Quality Measurement to Support Value-Based Purchasing: Aligning Federal and State Efforts

Accurate and reliable quality measurement is increasingly important to federal and state payment strategies. A new generation of technical infrastructure is enabling payers at both levels of government to define and identify high-value service delivery. Recent reforms, including the Affordable Care Act, are pushing payers to become more prudent purchasers of care, spurring them to implement payment strategies that reward value in the health care system. At the same time, a National Quality Strategy and mechanisms to reach consensus on quality metrics are emerging to more precisely define what quality—and thus value—mean in health care.

These efforts are taking a variety of shapes at the federal and the state level. At the federal level, Medicare is becoming a more prudent direct purchaser of health care services through several value-based purchasing initiatives and through programs that are fostering the development of accountable care organizations. States are likewise using provider performance on quality measure sets to affect reimbursements for primary care providers serving as medical homes, for hospitals, and for health plans. Investments in health information technology in states are helping to hold providers accountable for cost and quality outcomes, and to create new tools and portals to help them deliver better care.

In November 2013, the National Academy for State Health Policy (NASHP) convened and facilitated a discussion among high-level federal and state leaders. The meeting: 1) gave state participants the opportunity to learn about and discuss new opportunities and promising practices for measuring quality under value-based purchasing approaches with their peers, 2) gave states the chance to learn about new federal opportunities they can leverage to support quality measurement, and 3) gave federal participants the opportunity to learn about state approaches to quality measurement and identify potential federal policy changes that can support state activities or better align federal strategies with state approaches.