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Buying Value Measure Selection Tool Instructions

The Measure Selection Spreadsheet is the heart of the How to Build a Measure Set tool. It serves as a both a decision aid and a living measure library for measure set creators by tracking and displaying detailed information from a number of important sources to consider when selecting measures.

Measure specifications as outlined within these resources are subject to change. Buying Value will revise the measures as updates become available. If you would like to receive email alerts outlining these changes, please fill out a contact form.

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Below, we provide details on use of the Spreadsheet that amplify the Measure Selection Tool User Instructions that is available on the start page for this tool.

1) Measure Selection Tool

2) Summary

3) Measure Crosswalk

4) Links to Source Documents

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Summary Sheet

# Measure Name Steward Domain Population Data Source Comments

1 0005 AHRQ Process Adult & Pediatric Survey 7 4

2 0419 CMS Process Clinical Data 4 4

3 2371 NCQA Process #N/A 4 3

4 Plan All-Cause Readmission 1768 NCQA Process Claims 6

5 2510 CMS Process Claims 1

6 CMS Process #N/A

7 CMS Process #N/A

8 CMS Process #N/A

9 0275 AHRQ Process Claims 5


11 AHRQ Process Claims 1

12 AHRQ Process Pediatric Claims 1


14 #N/A Process #N/A

15 Potentially Avoidable ED visits Medi-Cal Process Claims 1

16 0728 AHRQ Process Claims

17 APA Process #N/A

18 Breast Cancer Screening 2372 NCQA Prevention Process Claims 10 7

19 0032 NCQA Prevention Process 6 8

20 Chlamydia Screening 0033 NCQA Prevention Process Claims 9 8

21 Colorectal Cancer Screening 0034 NCQA Prevention Process 10 11

22 0041 AMA-PCPI Prevention Process Adult & Pediatric 4 6


NQF Number

Process/ Outcome

Recommended for Inclusion

Total Selection Criteria Points

Aligned with other measure sets?

CAHPS® Clinician/Group Surveys - (Adult Primary Care, Pediatric Care, and Specialist Care Surveys)

Consumer Experience

Documentation of Current Medications in the Medical Record

Care Coordination/ Patient Safety

Adult18 & older

Annual Monitoring of Persistent Medications (roll-up)


Adult18 & older


Skilled Nursing Facility 30-Day All-Cause Readmission Measure (SNFRM)


'All-Cause Unplanned Admissions for Patients with Diabetes


All-Cause Unplanned Admissions for Patients with Heart Failure


All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions


Chronic Obstructive Pulmonary Disease (PQI -05)


Congestive Heart Failure Admission Rate (PQI -08)


Rate of Hospitalization for Ambulatory Care-Sensitive Conditions: PQI Composite (PQI 92)


Pediatric ambulatory care sensitive condition composite


Asthma in Younger Adults Admission Rate (PQI 15)


Annual % asthma patients (2-20) with 1 or more asthma-related ED visits

Care Coordination/ Patient SafetyCare Coordination/ Patient Safety

Hospital Admissions for Pediatric Asthma, per 100,000 children


Adult Major Depressive Disorder (MDD): Coordination of Care of Patients with Specific Comorbid Conditions


Women's Health50-74

Cervical Cancer Screening Women's Health Claims and Clinical Data

Women's Health16-24

Adult50-75

Claims and Clinical Data

Influenza Immunization Claims and Clinical Data

Human Papillomavirus (HPV) Vaccine for Female Adolescents

Women's Health13


# Measure Name Steward Domain Population Data Source CommentsNQF Number

Process/ Outcome





39 0054 NCQA Process Claims 4 6

40 0059 NCQA Outcome 10 11




44 Controlling High Blood Pressure 0018 NCQA Outcome Clinical Data 10 14

45 0083 AMA-PCPI Process 2 6



48 CAD: Medication adherence 0543 CMS Process Adult #N/A 1




52 0068 NCQA Process Clinical Data 4 4


54 0710 Outcome 4 2

55 1365 AMA-PCPI Process 4 2

56Unhealthy alcohol use - screening

N/A AMA-PCPI Process #N/A 2

57 0469 Obstetrics Process Women's Health Clinical Data 2 6

# Measure Name Steward Domain Population Data Source

Err:509 Err:509 Err:509 Err:509 Err:509 Err:509 Err:509 Err:509 Err:509 Err:509



Weight Assesment and counseling for nutrition and physical activity for children/ adolescents

Pediatric3-17


Disease Modifying Anti-Rheumatic Drug Therapy for Rheumatoid Arthritis

Acute & Chronic Care Management

Adult18 & older

Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Poor Control (>9.0%)


Adult18-75


Comprehensive Diabetes Care: Eye Exam


Adult18-75

Comprehensive Diabetes Care: Hemoglobin A1c testing


Adult18-75

Comprehensive Diabetes Care: Medical Attention for Nephropathy


Adult18-75


Adult18-85

Heart Failure (HF): Beta- Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)


Adult18 & older


Use of Spirometry Testing in the Assessment and Diagnosis of COPD


Adult40 & older

Persistence of Beta-Blocker Treatment After a Heart Attack


Adult18 & older


Use of Imaging Studies for Low Back Pain


Adult18-50

Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis


Adult18-64

Appropriate Treatment forChildren with Upper Respiratory Infection


Pediatric3mths - 18

Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic


Adult18 & older

Follow-Up Care for Children Prescribed Attention- Deficit/Hyperactivity Disorder Medication

Behavioral Health

Pediatric6-12

Depression Remission at Twelve Months

MN Community Measurement

Behavioral Health

Adult18 & older

Child and Adolescent Major Depressive Disorder: Suicide Risk Assessment

Behavioral Health

Pediatric6-17

Behavioral Health

Adult18 & older

Elective Delivery Prior to 39 Completed Weeks Gestation (PC-01)

The Joint Commission

NQF Number

Process/ Outcome


Aligned with Other Measure Sets?

# Measure Name Steward Domain Population Data Source CommentsNQF Number

Process/ Outcome









Measure Name NQF # Steward Description Data Source

0002 CWP CMS146 NCQA Claims 2 Yes (CMS146 - pediatric) Yes (066) 2014 EHR

0005 AHRQ Survey 3 Yes (46) Yes (321) 2014 EHR & Cross-Cutting

Controlling High Blood Pressure 0018 CBP CMS165 NCQA Clinical Data 9 Yes (37) Yes Yes Yes (ACO 28) Yes Yes (CMS165 - adult) Yes (236) 2014 EHR & Cross-Cutting Yes

0024 WCC CMS155 NCQA Claims and Clinical Data 4 Yes Yes (9) Yes (CMS155 - pediatric) Yes (239) 2014 EHR

0027 MSC NCQA Survey 1 Yes

Breast Cancer Screening 0031 BCS CMS125 NCQA Claims 3 Yes (ACO 20) Yes Yes (112) 2014 EHR

0032 CCS CMS124 NCQA Claims and Clinical Data 2 Yes Yes (309) 2014 EHR

Chlamydia Screening 0033 CHL CMS153 NCQA Claims 4 Yes Yes Yes (CMS153 - pediatric) Yes (310) 2014 EHR

Colorectal Cancer Screening 0034 COL CMS130 NCQA Claims and Clinical Data 5 Yes (6) Yes (ACO 19) Yes Yes (113) 2014 EHR

0036 ASM CMS126 NCQA Claims 2 Yes (CMS126 - pediatric) Yes (311) 2014 EHR

Childhood Immunization Status 0038 CIS CMS117 NCQA Claims and Clinical Data 4 Yes Yes (2) Yes (CMS117 - pediatric) Yes (240) 2014 EHR & Cross-Cutting

0041 CMS147 AMA-PCPI Claims and Clinical Data 5 Yes (3) Yes (ACO 14) Yes Yes (CMS147) Yes (110) 2014 EHR & Cross-Cutting

0043 PNU CMS127 NCQA Claims and Clinical Data 4 Yes (4) Yes (ACO 15) Yes (CMS127) Yes (111) 2014 EHR & Cross-Cutting

0052 LBP CMS166 NCQA Claims 2 Yes (CMS166 - adult) Yes (312) 2014 EHR

0055 CDC CMS131 NCQA Claims 4 Yes (12) Yes (ACO 41) Yes (117) 2014 EHR

0057 CDC NCQA Claims 1 Yes

0058 AAB NCQA Claims 1 Yes (116)

0059 CDC CMS122 NCQA Claims and Clinical Data 5 Yes Yes (ACO 27) Yes Yes (001) 2014 EHR & Cross-Cutting

0061 CDC NCQA Claims and Clinical Data 0

0062 CDC CMS134 NCQA Claims 3 Yes (14) Yes (119) 2014 EHR

NQF Endorsement Status

NCQA HEDIS Abbreviation

CMS Number

Count of Federal Programs used by:

