The goal of the updated CMS Quality Strategy is to shift Medicare payments from volume to value – tying 30% of traditional Medicare payments to alternative payment models and tying 85% of all traditional Medicare payments to quality or value by the end of 2016. The implementation of Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is a big opportunity to put a wide range of health care providers on the path to value through the new Merit-Based Incentive Payment System (MIPS) and incentive payments for participation in certain Alternative Payment Models (APMs). CMS says that the main purposes of the 2016 CMS Quality Strategy is to achieve the broad aims of the HHS National Quality Strategy (NQS) and the Triple Aim and to apply the strategy for shifting Medicare payments from volume to value:
- Better Care: Improve the overall quality of care by making health care more person-centered, reliable, accessible, and safe.
- Healthier People, Healthier Communities: Improve Americans’ health by supporting proven interventions to address behavioral, social, and environmental determinants of health and deliver higher-quality care.
- Smarter Spending: Reduce the cost of quality health care for individuals, families, employers, government, and communities.
The 2016 CMS Quality Strategy goals reflect the six priorities set out in the NQS and identify quality-focused objectives that CMS can drive or enable to further these goals:
- Goal 1: Make care safer by reducing harm caused in the delivery of care.
- Goal 2: Strengthen person and family engagement as partners in care.
- Goal 3: Promote effective communication and coordination of care.
- Goal 4: Promote effective prevention and treatment of chronic disease.
- Goal 5: Work with communities to promote best practices of healthy living.
- Goal 6: Make care affordable.
To meet these six goals CMS will:
- Measure the publicly reporting providers’ quality performance and cost of services provided;
- Provide technical assistance and foster learning networks for quality improvement;
- Adopt evidence-based National Coverage Determinations;
- Create incentives for quality and value;
- Set standards for providers that support quality improvement; and
- Create survey and certification processes that evaluate capacity for quality assurance and quality improvement