The Centers for Medicare & Medicaid Services (CMS) used the 2024 Medicare Advantage and Part D Advance Notice to announce a Universal Foundation for quality measurement which will serve as the foundation by which the agency will hardwire its recently refreshed National Quality Strategy across all programs and products. While some will understandably focus on the measures included in the Universal Foundation which are not yet included in the Medicare Advantage Star Ratings program, the more important hidden message is the impact and consequences this will have throughout the provider community.
What is the Universal Foundation?
The Universal Foundation is a core measure set CMS will begin using across different programs to standardize and align provider behaviors in the care of both adults and children. CMS intention is to ease the reporting burden and confusion while focusing provider attention on the quality measures which matter most to the largest segments of their patient populations. This now means providers can be expected to code their electronic medical records (EMR), establish payer- and product-agnostic clinical workflows and processes, and naturally align their patient interactions and interventions in predictable alignment with their payer partners.
As CMS moves to align all programs and embrace a shared measure set, with no variation in either the measures or measurement criteria, the use of the Universal Foundation will largely eliminate the need for payers to select different measures to report and incentivize providers to focus on. This Universal Foundation will also mostly eliminate the need for insurers to vary their provider contracts and incentive programs by product, will better enable cross-payer collaboration across a shared measure set, and will ease provider understanding and alignment across payers. Perhaps most importantly, it will also allow providers to anchor their EMRs with triggers, reminders and patient nudges seamlessly for all payers, all the time.
What Measures Will Be Included?
While starting with obvious measures of prevention, chronic condition management and outcomes, the foundation will include screenings for social risk factors and be augmented by population-specific measures where appropriate. This includes additional specific measures for frail elders, pediatric patients and disabled patients. Within Medicare Advantage, we can see the specific measures we know CMS will add to Star Ratings next.
What is the Impact of the Universal Foundation?
The new measures and increasing alignment will allow us to revisit and potentially redesign the payment criteria, contracting terms, expectations, incentives, reporting and engagement health plans use with their providers. This is a stellar moment for local health plan collaboration since there will be no need for extensive payer differentiation across the now standard clinical measure set, which will allow local colleagues to work together to improve access, care experiences and outcomes measured by Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Health Outcomes Surveys (HOS). This new model offers a refreshed pathway by which health plans can partner with providers in new ways.
This is an extremely valuable moment to rethink how we work with providers for Star Ratings and quality while we re-imagine risk-proofed risk adjustment and well-managed healthcare costs, especially as our provider community faces extreme and unprecedented workforce shortages.
While it’s true that change is hard, change is also fun and inspiring. And the impact is gratifying to the friends, family and neighbors we have the privilege of caring for.
This is not time for tiny tweaks. Rather, this is an ideal time to be bold and reimagine what we do, why we do it and how we do it. Healthmine’s consulting team has a long history of helping plans succeed through extensive waves of change. If you need help, email Melissa.Smith@Healthmine.com for more information.