Core Set of Children’s Health Care Quality Measures for Medicaid and CHIP (Child Core Set)

Version date: 03/2015

CMMI Priority Measures for Monitoring and Evaluation


CMS Health Home Measure Set


Core Set of Health Care Quality Measures for Adults Enrolled in Medicaid (Medicaid Adult Core Set)


CMS Medicare Shared Savings Program (MSSP) ACO for 2015


Comprehensive Primary Care Initiative


Meaningful Use Recommended Core Set of Clinical Quality Measures (CQMs) for 2014


Medicare-Medicaid Plans (MMPs) Capitated Financial Alignment Model (Duals Demonstrations)


Physician Quality Reporting System (PQRS) for 2015

EP EHR Incentive Clinical Quality Measures (eCQMs): 07/2014 (for 2015)

Cross Cutting Measures: 12/31/14

CCMI SIM Recommended Model Performance Metrics


Appropriate Testing for Children with Pharyngitis

Percentage of children ages 2 to 18 that were diagnosed with pharyngitis, dispensed an antibiotic, and received a group A streptococcus test for the episode

CAHPS® Clinician/Group Surveys - (Adult Primary Care, Pediatric Care, and Specialist Care Surveys)

• Adult Primary Care Survey: 37 core and 64 supplemental question survey of adult outpatient primary care patients.

YesACO 01 (NQF #0005): Getting Timely Care, Appointments, and Information ACO 2 (NQF #0005): How Well Your Providers Communicate ACO 3 (NQF #0005): Patient Rating of Provider ACO 4 (NQF #0005): Access to Specialist ACO 5 (NQF #0005): Health Promotion and Education ACO 6 (NQF #0005): Shared Decision Making

The percentage of patients 18 to 85 years of age who had a diagnosis of hypertension (HTN) and whose blood pressure (BP) was adequately controlled (<140/90) during the measurement year.

Weight Assessment and Counseling for Nutrition and Physical Activity for Children/ Adolescents: Body Mass Index Assessment for Children/ Adolescents

Percentage of children ages 3 to 17 that had an outpatient visit with a primary care practitioner (PCP) or obstetrical/gynecological (OB/GYN)

Medical Assistance With Smoking and Tobacco Use Cessation

Assesses different facets of providing medical assistance with smoking and tobacco use cessation:

Advising Smokers and Tobacco Users to Qui - A rolling average represents the percentage of patients 18 years of age and older who are current smokers or tobacco users and who received cessation advice during the measurement year.

Discussing Cessation Medications - A rolling average represents the percentage of patients 18 years of age and older who are current smokers or tobacco users and who discussed or were recommended cessation medications during the measurement year.

Discussing Cessation Strategies - A rolling average represents the percentage of patients 18 years of

No longer Endorsed

Percentage of women 40-69 years of age who had a mammogram to screen for breast cancer.

Cervical Cancer ScreeningPercentage of women 21-64 years of age, who received one or more Pap tests to screen for cervical cancer.

Percentage of women ages 16 to 24 that were identified as sexually active and had at least one test for Chlamydia during the measurement year

Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer.

Use of Appropriate Medications for Asthma

Percentage of patients 5-64 years of age who were identified as having persistent asthma and were appropriately prescribed medication during the measurement period.

Percentage of children that turned 2 years old during the measurement year and had specific vaccines by their second birthday

Influenza Immunization

Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization

Pneumonia Vaccination Status for Older Adults

Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine.

Use of Imaging Studies for Low Back Pain

Percentage of patients 18-50 years of age with a diagnosis of low back pain who did not have an imaging study (plain X-ray, MRI, CT scan) within 28 days of the diagnosis.

Comprehensive Diabetes Care: Eye Exam

Percentage of patients 18-75 years of age with diabetes who had a retinal or dilated eye exam by an eye care professional during the measurement period or a negative retinal exam (no evidence of retinopathy) in the 12 months prior to the measurement period

Comprehensive Diabetes Care: Hemoglobin A1c testing

The percentage of members 18-75 years of age with diabetes (type 1 and type 2) who received an HbA1c test during the measurement year.

Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis

The percentage of adults 18–64 years of age with a diagnosis of acute bronchitis who were not dispensed an antibiotic prescription.

Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Poor Control (>9.0%)

Percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period.

Comprehensive Diabetes Care: Blood Pressure Control (<140/90 mm Hg)

The percentage of members 18-75 years of age with diabetes (type 1 and type 2) whose most recent blood pressure (BP) reading is <140/90 mm Hg during the measurement year.

Comprehensive Diabetes Care: Medical Attention for Nephropathy

The percentage of patients 18-75 years of age with diabetes who had a nephropathy screening test or evidence of nephropathy during the measurement period.

O2

owner: (Sept 2012) Pioneer ACO Model: CMS has established robust quality measures that will be used to monitor the quality of care provided and beneficiary satisfaction. These measures mirror those in the Shared Savings Program. http://innovation.cms.gov/Files/fact-sheet/Pioneer-ACO-General-Fact-Sheet.pdf

Measure Name NQF # Steward Description Data SourceNQF Endorsement Status


CMS Number























0105 AMM CMS128 NCQA Claims 2 Yes Yes (009) 2014 EHR

0138 CDC Clinical Data 1 Yes (44)

0166 CMS Survey 2 Yes (49) Yes

Falls with injury 0202 0

MORT-30-AMI: Heart Attack Mortality 0230 CMS Claims 1 Yes (34)

0275 AHRQ Claims 3 Yes (66) Yes Yes (ACO 09)

STK-4: Thrombolytic Therapy 0437 Clinical Data 0

0471 Claims and Clinical Data 2 Yes Yes (39)

0480 Claims and Clinical Data 0

0531 AHRQ Claims 1 Yes (43)

Anti-depressant Medication Management

Percentage of patients 18 years of age and older who were diagnosed with major depression and treated with antidepressant medication, and who remained on antidepressant medication treatment. Two rates are reported:

A. Percentage of patients who remained on an antidepressant medication for at least 84 days (12 weeks).

B. Percentage of patients who remained on an antidepressant medication for at least 180 days (6 months).

HAI-2: CAUTI: Cather-Associated Urinary Tract Infection

Standardized Infection Ratio (SIR) of healthcare-associated, catheter-associated urinary tract infections (CAUTI) will be calculated among patients in the following patient care locations:

• Intensive Care Units (ICUs) (excluding patients in neonatal ICUs [NICUs: Level II/III and Level III nurseries])

• Specialty Care Areas (SCAs) - adult and pediatric: long term acute care, bone marrow transplant, acute dialysis, hematology/oncology, and solid organ transplant locations

• other inpatient locations (excluding Level I and Level II nurseries).

Data from these locations are reported from acute care general hospitals (including specialty hospitals), freestanding long term

HCAHPS- Cleanliness and Quietness of Hospital Environment- Communication about Medicines- Communication with Doctors- Communication with Nurses- Discharge Information- Pain Management- Overall Rating of Hospital- Responsiveness of Hospital Staff - Willingness to Recommend

27-items survey instrument with 7 domain-level composites including: communication with doctors, communication with nurses, responsiveness of hospital staff, pain control, communication about medicines, cleanliness and quiet of the hospital environment, and discharge information

American Nurses Association

All documented patient falls with an injury level of minor or greater on eligible unit types in a calendar quarter. Reported as Injury falls per 1000 Patient Days.

(Total number of injury falls / Patient days) X 1000

Measure focus is safety.Target population is adult acute care inpatient and adult rehabilitation patients.

The measure estimates a hospital 30-day risk-standardized mortality rate (RSMR), defined as death for any cause within 30 days after the date of admission of the index admission, for patients 18 and older discharged from the hospital with a principal diagnosis of acute myocardial infarction (AMI). CMS annually reports the measure for patients who are 65 years or older and are either enrolled in fee-for-service (FFS) Medicare and hospitalized in non-federal hospitals or are hospitalized in Veterans Health Administration (VA) facilities.

Chronic Obstructive Pulmonary Disease (PQI -05)

This measure is used to assess the number of admissions for COPD per 100,000 population


This measure captures the proportion of acute ischemic stroke patients who arrive at this hospital within 2 hours of time last known well for whom IV t-PA was initiated at this hospital within 3 hours of time last known well.

