Universal Foundation Measures: The Focus on Care Coordination After Hospitalization, Readmissions, Patient Experience, and Screening for Social Drivers of Health

The Centers for Medicare & Medicaid Services (CMS) introduced the Universal Foundation Measures to streamline quality measures and promote consistent tracking across healthcare programs. These measures align quality reporting and improvement efforts across different healthcare settings, including Medicare, Medicaid, and the Health Insurance Marketplace. Key Components The Universal Foundation Measures encompass several domains crucial for assessing and enhancing healthcare quality. These domains typically include: Clinical Outcomes: Measures related to the results of care, treatment, and services, focusing on patient health improvements and management of chronic conditions. Patient Safety: Metrics aimed at reducing harm to patients, such as hospital-acquired infections, medication errors, and surgical complications. Care Coordination: Measures that ensure patients receive timely and appropriate care, particularly during transitions between care settings. Patient and Caregiver Experience: Surveys and feedback tools that capture the experiences of patients and caregivers with healthcare providers and services. Access to Care: Metrics assessing the availability and timeliness of healthcare services, including primary care and specialty care access. Goals and Benefits Standardization: The Universal Foundation Measures aim to create a consistent framework for quality measurement, reducing the burden on providers who must currently navigate multiple, sometimes conflicting, reporting requirements. Improved Health Outcomes: By focusing on core quality measures, CMS aims to drive improvements in patient health outcomes, reduce disparities in care, and ensure patients receive high-value care. Data-Driven Decisions: Standardized measures enable better benchmarking and comparison across different healthcare providers and settings, facilitating data-driven decisions to enhance care quality and efficiency. Examples of Measures Hospital Readmission Rates: Tracking the frequency of patients being readmitted to the hospital within a certain time frame after discharge, often used as an indicator of care quality and effectiveness. Vaccination Rates: Measuring the percentage of patients who receive recommended vaccines, such as influenza and pneumococcal vaccines, to prevent common infectious diseases. Chronic Disease Management: Monitoring the control of chronic conditions such as diabetes and hypertension, including metrics like HbA1c levels and blood pressure control. The quality measures CMS selected (see table on next page) underlie many of the diseases and conditions associated with the highest morbidity and mortality in the United States, including diabetes, high blood pressure, and cancer. For example, the cancer-related measures are in line with the goals of the Cancer Moonshot program. The measures also reflect the importance of high-quality preventive care, including vaccination. Identification and treatment of depression and substance use disorders are included in the Universal Foundation because addressing these behavioral health conditions in an integrated way can improve both physical and behavioral health outcomes. The focus on quality in behavioral health care for pediatric populations reflects the need to improve care for children and adolescents with depression, other mental health disorders, and substance use disorders. Finally, the measures focus on care coordination after hospitalization, patient experience, and screening for social drivers of health (CMS intends for them to cover follow-up to address identified social needs eventually). Although equity is a measurement-category domain, CMS also plans to use the full set of measures to stratify outcome data and identify disparities among and within populations to inform future equity efforts internally and for health insurers and providers. Healthcare providers participating in CMS programs are required to report on these standardized measures. The data collected is used to monitor performance, identify areas for improvement, and implement targeted quality improvement initiatives. Looking Ahead CMS will also continue to engage in discussions about broader alignment of quality measures outside CMS, for instance, as part of the Core Quality Measures Collaborative, state efforts, and the Health Care Payment Learning and Action Network, to identify future opportunities for alignment. CMS believes that, by focusing providers’ attention, the Universal Foundation will result in higher-quality care for the more than 150 million Americans covered by our programs. However, quality-measure alignment is just the first step; they cannot accomplish the enormous task of quality improvement and care transformation without a concerted effort among clinicians, provider organizations, insurers, community-based organizations, state and local governments, and patients. Additional Resources For more detailed information on the Universal Foundation Measures and specific metrics used by CMS, you can visit CMS Quality Measures. Download ArticleDownload the Entire Issue

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Universal Foundation Measures: The Focus on Care Coordination After Hospitalization, Readmissions, Patient Experience, and Screening for Social Drivers of Health

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