Centers for Medicare & Medicaid Services Quality Measurement and Value-Based Incentives Group

Centers for Medicare & Medicaid Services Quality Measurement and Value-Based Incentives Group
Name	Centers for Medicare & Medicaid Services Quality Measurement and Value-Based Incentives Group
Formed	2016
Jurisdiction	United States federal government
Headquarters	Baltimore, Maryland
Parent agency	Centers for Medicare & Medicaid Services

Contents

Centers for Medicare & Medicaid Services Quality Measurement and Value-Based Incentives Group is a component of the Centers for Medicare & Medicaid Services responsible for designing and implementing performance measurement and payment incentives across Medicare, Medicaid, and related federal programs. The group coordinates technical work on quality metrics, value-based purchasing, and program evaluation in partnership with federal agencies such as the Agency for Healthcare Research and Quality and the Department of Health and Human Services, and interacts with stakeholders including American Medical Association, American Hospital Association, Kaiser Permanente, and Institute for Healthcare Improvement.

History and organizational development

The office traces its origins to policy shifts following the Patient Protection and Affordable Care Act, the Medicare Access and CHIP Reauthorization Act of 2015, and earlier initiatives such as the Hospital Readmissions Reduction Program, with reorganization influenced by directives from Centers for Medicare & Medicaid Services leadership and secretaries at the Department of Health and Human Services including Kathleen Sebelius and Alex Azar. Early structural development incorporated teams that previously operated under the Quality Improvement Organization contracts and legacy programs from the Centers for Medicare & Medicaid Services Innovation Center, aligning workstreams with federal statutes like the Social Security Act. Organizational evolution was informed by external guidance from bodies such as the National Quality Forum, National Academies of Sciences, Engineering, and Medicine, and advisory committees convened by the Office of the Assistant Secretary for Planning and Evaluation.

The group's mission centers on advancing performance measurement and aligning payments with outcomes for beneficiaries of Medicare, Medicaid, and the Children's Health Insurance Program, coordinating with the Centers for Disease Control and Prevention and the Food and Drug Administration on safety and population health measures. Responsibilities include developing measures for hospital quality reporting under the Hospital Value-Based Purchasing Program, setting benchmarks for physician performance under Merit-based Incentive Payment System, and administering measures used in demonstrations from the Centers for Medicare & Medicaid Services Innovation Center and statutory mandates under the Social Security Act.

Major programs administered or influenced by the group include the Hospital Value-Based Purchasing Program, the Skilled Nursing Facility Value-Based Purchasing Program, the End-Stage Renal Disease Quality Incentive Program, and the Merit-based Incentive Payment System for clinicians, as well as measure sets for the Medicare Shared Savings Program used by Accountable Care Organizations. Initiatives extend to interoperability and quality reporting aligned with Meaningful Use requirements and efforts linked to the 21st Century Cures Act, coordinating with vendors and standards organizations such as Health Level Seven International and National Quality Forum on electronic clinical quality measures.

Methodological work emphasizes clinical outcome measures, patient-reported outcome measures, and risk-adjustment methods developed in consultation with experts from Johns Hopkins University, Mayo Clinic, Massachusetts General Hospital, and academic centers participating in the Agency for Healthcare Research and Quality research networks. Measure development follows processes endorsed by the National Quality Forum and incorporates testing such as reliability and validity assessment, statistical modeling, and pilot testing in collaboration with Centers for Medicare & Medicaid Services Innovation Center demonstration sites, independent contractors, and measure stewards including specialty societies like the American College of Cardiology and the American College of Physicians.

Governance relies on public rulemaking processes under the Federal Register and stakeholder input from professional societies such as the American Medical Association, hospital groups like the American Hospital Association, consumer organizations including AARP, and patient advocacy groups such as the National Patient Safety Foundation. Advisory bodies, technical expert panels, and negotiated rulemaking sessions have included participation from payers like Blue Cross Blue Shield Association, health systems such as Cleveland Clinic, and accreditation organizations such as The Joint Commission, with oversight coordinated through the Department of Health and Human Services leadership and congressional oversight from committees including the United States House Committee on Ways and Means and the United States Senate Committee on Finance.

Evaluations of programs administered by the group appear in analyses by the Government Accountability Office, the Congressional Budget Office, and peer-reviewed studies in journals associated with institutions like Harvard Medical School and University of Michigan, documenting mixed effects on cost containment, quality improvement, and disparities. Criticisms have come from provider organizations such as the American Hospital Association and specialty societies over measure burden, unintended consequences reported by researchers at Stanford University and University of California, San Francisco, and legal challenges considered in federal courts including the United States Court of Appeals for the Federal Circuit. Ongoing reform debates involve legislators from the United States Congress, policy experts at the Brookings Institution and Urban Institute, and health services researchers advocating for refinements to measurement, transparency, and alignment across Medicare and Medicaid programs.