How NQF Measures Could Affect Plans

“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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