Building Additional Serious Illness Measures into Medicare Programs

There is widespread agreement on the need to improve care provided to individuals who are seriously ill. Significant changes to the healthcare delivery system are necessary for patients with serious illness to consistently receive high-quality, affordable, and person-centered care that is tied to their documented goals and preferences. However, such changes are unlikely to result in better care without measures that assess quality across the various settings in which seriously ill patients receive care.

To this end, in September 2016, the Gordon and Betty Moore Foundation and The Pew Charitable Trusts, with assistance from Discern Health, sought to identify a small number of setting-specific quality measures applicable to various types of serious illness that could be immediately implemented by the Centers for Medicare & Medicaid Services (CMS) for relevant Medicare quality programs. The Discern and Pew teams—working closely with a multi-stakeholder panel of 16 experts and building on previous measurement initiatives—identified and prioritized gaps among current Medicare measures for the home health, hospice, hospital, and nursing home settings and recommended measures that could fill these gaps. The panel also identified areas where new measures need to be developed, validated, and implemented to drive improvements in the care of seriously ill patients.

These insights are compiled into a white paper titled, “Building Additional Serious Illness Measures into Medicare Programs” (PDF).

The recommendations from this work were also incorporated into a letter sent to Tom Price, Secretary of Health and Human Services and Seema Verma, Administrator of the Centers for Medicare & Medicaid Services on March 14, 2017.

Although setting-specific measures for Medicare programs were the focus of this project, they are only a starting place. Serious illness care measures are needed at the community and program levels, as well as at the care setting level. Better measures can also facilitate the ongoing shift away from setting-based fee-for-service to value-based payment, and drive the healthcare system toward more comprehensive, community-based care.

To learn more about the white paper and other similar projects, please contact Donna Dugan at ddugan@discernhealth.com or Tom Valuck at tvaluck@discernhealth.com.

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