Cesarean Rate for Nulliparous Singleton Vertex (PC-02)


This measure assesses the number of nulliparous women with a term, singleton baby in a vertex position delivered by cesarean section. This measure is part of a set of five nationally implemented measures that address perinatal care (PC-01: Elective Delivery, PC-03: Antenatal Steroids, PC-04: Health Care-Associated Bloodstream Infections in Newborns, PC-05: Exclusive Breast Milk Feeding).

PC-05: Exclusive breast milk feeding PC-05a: Exclusive breast milk feeding considering mother’s choice


PC-05 assesses the number of newborns exclusively fed breast milk during the newborn´s entire hospitalization and a second rate, PC-05a which is a subset of the first, which includes only those newborns whose mothers chose to exclusively feed breast milk. This measure is a part of a set of five nationally implemented measures that address perinatal care.

PSI-90: Complications/Patient Safety for Selected Indicators (Composite)

A composite measure of potentially preventable adverse events for selected indicators. The weighted average of the observed-to-expected ratios for the following component indicators:

• PSI #3 Pressure Ulcer Rate

• PSI #6 Iatrogenic Pneumothorax Rate

• PSI #7 Central Venous Catheter-Related Blood Stream Infection Rate

• PSI #8 Postoperative Hip Fracture Rate

• PSI #9 Perioperative Hemorrhage or Hematoma Rate

• PSI #10 Postoperative Physiologic and Metabolic Derangement Rate

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CMS Number























0541 Clinical Data 2 Yes (11)

0576 FUH NCQA Claims 4 Yes Yes (28) Yes Yes

0577 SPR NCQA Claims 0

Immunization Status for Adolescents 1407 IMA NCQA Claims and Clinical Data 2 Yes Yes (394)

1419 Claims 0

1516 W34 NCQA Claims 2 Yes Yes (8)

Plan All-Cause Readmission 1768 PCR NCQA Claims 4 Yes Yes (PCR) Yes

1959 HPV NCQA Claims and Clinical Data 1 Yes

NA AAP NCQA Claims 0

Adult BMI Assessment (ABA) NA ABA NCQA Claims and Clinical Data 0

NA CAP NCQA Claims 1 Yes

Unintended Pregnancies NA PRAMS Survey 0

NA BRFSS Survey 0

NA BRFSS Survey 0

NA Claims 0

NA Claims 0

NA Claims 0

Potentially Avoidable ED visits NA Medi-Cal Claims 0

NA Clinical 0

NA Claims 0

Proportion of Days Covered (PDC): 5 Rates by Therapeutic Category

Pharmacy Quality Alliance

Percentage of patients 18 years and older who met the proportion of days covered threshold of 80% during the measurement year. Rate is calculated separately for the following medication categories: Beta-Blockers, ACEI/ARB, Calcium-Channel Blockers, Diabetes Medication, Statins

Follow-Up After Hospitalization for Mental Illness

Percentage of discharges for members 6 years of age and older who were hospitalized for treatment of selected mental health disorders and who had an OP visit, an intensive OP encounter, or partial hospitalization with a mental health practitioner. Two rates are reported: 1) the percentage of members who received follow-up within 30 days of discharge, 2) the percent of members who received follow-up within 7 days of discharge

Use of Spirometry Testing in the Assessment and Diagnosis of COPD

The percentage of patients 40 years of age and older with a new diagnosis of COPD or newly active COPD, who received appropriate spirometry testing to confirm the diagnosis.

Percentage of adolescents that turned 13 years old during the measurement year and had specific vaccines by their 13th birthday

Primary Caries Prevention Intervention as Part of Well/Ill Child Care as Offered by Primary Care Medical Providers

University of Minnesota

The measure will a) track the extent to which the PCMP or clinic (determined by the provider number used for billing) applies FV as part of the EPSDT examination and b) track the degree to which each billing entity’s use of the EPSDT with FV codes increases from year to year (more children varnished and more children receiving FV four times a year according to ADA recommendations for high-risk children).

Well-Child Visits in the 3rd, 4th, 5th, and 6th Years of Life

Percentage of children ages 3 to 6 that had one or more well-child visits with a PCP during the measurement year

For patients 18 years of age and older, the number of acute inpatient stays during the measurement year that were followed by an acute readmission for any diagnosis within 30 days and the predicted probability of an acute readmission. Data are reported in the following categories:

1. Count of Index Hospital Stays* (denominator)

2. Count of 30-Day Readmissions (numerator)

3. Average Adjusted Probability of Readmission

Human Papillomavirus (HPV) Vaccine for Female Adolescents

Percentage of female adolescents 13 years of age who had three doses of the human papillomavirus (HPV) vaccine by their 13th birthday.

Adult Access to Preventive/Ambulatory Health Services (AAP)

The percentage of members 20 to 44 years, 45 to 64 years, and 65 years and older who had an ambulatory or preventive care visit. The organization reports three separate percentages for each age stratification and product line (commercial, Medicaid and Medicare) and a total rate:

• Medicaid and Medicare members who had an ambulatory or preventive care visit during the measurement year • Commercial members who had an ambulatory or preventive care visit during the measurement year or the two years prior to the measurement year

The percentage of members 18 to 74 years of age who had an outpatient visit and whose body mass index (BMI) was documented during the measurement year or the year prior to the measurement year.

Child and Adolescent Access to Primary Care Practitioners

Percentage of children and adolescents ages 12 months to 19 years that had a visit with a PCP, including four separate percentages:

• Children ages 12 to 24 months and 25 months to 6 years who had a visit with a PCP during the measurement year• Children ages 7 to 11 years and adolescents ages 12 to 19 years who had a visit with a PCP during the measurement year or the year prior to the measurement year

Percentage of adults who smoke cigarettes

Percentage of adults reporting 14 or more days of poor mental health

30-day Psychiatric Inpatient Readmission

Washington State (homegrown)

Cardiovascular Disease: Use of Statins

American College of Cardiology /American Heart Association

Medications: Percent Generic (Antacid, Antidepressants, Statins, ACEs/ARBs, ADHD)

Washington Health Alliance (homegrown)

Percent of Patients with 5 or more visits to the Emergency Room without a Care Guideline

Washington Health Alliance (homegrown)

Annual State-purchased Health Care Spending Growth Relative to State GDP


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CMS Number























Medicaid Per Enrollee Spending NA Claims 0

NA Claims 0

0021 MPM NCQA Claims 1 Yes

0001 AMA-PCPI Claims and Clinical Data 0

0004 IET CMS137 NCQA Claims 4 Yes (24) Yes Yes Yes (305) 2014 EHR

0006 AHRQ Survey 4 Yes (47) Yes (321) 2014 EHR & Cross-Cutting

0007 NCQA Survey 1 Yes (NQF # 0007 v 5.0H)

0009 AHRQ Survey 1 Yes (48)

0013 AMA-PCPI Clinical Data 0

0022 DAE CMS156 NCQA Claims and Clinical Data 3 Yes (CMS156 - adult) Yes (238) 2014 EHR

0028 CMS138 AMA-PCPI Claims and Clinical Data 6 Yes (5) Yes (ACO 17) Yes Yes (CMS138 - adult) Yes (226) 2014 EHR & Cross-Cutting Yes

0029 PAO NCQA Survey 1


Public Employee/Dependent Spending per Enrollee (include public schools)


Annual Monitoring for Patients on Persistent Medications

The percentage of members 18 years of age and older who received at least 180 treatment days of ambulatory medication Therapy for a select therapeutic agent during the measurement year and at least one therapeutic monitoring event for the therapeutic agent in the measurement year. For each product line, report each of the four rates separately and as a total rate.

• Annual monitoring for members on angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB)

• Annual monitoring for members on digoxin

• Annual monitoring for members on diuretics

• Annual monitoring for members on anticonvulsants

Asthma: Assessment of Asthma Control

Percentage of patients who were evaluated during at least one office visit for the frequency (numeric) of daytime and nocturnal asthma symptoms

Initiation and Engagement of Alcohol and Other Drug Dependence Treatment

The percentage of adolescent and adult patients with a new episode of alcohol or other drug (AOD) dependence who received the following:

• Initiation of AOD Treatment. The percentage of patients who initiate treatment through an inpatient AOD admission, outpatient visit, intensive outpatient encounter or partial hospitalization within 14 days of the diagnosis.

• Engagement of AOD Treatment. The percentage of patients who initiated treatment and who had two or more additional services with a diagnosis of AOD within 30 days of the initiation visit

CAHPS® Health Plan Survey v 4.0 - Adult questionnaire

30-question core survey of adult health plan members that assesses the quality of care and services they receive. Level of analysis: health plan – HMO, PPO, Medicare, Medicaid, commercial

YesACO 7 (NQF #0006): Health Status/Functional Status

NCQA Supplemental items for CAHPS® 4.0 Adult Questionnaire (CAHPS 4.0H)

This supplemental set of items was developed jointly by NCQA and the AHRQ-sponsored CAHPS Consortium and is intended for use with the CAHPS 4.0 Health Plan survey. Some items are intended for Commercial health plan members only and are not included here. This measure provides information on the experiences of Medicaid health plan members with the organization. Results summarize member experiences through composites and question summary rates.

