS initiative by more than 170 quality leaders nationwide. What may surprise you is that the concept of health equity as a national priority is not that new. “Equitable health care” was one of the six domains in the Institute of Medicine’s (IOM) landmark publication Crossing the Quality Chasm: A New Health System for the 21^st Century published in 2001. The pandemic seems to have exposed inequities in our healthcare system in a way that has focused our collective attention like never before. Addressing equity is a key priority of the federal government with HHS and CMS leading the charge in healthcare.

Welcome to the Dawn of Health Equity Performance Measurement

While still early, a focus on better and more granular Social Determinants/Drivers of Health (SDOH) data collection seems to be high on the list of initiatives. CMS has collected basic Race, Ethnicity, and Gender data for many years but there is recognition that more standardized data across richer set of elements may provide more actionable insights for health care providers. You can already see the early stages of this in the CMS IQR program’s new SDOH-01 and SDOH-02 measures, which will be required in 2024. (Learn more about the measures here.)

SDOH data standards are being addressed within the HL7 FHIR accelerator Gravity project to facilitate interoperability at scale. Incorporation of these data into the quality measures ecosystem either for risk adjustment or for stratification of existing measures is also getting renewed interest. 

As health equity data becomes plentiful, standardized, and meaningful, interesting policy questions will emerge on how best to use them for accountability or payment adjustment programs. Should CMS extend support or penalize poor performance metrics in hospitals with more challenging SDOH patient populations? There isn't a clear national consensus on these challenging questions.

While much of the attention has focused on Federal efforts, states may also start their own initiatives. Maryland is perhaps the first state where hospital are financially rewarded by the Maryland Health Services Cost Review Commission for showing improvement in their health equity-adjusted readmission rates. Other states are likely to follow similar projects.

Many forward thinking healthcare organizations are already moving ahead with their own health equity initiatives as CMS and The Joint Commission role out their policies. Buy-in from organizational stakeholders and establishment of standardized data collection processes are the first steps in this journey.

Maternal Health Is Another Priority to Watch

For far too long, the United States has ranked amongst the worst nations in the developed world when it comes to maternal health. This year, CMS took real action with the announcement of two required eCQMs that focus on perinatal care: ePC-02 (Cesarean Birth) and ePC-07 (Severe Obstetric Complications). Reporting data for these measures will be required and publicly reported starting in 2024. (Learn how to get started with both measures here.) Both these measures are paired together as “balancing measures.” This simply means improvement in performance on any one of these measures should not be at the expense of the other. Reducing C-section rates should be accomplished without increase in maternal morbidity. CMS as a payer does not usually cover child bearing beneficiaries through the Medicare program but is acting more in its capacity as a regulator in implementing reporting of these measures.

Construction Ahead: dQMs are Still a Major Work in Progress

CMS has stated their intention to go completely digital in its performance measurement reporting programs by 2025 replacing existing measures with digital quality measures (dQMs).

While many details are still being finalized, the overarching concepts behind dQMs are the use of data from multiple sources including EHRs using Fast Healthcare Interoperability Resources (FHIR) and specifications using the Clinical Quality Language (CQL) standards. In addition, data query and measure calculations are not necessarily embedded within EHRs only and could be independent third party software products or “tools.” Data aggregation, de-duplication, and managing data quality will be crucial to generate reliable and accurate measure results that can be trusted and embraced by providers, regulators, payers, and the public.

Measure harmonization across multiple reporting programs is another important goal of the dQM initiative and has been a national priority for quite some time. Just imagine a world where you won’t have to process a blood pressure measure four different ways for four different entities. Not surprisingly, the Core Quality Measures Collaborative (CQMC)—which is a partnership between CMS, NQF, and America’s Health Insurance Plans (AHIP)—currently has a lot of active participation from both the plans and the provider community to iron out this challenge.

CMS’s vision for dQMs is not just about creating a new set of measures using new standards, but building an entire end-to-end ecosystem, one that will rely on knowledge, technology, and all-hands-on-deck industry collaboration in order to flourish with widespread interoperability.

Final Thoughts: Have a 3-5 Year Digital Plan Ready

Finally, as your trusted quality measures partner you can be sure we will have you covered for whatever changes are necessary in this new dQM world. But we can’t do this alone. We strongly recommend our clients develop a 3–5-year internal plan for transitioning to the new world of quality measurement and reporting.

Check back into our Education Center often; we here at Medisolv are working hard to keep you informed as news emerges.

Last but certainly not least, always remember that this burden doesn’t have to rest solely on your quality team’s shoulders. Include your leadership, clinicians, clinical informatics experts, and your IT teams to navigate these conversations. Quality improvement takes all of us. You’re not in this fight alone.

To learn more about where we’ve been and where we’re headed in terms of quality improvement and quality measurement, please read more of our industry trend outlooks from Dr. Butt:

• What is Social Determinants of Health (SDOH) Data?
• The Quest for Quality Improvement Continues in 2022
• What are dQMs?
• Cooking Up Great Clinical Quality Measures