Putting Patients Back at the Center of Healthcare: How CMS Measures Prioritize Patient-Centered Outcomes

本报告基于金伯利·罗林斯(MPP，措施管理系统主管，CMS)在2019年医疗保健分析峰会上的演讲，题为“有意义的措施:优先考虑患者高于书面工作”。

Two themes dominate patient and clinician experience today: drastically increased clinician screen time in the exam room and increased regulatory burdens on clinicians and health systems. A primary side effect of these contemporary trends is a loss of patient engagement. Clinicians and organizations become so taxed with reports and measures that what should be their number one priority—the patient—gets lost in the shuffle. Without patients at the center, healthcare organizations can miss information about care delivery or outcomes, and thus fail to properly align goals and resources around patient-centered outcomes improvements and lowered costs.

To move the patient back to the center of care, CMS launched itsMeaningful Measuresframework, including the Patients over Paperwork initiative, in 2017. The patient-centered effort aims to evaluate the current regulatory practices that hinder a productive patient-clinician relationship and establish CMS strategies that put patients first across all programs (Medicare, Medicaid, and the exchanges). Meaningful Measures works to empower patients and clinicians in key ways: getting patients the right care, at the right time, in the right place and ensuring both patients and clinicians have the data they need to realize these goals.

Interoperability: The Foundation for Innovation in Patient-Centered Care

Achieving CMS’s patient-centered goals will require innovation across all payment models, including interoperability—the ability to share data across disparate systems for seamless data sharing among patients, clinicians, payer, and providers. Health systems must have effective, open data sharing practices to keep patients healthy, while payers need shared data to tie payments to outcomes. As the lynchpin of patient-centered care and Meaningful Measures objectives, interoperability also gives clinicians the timely information they need to make decisions at the point of care, versus waiting days or weeks for critical information. Data sharing across patients and clinicians enables coordinated care, better outcomes, and reduced costs, as providers have insights to avoid drivers of cost and poor outcomes, such as repeats of costly tests and adverse drug interactions.

From Aligning and Reducing Measures to Incentivizing Sound Decision Making

CMS引入了“有意义的措施”，以解决太多不同的措施以及随之而来的不可持续的行政报告和供应商成本负担的问题。该框架旨在简化流程，将重点放在对临床医生和患者最重要的关键领域，并促进协调和刺激创新新措施类型，以更好地服务于患者、临床医生和提供者。

Meaningful Measures focus industry efforts on quality areas that fulfill certain criteria:

• Address high-impact measure areas that safeguard public health.
• Are patient-centered and meaningful to patients, clinicians, and providers.
• Are outcome-based where possible.
• Fulfill requirements in CMS statutes.
• 尽量减少供应商的负担。
• Identify significant opportunity for improvement.
• Address measure needs for population-based payment throughalternative payment
• 跨项目和/或与其他付款人保持一致。

The framework’s introduction allowed CMS to pause from the fast pace of measure development and implementation to reflect on what’s meaningful to patients, resolve disparate measures and reporting burdens, and promote measurement alignment with four strategic goals (Figure 1):

1. Introduce more flexibility and local leadership.
2. Support innovation.
3. Empowering patients and clinicians.
4. 改善客户体验。

Meaningful Measures promotes patient-centered healthcare improvement in eight areas—each with accompanying measures to support improved outcomes:

1. Preventive care.
2. 慢性病的管理。
3. Prevention, treatment, and management of mental health.
4. Prevention, treatment, and management of opioid and substance use disorders.
5. Risk-adjusted mortality.
6. 药物管理。
7. Admissions and readmissions to hospitals.
8. Transfer of health information and interoperability.

有意义的措施与现有的质量报告计划相一致，并帮助那些计划识别和选择个别的措施。它还允许临床医生和其他提供者关注患者并以有意义的方式改善护理，为包括专家在内的所有临床医生捕捉最有效和最优先的质量改善领域。该倡议指导规则制定、在建措施清单和影响评估。

The Next Steps for CMS Quality Measures

In the coming years, Meaningful Measures will continue to focus on engaging stakeholders in the development of measures that matter most to clinicians and patients. Clinicians don’t want to report on what they feel doesn’t matter (i.e., doesn’t improve outcomes or reduce costs). To that end and based on stakeholder input, priorities moving forward will include patient-reported outcomes, electronic clinical quality measures, appropriate use of opioids and avoidance of harm, nursing home safety, maternal mortality, and sepsis.

A Framework for Patient-Centered Care

Meaningful Measures established a vision and a practical strategy for getting patients back at the center of healthcare. Importantly, CMS is listening to stakeholders on the frontlines of care delivery—including patients, clinicians, and providers—to ensure that quality measures work for, not against, better care and lower costs. As more advanced electronic infrastructure promises to support more data interoperability, CMS will have further insights into ways to remove obstacles to patient engagement while also advancing quality goals.

Additional Reading

Would you like to learn more about this topic? Here are some articles we suggest:

1. The Medicare Shared Savings Program: Four Tools for Better Profit Margins and High-Quality Care
2. Millions Saved: Complex Care Coordination Reduces Total Cost of Care
3. Exceptions to Information Blocking Defined in Proposed Rule: Here’s What You Need to Know
4. DSRIP in 2018: Continuing Efforts for Medicaid Reform

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