In addition to the 4 core composites from the CAHPS 4.0 Health Plan survey and two composites for commercial populations only, the HEDIS supplemental set includes one composite score and two item-specific summary rates.

1. Shared Decision Making Composite

CAHPS® Health Plan Survey v 3.0 children with chronic conditions supplement

31- questions that supplement the CAHPS Child Survey v 3.0 Medicaid and Commercial Core Surveys, that enables health plans to identify children who have chronic conditions and assess their experience with the health care system. Level of analysis: health plan – HMO, PPO, Medicare, Medicaid, commercial

Hypertension (HTN): Blood Pressure Measurement

Percentage of patients aged 18 years and older with a diagnosis of hypertension with a blood pressure <140/90 mm Hg OR patients with a blood pressure >= 140/90 mm Hg and prescribed 2 or more anti-hypertensive medications during the most recent office visit within a 12 month period

Use of High-Risk Medications in the Elderly

Percentage of patients 66 years of age and older who were ordered high- risk medications. Two rates are reported:

A. % of patients who were ordered at least one high-risk medication.

B. % of patients who were ordered at least two different high-risk medication.

Tobacco Use: Screening and Cessation Intervention

Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received cessation counseling intervention if identified as a tobacco user

Physical Activity in Older Adults (PAO)

This measure has two rates that assess the promotion of physical activity in older adults:

Discussing Physical Activity: Percentage patients 65 years of age and older who reported discussing their level of exercise or physical activity with a doctor or other health provider in the last 12 months

Advising Physical Activity: Percentage patients 65 years of age and older who reported receiving advice to start, increase, or maintain their level of exercise or physical activity from a doctor or other health provider in the last 12 months

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CMS Number























0030 NCQA Survey 1

Fall Risk Management (FRM) 0035 FRM NCQA Survey 1

0039 FVA NCQA Survey 1 Yes

Flu Shot for Older Adults 0040 NCQA Survey 1

0045 NCQA 1 Yes (024)

0046 NCQA 1 Yes (039)

Asthma: Pharmacologic Therapy 0047 AMA-PCPI Claims and Clinical Data 2 Yes (23) Yes (053)

0048 NCQA 1 Yes (040)

0053 OMW NCQA Claims and Clinical Data 1

0054 ART NCQA Claims 2 Yes (108)

0056 CMS123 NCQA Clinical Data 2 Yes (13) Yes (163) 2014 EHR

0060 CMS148 NCQA 1 Yes (365) 2014 EHR

0063 Retired NCQA Claims 1

0064 Retired CMS163 NCQA Claims and Clinical Data 3 Yes Yes (002) 2014 EHR

0066 Claims and Clinical Data 3 Yes (15) Yes (ACO 33) Yes (118)

0067 Claims and Clinical Data 2 Yes (16) Yes (006)

Urinary Incontinence Management in Older Adults (MUI) - a. Discussing urinary incontinence, b. Receiving urinary incontinence treatment

Percentage of patients 65 years of age and older who reported having a urine leakage problem in the last six months and who discussed their urinary leakage problem with their current practitioner

The percentage of patients 65 years of age and older who reported having a urine leakage problem in the last six months and who received treatment for their current urine leakage problem

Assesses different facets of fall risk management:

Discussing Fall Risk. The percentage of adults 75 years of age and older, or 65–74 years of age with balance or walking problems or a fall in the past 12 months, who were seen by a practitioner in the past 12 months and who discussed falls or problems with balance or walking with their current practitioner.

Managing Fall Risk. The percentage of adults 65 years of age and older who had a fall or had problems with balance or walking in the past 12 months, who were seen by a practitioner in the past 12 months and who received fall risk intervention from their current practitioner.

Flu Vaccinations for Adults Ages 18–64

The percentage of adults 18 years of age and older who self-report receiving an influenza vaccine within the measurement period. This measure collected via the CAHPS 5.0H adults survey for Medicare,

Percentage of patients age 65 and over who received an influenza vaccination from September through December of the year

Osteoporosis: Communication with the Physician Managing On-going Care Post-Fracture of Hip, Spine or Distal Radius for Men and Women Aged 50 Years and Older

Percentage of patients aged 50 years and older treated for a hip, spine or distal radial fracture with documentation of communication with the physician managing the patient’s on-going care that a fracture occurred and that the patient was or should be tested or treated for osteoporosis

Screening or Therapy for Osteoporosis for Women Aged 65 Years and Older

Percentage of female patients aged 65 years and older who have a central dual-energy X- ray absorptiometry (DXA) measurement ordered or performed at least once since age 60 or pharmacologic therapy prescribed within 12 months

Percentage of patients aged 5 through 64 years with a diagnosis of persistent asthma who were prescribed long-term control medication. Three rates are reported for this measure:

1. Patients prescribed inhaled corticosteroids (ICS) as their long term control medication

2. Patients prescribed other alternative long term control medications (non-ICS)

3. Total patients prescribed long-term control medication

Osteoporosis: Management Following Fracture of Hip, Spine or Distal Radius for Men and Women Aged 50 Years and Older

Percentage of patients aged 50 years and older with fracture of the hip, spine, or distal radius who had a central dual-energy X-ray absorptiometry (DXA) measurement ordered or performed or pharmacologic therapy prescribed

Osteoporosis Management in Women who had a Fracture (OMW)

The percentage of women 67 years of age and older who suffered a fracture and who had either a bone mineral density (BMD) test or prescription for a drug to treat or prevent osteoporosis in the six months after the date of fracture.

Disease Modifying Anti-Rheumatic Drug Therapy for Rheumatoid Arthritis

The percentage of patients 18 years and older by the end of the measurement period, diagnosed with rheumatoid arthritis and who had at least one ambulatory prescription for a disease-modifying anti-rheumatic drug (DMARD).

Diabetes: Foot Exam

The percentage of patients 18-75 years of age with diabetes (type 1 and type 2) who received a foot exam (visual inspection with either a sensory exam or a pulse exam) during the measurement year.

Hemoglobin A1c (HbA1c) Testing for Pediatric Patients Percentage of pediatric patients

aged 5-17 years of age with diabetes who received an HbA1c test during the measurement year.

Comprehensive Diabetes Care: LDL-C Screening

The percentage of members 18-75 years of age with diabetes (type 1 and type 2) who received an LDL-C test during the measurement year.

Comprehensive Diabetes Care: LDL-C Control <100 mg/dL

Percentage of patients 18-75 years of age with diabetes whose LDL-C was adequately controlled (<100 mg/dL) during the measurement period.

Chronic Stable Coronary Artery Disease: ACE Inhibitor or ARB Therapy--Diabetes or Left Ventricular Systolic Dysfunction (LVEF <40%)

American College of Cardiology

Percentage of patients aged 18 years and older with a diagnosis of CAD seen within a 12 month period who also have diabetes or a current or prior LVEF <40% who were prescribed ACE inhibitor or ARB therapy

Chronic Stable Coronary Artery Disease: Antiplatelet Therapy


Percentage of patients aged 18 years and older with a diagnosis of CAD seen within a 12 month period who were prescribed aspirin or clopidogrel

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CMS Number























0068 CMS164 NCQA Clinical Data 3 Yes (19) Yes (ACO 30) Yes (204) 2014 EHR

0069 URI CMS154 NCQA Claims 2 Yes (CMS154 - pediatric) Yes (065) 2014 EHR

0070 CMS145 AMA-PCPI Clinical data 2 Yes (17) Yes (007) 2014 EHR

0071 PBH NCQA Claims 0

0074 Claims and Clinical Data 0

0075 CMS182 NCQA Claims and Clinical Data 3 Yes Yes (241) 2014 EHR

Optimal Vascular Composite 0076 MNCM 1 Yes (349)

0081 CMS135 AMA-PCPI Claims and Clinical Data 1 Yes (005) 2014 EHR

0083 CMS144 AMA-PCPI Claims and Clinical Data 4 Yes (18) Yes (ACO 31) Yes Yes (008) 2014 EHR


0087 AAO 1 Yes (014)



0090 AMA-PCPI 1 Yes (054)

Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic

Percentage of patients 18 years of age and older who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous coronary interventions (PCI) in the 12 months prior to the measurement period, or who had an active diagnosis of ischemic vascular disease (IVD) during the measurement period, and who had documentation of use of aspirin or another antithrombotic during the measurement period.

