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Failure to align quality measures across payers poses challenges for providers — 7 things to know

A Government Accountability Office report found failure to align quality measures across payers impeded providers' ability to develop quality improvements for value-based care models, according to RevCycle Intelligence.

Here are seven things to know:

1. A Health Affairs 2013 study found merely 5 percent of the quality measures commercial payers used were included in more than half of their plans.

2. Antler report found 48 state and regional healthcare programs as well as regional collaboratives used 509 quality measures, but only 20 percent of the measures were used by more than one program.

3. GAO found providers often report the same measures, although payers each have their own set of specifications. These specifications led to clinical workflow disruptions and put a toll on provider workloads.

4. GAO noted this quality measure misalignment led to contrasting performance assessments from different payers. The report stated, "A provider may receive feedback from one payer indicating that the provider performs adequately, while receiving feedback from another payer indicating poor performance."

5. Factors such as decision-making gaps amongst payers and providers, data collection and quality reporting differences as well as a lack of meaningful healthcare quality measures are leading to quality measure misalignment.

6. Based on the report, GAO is imploring HHS to create electronic quality measures for its Core Quality Measures Collaborative. HHS created the collaborative in 2014 to give private payers and CMS an avenue to negotiate core quality measure sets to assess provider performance. CQMC released its first seven core measure sets this year.  However, GAO said the agency has not taken a big enough effort to create electronic quality measures and standardizing data elements for the seven sets.

7. HHS agreed with GAO's recommendations and confirmed the agency plans to prioritize the creation of electronic quality measures.

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