How NQF Measures Could Affect Plans


Beware of the spillover effect regarding the endorsement of 12 measures for coordination of care last month by the National Quality Forum. The measures focus on areas such as medication reconciliation, proper use of the ED, and timely initiation of care.

“The NQF has a special line to/relationship with Medicare, so anything recommended by NQF is likely to percolate over to Medicare fee-for-service as another measurement headache for participating hospitals/providers,” says Jaan Sidorov, MD, a consultant and member of Managed Care’s editorial board.

“They’re also likely to spill into Medicare Advantage, which doesn’t use HEDIS.... So this is a heads-up and a warning about what’s around the corner for MA plans.”

Here are the 12 measures and the organizations they came from:

  • Medication reconciliation (NCQA)
  • Admission into an acute-care hospitalization based on risk (CMS)
  • Proper use of emergency department without hospitalization (CMS)
  • An advance care plan (NCQA)
  • Surveys to measure quality of medical home care (NCQA)
  • Timely initiation of care (CMS)
  • Medication review when caring for older adults (NCQA)
  • Medication reconciliation after discharge (NCQA)
  • Reconciled medication list given to discharged patients (AMA)
  • Transition record with specified elements given to patients discharged from an inpatient facility (AMA)
  • Transition record given promptly to patients discharged from an inpatient facility (AMA)
  • Transition record with specified elements given to patients discharged from an emergency department (AMA)

Donald Casey Jr., MD, MPH, MBA, co-chairman of the NQF’s Care Coordination Steering Committee, says that the goals are “developing and implementing a proactive and patient-centered plan of care; effective communication between patients, families, and caregivers; efficient information systems that support timely communication; and transitions of care that promote safe, evidence-based care.”

Richard J. Stefanacci, DO, MBA, the chief medical officer of the Access Group who is also a member of Managed Care’s editorial advisory board, says that NQF’s announcement “adds positive movement toward a critical improvement effort.”

Stefanacci adds that “Striving for these measures will reduce costs for health plans, and the NQF is a recognized authority so these measures are recognized as having value.”

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