Appropriate Treatment forChildren with Upper Respiratory Infection

Percentage of children 3 months-18 years of age who were diagnosed with upper respiratory infection (URI) and were not dispensed an antibiotic prescription on or three days after the episode.

Coronary Artery Disease (CAD):Beta-Blocker Therapy—Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF <40%)

Percentage of patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12 month period who also have a prior MI or a current or prior LVEF <40% who were prescribed beta-blocker therapy

Persistence of Beta-Blocker Treatment After a Heart Attack

The percentage of patients 18 years of age and older during the measurement year who were hospitalized and discharged alive from 6 months prior to the beginning of the measurement year through the 6 months after the beginning of the measurement year with a diagnosis of acute myocardial infarction (AMI) and who received persistent beta-blocker treatment for six months after discharge.

Chronic Stable Coronary Artery Disease: Lipid Control


Percentage of patients aged 18 years and older with a diagnosis of CAD seen within a 12 month period who have a LDL-C result <100 mg/dL OR patients who have a LDL-C result >=100 mg/dL and have a documented plan of care to achieve LDL-C <100mg/dL, including at a minimum the prescription of a statin

No (used to be ACO 32, removed Nov 2014)

Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control

Percentage of patients 18 years of age and older who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous coronary interventions (PCI) in the 12 months prior to the measurement period, or who had an active diagnosis of ischemic vascular disease (IVD) during the measurement period, and who had a complete lipid profile performed during the measurement period and whose LDL-C was adequately controlled (< 100 mg/dL).


Percent of patients aged 18 to 75 with ischemic vascular disease (IVD) who have optimally managed modifiable risk factors demonstrated by meeting all of the numerator targets of this patient level all-or-none composite measure: blood pressure less than 140/90, tobacco-free status, and daily aspirin use

Heart Failure (HF): Angiotensin-Converting Enzyme (ACE)Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy forLeft Ventricular Systolic Dysfunction (LVSD)

Percentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a current or prior left ventricular ejection fraction (LVEF) < 40% who were prescribed ACE inhibitor or ARB therapy either within a 12 month period when seen in the outpatient setting OR at each hospital discharge

Heart Failure (HF): Beta- Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)

Percentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a current or prior left ventricular ejection fraction (LVEF) <40% who were prescribed beta-blocker therapy either within a 12 month period when seen in the outpatient setting OR at each hospital discharge

Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation

Percentage of patients aged 18 years and older with a diagnosis of POAG who have an optic nerve head evaluation during one or more office visits within 12 months

Age-Related Macular Degeneration (AMD): Dilated Macular Examination

Percentage of patients aged 50 years and older with a diagnosis of age-related macular degeneration (AMD) who had a dilated macular examination performed which included documentation of the presence or absence of macular thickening or hemorrhage AND the level of macular degeneration severity during one or more office visits within 12 months

Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy

Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed which included documentation of the level of Diabetic Retinopathy:

Communication with the Physician Managing Ongoing Diabetes Care

Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed with documented communication to the physician who manages the ongoing care of the patient with diabetes mellitus regarding the findings of the macular or fundus exam at least once within 12 months

Emergency Medicine: 12-Lead Electrocardiogram (ECG) Performed for Non-Traumatic Chest Pain

Percentage of patients aged 40 years and older with an emergency department discharge diagnosis of non-traumatic chest pain who had a 12-lead electrocardiogram (ECG) performed

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CMS Number























0091 ATS 1 Yes (051)

Medication Reconciliation 0097 NCQA Clinical Data 1 Yes (046) Cross-Cutting

0101 CMS139 NCQA Claims 3 Yes (ACO 13) Yes

0102 AMA-PCPI Claims and Clinical Data 1 Yes (052)

0104 CMS161 AMA-PCPI 1 Yes (107) 2014 EHR

0108 ADD CMS136 NCQA Claims 3 Yes Yes (CMS136 - pediatric) Yes (366) 2014 EHR

0110 CMS169

CQAIMH

1 Yes (367) 2014 EHR

0113 Clinical Data/Registry 0

0114 STS 1 Yes (167)

0115 STS 1 Yes (168)

0129 STS 1 Yes (164)

0130 STS 1 Yes (165)

0131 STS 1 Yes (166)

0132 CMS Claims and Clinical Data 0

0134 STS 1 Yes (043)


0136 CMS Clinical Data 0

AMI-3: ACEI or ARB for LVSD 0137 CMS Claims and Clinical Data 0

Chronic Obstructive Pulmonary Disease (COPD): Spirometry Evaluation

Percentage of patients aged 18 years and older with a diagnosis of COPD who had spirometry results documented

Percentage of patients aged 65 years and older discharged from any IP facility (e.g. hospital, skilled nursing facility, or rehabilitation facility) and seen within 60 days following discharge in the office by the physician providing on-going care who had a reconciliation of the discharge medications with the current medication list in the medical record documented


Falls: Screening, Risk-Assessment, and Plan of Care to Prevent Future Falls

This is a clinical process measure that assesses falls prevention in older adults. The measure has three rates:

A. Screening for Future Fall Risk: Percentage of patients aged 65 years of age and older who were screened for future fall risk at least once within 12 months

B. Falls: Risk Assessment: Percentage of patients aged 65 years of age and older with a history of falls who had a risk assessment for falls completed within 12 months

C. Plan of Care for Falls: Percentage of patients aged 65 years of age and older with a history of falls who had a plan of care for falls documented within 12 months.

Yes (154, 155 & 318) 2014 EHR & Cross-Cutting

COPD: Bronchodilator TherapyPercentage of symptomatic patients with COPD who were prescribed an inhaled bronchodilator

Adult Major Depressive Disorder (MDD): Suicide Risk Assessment Percentage of patients aged 18

years and older with a new diagnosis or recurrent episode of major depressive disorder (MDD) with a suicide risk assessment completed during the visit in which a new diagnosis or recurrent episode was identified

Follow-Up Care for Children Prescribed Attention- Deficit/Hyperactivity Disorder Medication

Percentage of children newly prescribed ADHD medication that had at least three follow-up care visits within a 10-month period, one of which was within 30 days from the time the first ADHD medication was dispensed, including two rates: one for the initiation phase and one for the continuation and maintenance phase

Bipolar Disorder and Major Depression: Appraisal for alcohol or chemical substance use

No longer Endorsed

Percentage of patients with depression or bipolar disorder with evidence of an initial assessment that includes an appraisal for alcohol or chemical substance use

SM-PART-CARD: Participation in a systematic database for cardiac surgery

Society of Thoracic Surgeons

Participation in a clinical database with broad state, regional, or national representation, that provides regular performance reports based on benchmarked data

Coronary Artery Bypass Graft (CABG): Postoperative Renal Failure

Percentage of patients aged 18 years and older undergoing isolated CABG surgery (without pre-existing renal failure) who develop postoperative renal failure or require dialysis

Coronary Artery Bypass Graft (CABG): Surgical Re-Exploration

Percentage of patients aged 18 years and older undergoing isolated CABG surgery who require a return to the operating room (OR) during the current hospitalization for mediastinal bleeding with or without tamponade, graft occlusion, valve dysfunction, or other cardiac reason

Coronary Artery Bypass Graft (CABG): Prolonged Intubation

Percentage of patients aged 18 years and older undergoing isolated CABG surgery who require postoperative intubation > 24 hours

Coronary Artery Bypass Graft (CABG): Deep Sternal Wound Infection Rate

Percentage of patients aged 18 years and older undergoing isolated CABG surgery who, within 30 days postoperatively, develop deep sternal wound infection involving muscle, bone, and/or mediastinum requiring operative intervention

Coronary Artery Bypass Graft (CABG): Stroke

Percentage of patients aged 18 years and older undergoing isolated CABG surgery who have a postoperative stroke (i.e., any confirmed neurological deficit of abrupt onset caused by a disturbance in blood supply to the brain) that did not resolve within 24 hours

AMI-1: Aspirin at Arrival

Percentage of acute myocardial infarction (AMI) patients who received aspirin within 24 hours before or after hospital arrival

Coronary Artery Bypass Graft (CABG): Use of Internal Mammary Artery (IMA) in Patients with Isolated CABG Surgery

Percentage of patients aged 18 years and older undergoing isolated CABG surgery who received an IMA graft

HF-2: Percent of Heart Failure Patients Given an Evaluation of Left Ventricular Systolic (LVS) Function

Percentage of heart failure patients with documentation in the hospital record that left ventricular systolic (LVS) function was evaluated before arrival, during hospitalization, or is planned for after discharge.

