CMS Roadmaps for Quality Measurement, Resource Use and Promoting Value in Medicare

This issue brief from the Consumer-Purchaser Disclosure Project (CPDP) summarizes three “roadmaps” from the Centers for Medicare & Medicaid Services (CMS) to promote lower-cost, high-quality care in the traditional fee-for-service-based Medicare program. These roadmaps describe the measures CMS uses to assess physicians, hospitals and other health care settings; how CMS measures the quality and cost of health care through resource-use measurement; and how CMS supports purchasing health care based on value and cost.

The three roadmaps highlight both how far Medicare has come, as well as how far it has to go to transform Medicare, and all of health care, into systems that base reimbursements and priorities on the value of services provided to patients—measured by both quality and cost—rather than on the quantity of services delivered. In reviewing these roadmaps, CPDP recommends that there is more work to be done to measure the performance of clinicians, change how CMS pays for care and realign priorities to focus on preventing disease and ensuring that patients get the right care at the right time. In an era of health reform, these roadmaps are important tools to plot the path forward and highlight areas where CMS and the nation need greater clarity on how to proceed.