In 2022, the Centers for Medicare & Medicaid Services (CMS) unveiled the National Quality Strategy, focusing on the vision of ensuring everyone achieves the best possible health and well-being. The strategy centers around eight fundamental goals:
- Advancing health equity and whole-person care.
- Encouraging individuals and communities to actively participate in their healthcare.
- Striving to eliminate preventable harm.
- Fostering a healthcare system that is flexible and able to enhance quality.
- Improving healthcare quality and outcomes throughout the care journey.
- Ensuring alignment and coordination across programs and care settings.
- Spearheading the shift to a digital, data-driven healthcare system.
- Harnessing the power of science, analytics, and technology to transform healthcare.
To enhance the quality of healthcare, CMS employs a variety of tools, including value-based payment models, alternative payment frameworks, quality measurements, and public reporting. To maintain consistency across varied quality initiatives and push the National Quality Strategy forward, CMS has crafted a Universal Foundation of quality measures.
By emphasizing the need for interoperable, digital quality measures capable of cross-program comparisons, CMS aims to ease the burden on healthcare providers. This strategy allows them to concentrate more on bridging care gaps and tackling disparities.
Criteria for CMS Universal Foundation Selection
CMS oversees over 20 quality programs, delivering transparent quality performance data, accountability, and improvements. However, concerns about reporting burdens and possible misalignment have prompted CMS to streamline measures using specific criteria:
- Significant National Impact: The measure tackles critical health challenges.
- Benchmarking Capability: The measure is suitable for national and global comparisons.
- Applicability: It is pertinent across multiple populations and settings.
- Stratification: It can be divided to pinpoint disparities.
- Scientific Credibility: It is grounded in robust scientific evidence.
- Feasibility: It is practical, computable, or can potentially go digital.
- No Adverse Effects: It should not lead to negative consequences.
The CMS Innovation Center continues to experiment with new quality measures under various CMS models. As quality measurement progresses or when quality objectives are met, CMS plans to revise the set of measures over time.
Significance for Health Plans
Roughly 70% of the early Universal Foundation measures correspond to the Healthcare Effectiveness Data and Information Set (HEDIS) metrics. The National Committee for Quality Assurance (NCQA)’s vision for electronic clinical data systems and digital quality measures aligns closely with CMS’s Universal Foundation goals. Additionally, the Core Quality Measures Collaborative, a joint effort by America’s Health Insurance Plans and CMS, seeks to harmonize measures across public and private payers. This alignment aims to standardize quality improvement, transparency, and payment measures. There’s a noticeable overlap between the CQMC Core Measure Sets and the Universal Foundation, helping health plans implement value-based programs, reduce provider burdens, and facilitate meaningful benchmarking.
The Universal Foundation features prominently in the 2025 CMS Call Letter for Medicare Advantage Plans. Plans for 2025 include adding Social Need Screening and Intervention to the display page based on 2023 data, while Depression Screening and Follow-Up for Adolescents and Adults and Adult Immunization Status will appear in 2026, based on 2024 data. CMS plans to integrate all Universal Foundation measures into the Part C and D Star Ratings, pending future rulemaking.
Maximizing clinical data use through interoperability standards will remain a focus for NCQA and CMS. This task entails health plans collaborating with providers to obtain members’ clinical data in Continuity of Care Document (CCD) or Fast Healthcare Interoperability Resources (FHIR) formats.
Promoting Health Equity
A key pillar of these programs is advancing health equity. Health plans are encouraged to assess their existing data on race, ethnicity, and other Social Determinants of Health (SDoH)enabling them to effectively measure disparities and implement programs for closing access gaps and improving outcomes. Social needs screening is a vital component of the Universal Foundation in the realm of equity.
Evolving the Universal Foundation
The initial set of Universal Foundation measures includes 10 for adults and 13 for children, with additional measures under evaluation as potential add-ons for specific programs. Behavioral health is a top priority, with new measures anticipated by 2024.
Collecting data on behavioral health presents unique challenges, yet it remains integral to comprehensive care. Health plans should expect ongoing emphasis on screening and follow-up for patients dealing with depression, serious mental illnesses, and substance use issues.
Conclusion
CMS’s move toward establishing consistent, nationally standardized quality measures across its programs is poised to enhance healthcare outcomes and promote health equity. Successfully implementing these measures will require diligent monitoring and the application of best practices.
For Measurement Year 2024, CMS has incorporated 17 NCQA HEDIS measures. If you’re in need of a seasoned HEDIS vendor, our team boasts some of the most experienced professionals in the industry. With extensive experience and adaptability, we can meet both current and future demands. For more information about our offerings, feel free to download our "SS&C® CareAnalyzer HEDIS® Reporting" brochure and contact us today.