HF-1: Heart Failure: Instructions Given When Patient is Released from the Hospital

No longer Endorsed

Percentage of heart failure patients discharged home with written instructions or educational material given to patient or caregiver at discharge or during the hospital stay addressing all of the following: activity level, diet, discharge medications, follow-up appointment, Percentage of acute myocardial infarction (AMI) patients with left ventricular systolic dysfunction (LVSD) who are prescribed an ACEI or ARB at hospital discharge. For purposes of this measure, LVSD is defined as chart documentation of a left ventricular ejection fraction (LVEF) less than 40% or a narrative description of left ventricular systolic (LVS) function consistent with moderate or severe systolic dysfunction.

O2




CMS Number























0139 CDC Clinical Data 2 Yes (Pediatric Only) Yes (45)

Patient Fall Rate 0141 Clinical Data 0


0143 Clinical Data 0

0144 Clinical Data 0

0147 CMS Clinical Data 0



HF-3: ACEI or ARB for LVSD 0162 CMS Claims and Clinical Data 0


0164 CMS Claims and Clinical Data 1 Yes (20)

HAI-1: CLABSI: Central Line-Associated Blood Stream Infection

Standardized Infection Ratio (SIR) of healthcare-associated, central line-associated bloodstream infections (CLABSI) will be calculated among patients in the following patient care locations:

• Intensive Care Units (ICUs)

• Specialty Care Areas (SCAs) - adult and pediatric: long term acute care, bone marrow transplant, acute dialysis, hematology/oncology, and solid organ transplant locations

• other inpatient locations.

(Data from these locations are reported from acute care general hospitals (including specialty hospitals), freestanding long term acute care hospitals, rehabilitation hospitals, and behavioral health hospitals. This scope of coverage includes but is not limited to all

American Nurses Association

All documented falls, with or without injury, experienced by patients on eligible unit types in a calendar quarter. Reported as Total Falls per 1,000 Patient Days and Unassisted Falls per 1000 Patient Days.

(Total number of falls / Patient days) X 1000

Measure focus is safety.Target population is adult acute care inpatient and adult rehabilitation patients.

AMI-2: Aspirin Prescribed at Discharge

Percentage of acute myocardial infarction (AMI) patients who are prescribed aspirin at hospital discharge

CAC-1a: Relievers for Inpatient Asthma (age 2 years through 17 years) – Overall Rate


Use of relievers in pediatric patients, age 2 years through 17 years, admitted for inpatient treatment of asthma. This measure is a part of a set of three nationally implemented measures that address children’s asthma care that are used in The Joint Commission’s accreditation process.

CAC-2a: Systemic Corticosteroids for Inpatient Asthma (age 2 years through 17 years) – Overall Rate


Use of systemic corticosteroids in pediatric asthma patients (age 2 through 17 years) admitted for inpatient treatment of asthma. This measure is a part of a set of three nationally implemented measures that address children’s asthma care that are used in The Joint Commission’s accreditation process.

PN-6: Appropriate Initial Antibiotic Selection for Community-Acquired Pneumonia (CAP) in Immunocompetent Patients

PN-6a: Initial Antibiotic Selection for CAP in Immunocompetent –ICU Patient

PN-6b: Initial Antibiotic Selection for CAP in Immunocompetent –Non ICU Patient

Percentage of pneumonia patients 18 years of age or older selected for initial receipts of antibiotics for community-acquired pneumonia (CAP)

PN-3b: Blood Cultures Performed in the Emergency Department Prior to Initial Antibiotic Received in Hospital

No longer Endorsed

Percentage of pneumonia patients 18 years of age and older who have had blood cultures performed in the emergency department prior to initial antibiotic received in hospital

AMI-5: Beta-Blocker Prescribed at Discharge

Percentage of acute myocardial infarction (AMI) patients who are prescribed a beta-blocker at hospital discharge

Percentage of heart failure (HF) patients with left ventricular systolic dysfunction (LVSD) who are prescribed an ACEI or ARB at hospital discharge. For purposes of this measure, LVSD is defined as chart documentation of a left ventricular ejection fraction (LVEF) less than 40% or a narrative description of left ventricular systolic (LVS) function consistent with moderate or severe systolic dysfunction.

AMI-8a: Primary PCI Received Within 90 Minutes of Hospital Arrival

Percentage of acute myocardial infarction (AMI) patients with ST-segment elevation or LBBB on the ECG closest to arrival time receiving primary percutaneous coronary intervention (PCI) during the hospital stay with a time from hospital arrival to PCI of 90 minutes or less.

AMI-7a: Fibrinolytic Therapy Received Within 30 Minutes of Hospital Arrival

Percentage of acute myocardial infarction (AMI) patients with ST-segment elevation or LBBB on the ECG closest to arrival time receiving fibrinolytic therapy during the hospital stay and having a time from hospital arrival to fibrinolysis of 30 minutes or less.

O2


Recommended Comprehensive ACC Measure Set as of November 22, 2013- Detail“This product was prepared with support provided through a grant from the Robert Wood Johnson Foundation’s State Quality and Value Strategies program.”

“This product was prepared with support provided through a grant from the Robert Wood Johnson Foundation’s State Quality and Value Strategies program.”

Measure Selection Tool

Criterion A Criterion B Criterion C Criterion D Criterion E Criterion F Criterion G Criterion H Criterion I Criterion J

CalculationCommercial and State Measure Sets

NQF Endorsed Has a relevant benchmark Commercial Measures

# Measure Name NQF Number Steward Description Domain Population Data Source Rationale Criterion A Criterion B Criterion C Criterion D Criterion E Criterion F Criterion G Criterion H Criterion I Criterion J 1 2 3 4

1 0005 AHRQ Process Adult & Pediatric Survey 7 Yes yes Yes Somewhat No No No 4 1 3 0 0

2 0419 CMS CMS68 Process Clinical Data 4 yes yes no No 4 0 4 0 0

3 2371 NCQA #N/A Process #N/A 4 yes Yes No 3 3 0 0 0 Yes Yes Yes

4 Plan All-Cause Readmission 1768 NCQA Process Claims 0 6 0 4 0 2

5 2510 CMS Process Claims 0 1 0 1 0 0

6 CMS #N/A #N/A Process #N/A 0 0 0 0 0 0



9 0275 AHRQ Process Claims 0 5 0 3 0 2


11 AHRQ #N/A Process Claims 0 1 1 0 0 0 yes

12 AHRQ #N/A Process Pediatric Claims 0 1 1 0 0 0 Yes


14 #N/A #N/A Process #N/A 0 0 0 0 0 0

15 Potentially Avoidable ED visits Medi-Cal #N/A Process Claims 0 1 1 0 0 0 Yes


17 APA #N/A Process #N/A 0 0 0 0 0 0

18 Breast Cancer Screening 2372 NCQA Prevention Process Claims 10 Yes Yes Yes Yes Yes No No 7 5 2 0 0 Yes Yes Yes Yes

19 0032 NCQA CMS124 Prevention Process 6 yes yes Yes No No No No 8 5 2 0 1 Yes Yes Yes Yes

20 Chlamydia Screening 0033 NCQA CMS153 Prevention Process Claims 9 yes yes Yes Yes Somewhat No No 8 2 4 0 2 Yes Yes

21 Colorectal Cancer Screening 0034 NCQA CMS130 Prevention Process 10 yes yes Yes Yes No No Yes 11 3 5 0 3 Yes Yes

22 0041 AMA-PCPI CMS147 Prevention Process Adult & Pediatric 4 yes yes no No 6 1 5 0 0 Yes

23 1959 NCQA Prevention Process 6 yes yes Yes No 2 1 1 0 0 Yes

24 0024 NCQA CMS155 Prevention Process 4 yes no Yes No 6 1 4 0 1

25 0421 CMS CMS69 Prevention Process Clinical Data 6 yes yes no No yes 11 2 8 0 1 Yes

26 1448 NCQA Prevention Process Pediatric 6 yes yes Yes No 5 1 1 0 3

27 1392 NCQA Prevention Process Claims 6 yes yes Yes No 7 4 2 0 1 Yes Yes

28 1516 NCQA Prevention Process Claims 6 yes yes Yes No 6 4 2 0 0 Yes Yes

29 Adolescent well-care visits N/A NCQA #N/A Prevention Process Claims 6 yes yes Yes No 4 4 0 0 0 Yes Yes

30 0028 AMA-PCPI CMS138 Prevention Process 6 yes yes no No yes 7 1 6 0 0 Yes

31 N/A CMS22 Prevention Process #N/A 2 yes no no No 0 0 0 0 0

32 Prenatal & Postpartum Care 1517 NCQA Prevention Process Women's Health 4 yes Yes No 7 3 2 0 2 Yes Yes

33 1391 NCQA Prevention Process Women's Health 4 yes Yes No 3 1 2 0 0

34 1419 Prevention Process Pediatric Claims 2 yes no no No 0 0 0 0 0

35 0418 CMS CMS2 Prevention Process 6 yes Yes No yes 12 0 9 0 3

36 Maternal Depression Screening 1401 NCQA CMS82 Prevention Process Women's Health 0 0 no no No 1 0 1 0 0

37 0722 Mass General #N/A #N/A Prevention Outcome Claims 4 yes no Yes 0 0 0 0 0

38 1799 NCQA Process Claims 6 yes yes Yes No 2 1 1 0 0

39 0054 NCQA Process Claims 4 yes Yes No 6 4 2 0 0 Yes Yes Yes

40 0059 NCQA CMS122 Outcome 10 yes yes Yes Yes yes 11 3 5 0 3 Yes Yes

41 0055 NCQA CMS131 Process Claims 8 yes yes Yes No yes 10 6 4 0 0 Yes Yes Yes Yes

42 0057 NCQA Process Claims 4 yes yes no No 5 3 1 0 1 Yes Yes

43 0062 NCQA CMS134 Process Claims 6 yes yes Yes No 5 2 3 0 0 Yes Yes

44 Controlling High Blood Pressure 0018 NCQA CMS165 Outcome Clinical Data 10 yes yes Yes Yes yes 14 3 9 0 2 Yes Yes

45 0083 AMA-PCPI CMS144 Process 2 yes no No 6 2 4 0 0 Yes

46 0577 NCQA Process Claims 4 yes Yes No 2 2 0 0 0 Yes

47 0071 NCQA Process Claims 4 yes Yes No 5 5 0 0 0 Yes Yes Yes Yes

48 CAD: Medication adherence 0543 CMS #N/A Process Adult #N/A 0 no no No 1 1 0 0 0 Yes

49 0052 NCQA CMS166 Process Claims 4 yes Yes No 5 3 2 0 0 Yes Yes

50 0058 NCQA Process Claims 4 yes Yes No 5 3 1 0 1 Yes Yes

51 0069 NCQA CMS154 Process Claims 4 yes Yes No 6 4 2 0 0 Yes Yes Yes

52 0068 NCQA CMS164 Process Clinical Data 4 yes Yes No 4 1 3 0 0 Yes

53 0108 NCQA CMS136 Process Claims 6 yes yes Yes No 8 3 3 0 2 Yes Yes

54 0710 CMS159 Outcome 0 4 yes yes no No 2 0 2 0 0

55 1365 AMA-PCPI CMS177 Process 0 4 yes no Yes 2 0 2 0 0

56 N/A AMA-PCPI #N/A Process #N/A 2 yes no no No 0 0 0 0 0

57 0469 Obstetrics Process Women's Health Clinical Data 2 yes no No 6 0 2 2 2

Instruction s:• Enter Measures for Consideration in Columns A through J.• Begin with entering known NQF number in Column C (note: you must enter a 4-digit number (e.g., 0002 not 2 or 02)).• 'Measure Name', 'Steward', 'CMS Number', 'Description, and 'Data Source' w ill auto-populate for measures currently included in the Measure Crosswalk tab. • Enter all remaining information manually.

Instructions:• Identify, using the drop-down box in Row 4, the Selection Criteria identified as "Include" from Selection Criteria Worksheet .• If your program identifies new criteria (not included on Selection Criteria worksheet) add those by manually typing into the cell. • For every measure, answer "Yes", "Somewhat" or "No" for every Selection Criteria using the drop-down box in each row, to select your answer.• Manually enter measure-specific comments (e.g., benchmark, etc.) for each Criterion.

Instructions:Enter (Row 2, Column AW thru BC) the name of commercial or state measure set in use in your state.Enter "Yes" if the measure is used by the commercial or state measure set. Enter "Yes" if the measure is used by the commercial or state measure set.

Sufficient denominator size (i.e., base rate)

Present an opportunity for quality improvement (>90 = 0, 75-90 = 1, <75 = 2

Present an opportunity for quality improvement (50-75= 0, 25-50=1, <25 = 2)

Is the measure a process measure for which an available outcome measure would better serve?

Health Equity Design Group: most important to measure and reward from a health equity perspective

Click here to use criterion dropdown menu

Click here to use criterion dropdown menu

CMS Number

Process/ Outcome

Measure Origin

Measure Status


Measure-specific comments for Criterion A

Measure-specific comments for Criterion B

Measure-specific comments for Criterion C

Measure-specific comments for Criterion D

Measure-specific comments for Criterion E

Measure-specific comments for Criterion F

Measure-specific comments for Criterion G

Measure-specific comments for Criterion H

Measure-specific comments for Criterion I

Measure-specific comments for Criterion J

Aligned with Other Measure Sets?

Aligned with Commercial and State Measure Sets

Aligned with Federal Measure Sets Focused on Ambulatory Care

Aligned with National Hospital Measure Sets

Aligned with Select State Measure Sets

CAHPS® Clinician/Group Surveys - (Adult Pr imary Care, Pediatric Care, and Specialist Care Surveys)

• Adult Prim ary Care Survey: 37 core and 64 supplemental quest ion survey of adult outpat ient primary care patients.

• Pediatric Care Survey : 36 core and 16 supplem ental quest ion survey of outpatient pediatric care patients.

• Specialist Care Survey: 37 core and 20 supplemental ques tion survey of adult outpatients specialist care patients . Level of analysis for each of the 3 surveys: group practices, sites of care, and/or individual clinicians

Consumer Experience

Documentation of Current Medications in the Medical Reco rd

Percentage of specif ied visits for patients aged 18 years and older for which the eligible professional attes ts to documenting a list of current m edications to the bes t of his/her knowledge and ability. This list must include ALL prescriptions , over-the-counters, herbals , and vitamin/mineral/dietary (nutrit ional) supplements AND must contain the medicat ions’ name, dosage, frequency and route of adminis trat ion.

Care Coordination/ Pat ient Safety

Adult18 & older

Annual Monitor ing of Persistent Medications (roll-up)

This measure assesses the percentage of patients 18 years of age and older who received a least 180 treatment days of ambulatory medication therapy for a select therapeutic agent during the measurement year and at least one therapeutic monitoring event for the therapeutic agent in the measurement year.- Angiotens in converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB): At least one serum potass ium and a serum creatinine therapeutic monitoring test in the measurement year. - Digox in: At leas t one serum potassium, one serum c reatinine and a serum digoxin therapeut ic monitoring test in the measurement year.- Diuret ics: At least one serum potassium and a serum creat inine therapeutic monitoring tes t in the measurement year. - Total rate (the sum of the three numerators divided by the sum of the three denominators)


Adult18 & older

For pat ients 18 years of age and older, the number of acute inpatient stays during the measurement year that were followed by an acute readmission for any diagnosis w ithin 30 days and the predicted probability of an acute readm ission. Data are reported in the following categories:

1. Count of Index Hospital Stays* (denominator)

2. Count of 30-Day Readmissions (numerator)

3. Average Adjusted Probability of Readmission


Skilled Nu rsing Facil ity 30-Day All-C ause Readmission Measure (SNFRM)

This measure est imates the risk-standardized rate of all-cause, unplanned, hospital readmissions for patients who have been admit ted to a Skilled Nursing F acility (SNF) (Medicare fee-for-service [FF S] beneficiaries) within 30 days of discharge from their prior proximal hospitalization. The prior proximal hospitalization is def ined as an admission to an IPPS, CAH, or a psychiatric hospital. The measure is based on data for 12 months of SNF admissions.


'All-C ause Unplan ned Admissions for Patients with Diabetes


All-C ause Unplan ned Admissions for Patients with Heart Failure


All-C ause Unplan ned Admissions for Patients with Multiple Chronic Con dition s


Chro nic Obstructive Pulmo nary Disease (PQI -05)

This measure is used to assess the number of admissions for COPD per 100,000 population


Congestive Heart Failure Admission Rate (PQI -08) Percent of county population with an admiss ions for C HF


Rate of Hospitalizatio n for Amb ulatory Care-Sensitive Conditions: PQI Composite (PQI 92)

The composite Ambulatory Care Sensitive Admissions rate per 1,000 members age 18 and older during the measurement period. Anthem internally developed. Inforned by the Agency for Healthcare Research and Quality (AHRQ) Prevention Quality Indicators. Version 4.4 March 2012. The composite Ambulatory Care Sens itive Admiss ions rate per 1,000 members age 18 and older during the measurement period. Includes the following admiss ions: Angina, Asthma/Bronchitis, COBD, Dehydration, Diabetes, Heart Failure, Hypertens ion, Pneumonia, UTI.


Pediatric ambulatory care sensitive condition composite

Internally developed informed by the agency for healthcare research and quality (ahrq) pediatric quality indicators. AHRQ quality indicators version 4.4, march 2012. The compos ite ambulatory care sensit ive admissions rate per 1,000 pediatric members under 18 years . Note: this measure only applies to pediatricians. Dx c riteria can be shared if determ ined a viable scorecard metric


Asth ma in Younger Ad ults Admission Rate (PQI 15)

Admiss ions for a principal diagnos is of asthma per 100,000 populat ion, ages 18 to 39 years. Excludes admissions with an indication of cystic fibrosis or anomalies of the respiratory sys tem, obstetric admissions, and transfers from other institutions .


Annual % asthma p atients (2-20) with 1 or more asth ma-related ED visits

Custom Measure - Based on the C hildren's Health Insurance Program Reauthorization Ac t (CHIPRA) Measure, but w ith ED Rev Codes added; NQF 1381, but with the addition of the ED Rev Codes due to CT Medicaid billing methodology. Not among the pediatric design group recommended measures. Ins tead proposed CH IPR A measure, hospital admissions for as thma.


Internally developed informed by research conducted by the NYU Center for Health and Public Service Research and the United Hospital Fund of New York . The rate of Potent ially avoidable empergency room visits per 1,000 members . Anthem will share Dx criteria if determined a viable scorecard metric


Hospital Admission s fo r Pediatric Asth ma, per 100,000 children

Admiss ion rate for asthma in children ages 2-17, per 100,000 populat ion (area level rate)


Adult Major Depressive Disord er (MDD): Coord ination of Care of Patients with Specific Comorbid Conditions

Percentage of medical records of patients aged 18 years and older with a diagnosis of major depressive disorder (MDD) and a specific diagnosed comorbid condition (diabetes, coronary artery disease, ischemic stroke, intracranial hemorrhage, chronic k idney disease [stages 4 or 5] , End Stage Renal Disease [ESRD] or congestive heart failure) being treated by anoTher clinician with communicat ion to the clinician treat ing the comorbid condition


Percentage of women 50-74 years of age who had a mammogram to sc reen for breast cancer.

Women's Health50-74

Cervical Cancer Screening Percentage of women 21-64 years of age, who received one or more Pap tests to sc reen for cervical cancer.

Women's Health Claims and Clinical Data

Percentage of women ages 16 to 24 that were ident ified as sexually ac tive and had at leas t one test for Chlamydia during the measurement year

Women's Health16-24

Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer.

Adult50-75


Influen za ImmunizationPercentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an inf luenza immunization OR who reported prev ious receipt of an influenza immunization


Human Papillomavirus (HPV) Vaccine for Female Ado lescents

Percentage of female adolescents 13 years of age who had three doses of the human papillomavirus (HPV) vaccine by their 13th birthday .

Women's Health13


Weight Assesment and counseling for n utr ition and physical activity for child ren/ adolescents

Percentage of children ages 3 to 17 that had an outpatient visit with a primary care practitioner (PCP) or obs tetrical/gynecological (OB/GYN) practitioner and whose weight is classified based on body mass index percentile for age and gender

Pediatric3-17


Adult Body Mass Index (BMI) Assessment

Percentage of patients aged 18 years and older with a documented BMI during the current encounter or during the previous six months AND when the BMI is outside of normal parameters , a follow-up plan is documented during the encounter or during the previous six months of the encounter.

Normal Parameters: Age 65 years and older BMI > or = 23 and < 30 Age 18 – 64 years BMI > or = 18.5 and < 25

Adult18 & older

Develo pmental Screenin g In the First Three Years of Life

The percentage of children screened for risk of developmental, behavioral and soc ial delays using a s tandardized screening tool in the first three years of life. This is a measure of screening in the first three years of life that includes three, age-specific indicators assessing whether children are screened by 12 months of age, by 24 months of age and by 36 months of age.

Claims (Depending on s tate)

Well-Child Visits in the First 15 Months of Life

Percentage of children that turned 15 months old during the measurement year and had zero, one, two, three, four, five, or six or more well-child visits with a PCP during their f irst 15 months of life

Pediatric 15 months

Well-Child Visits in the 3rd, 4th , 5th, and 6th Years of L ife

Percentage of children ages 3 to 6 that had one or more well-child visits with a PC P during the measurement year

Pediatric3-6

Percentage of adolescents ages 12 to 21 that had at least one comprehensive well-care v is it with a PCP or an OB/GYN pract itioner during the measurement year

Pediatric12-21

Tobacco Use: Screen ing and Cessation Interventio n

Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received cessation counseling intervent ion if identified as a tobacco user

Adult18 & older


Screening for high blood pressu re an d follow-up

Quality Insights of PA Centers for Medicare & Medicaid Services

Percentage pf patients aged 18 years and older seen during the reporting period who were screened for high blood pressure AND a recommended follow-up plan is documented based on the current BP reading as indicated

The percentage of deliveries of live births between Novem ber 6 of the year prior to the measurement year and November 5 of the measurement year. For these women, the measure assesses the following facets of prenatal and postpartum care.

• Rate 1: Timeliness of Prenatal Care. The percentage of deliveries that received a prenatal care visit as a pat ient of the organizat ion in the first trimester or within 42 days of enrollment in the organizat ion.

• Rate 2: Pos tpartum Care. T he percentage of deliveries that had a postpartum visit on or between 21 and 56 days after delivery


Frequency of Ongoing Pren atal C are

Measure examines the percentage of Medicaid deliveries that received various numbers of expected prenatal vis its.


Primary C aries Preven tion Intervention as Part of Well/ Ill Child Care as Offered by Primary C are Medical Providers

University of Minnesota

The measure will a) track the extent to which the PCM P or clinic (determined by the provider number used for billing) applies FV as part of the EPSDT examination and b) track the degree to which each billing entity’s use of the EPSDT with FV codes increases from year to year (more children varnished and more children receiving FV four times a year according to ADA recommendations for high-risk children).

Screening for Clinical Depressio n and F ollo w-Up Plan

Percentage of patients aged 12 years and older screened for clinical depression on the date of the encounter us ing an age appropriate standardized depression screening tool AND if pos it ive, a follow up plan is documented on the date of the pos it ive screen.

Adult & Pediatric12 & older


The percentage of children 6 months of age who had documentation of a maternal depression screening for the mother

Pediatric behavio ral health screenin g

Pediatric4-16

Medication Management for Peop le with Asthma

The percentage of patients 5-64 years of age during the measurement year who were identified as hav ing pers is tent asthma and were dispensed appropriate m edications that they remained on during the treatment period. Two rates are reported:

1. The percentage of pat ients who remained on an asthma controller medication for at least 50% of their treatment period.

2. The percentage of pat ients who remained on an asthma controller medication for at least 75% of their treatment period.


Adult & Pediatric5-64

Disease Modifying Anti-Rheumatic Drug Th erapy for Rheumatoid Arthritis

The percentage of patients 18 years and older by the end of the measurement period, diagnosed with rheumatoid arthritis and who had at least one ambulatory prescription for a disease-modifying anti-rheumatic drug (DMARD).


Adult18 & older

Comprehensive Diab etes Care: Hemoglobin A1c (HbA1c) Poor Contro l (>9.0%)

Percentage of patients 18-75 years of age with diabetes w ho had hemoglobin A1c > 9.0% during the measurement period.


Adult18-75


Comprehensive Diab etes Care: Eye Exam

Percentage of patients 18-75 years of age with diabetes w ho had a retinal or dilated eye exam by an eye care profess ional during the measurement period or a negative retinal exam (no evidence of retinopathy) in the 12 months prior to the measurement period


Adult18-75

Comprehensive Diab etes Care: Hemoglobin A1c testing

The percentage of members 18-75 years of age with diabetes (type 1 and type 2) who received an HbA1c test during the measurement year.


Adult18-75

Comprehensive Diab etes Care: Med ical Atten tion for Nephrop athy

The percentage of patients 18-75 years of age with diabetes who had a nephropathy sc reening test or evidence of nephropathy during the measurement period.


Adult18-75

The percentage of patients 18 to 85 years of age who had a diagnosis of hypertension (HTN) and whose blood pressure (BP) was adequately controlled (<140/90) during the measurement year.


Adult18-85

Heart Failure (HF): Beta- Blocker Therapy for Left Ventricu lar Systolic Dysfunction (LVSD)

Percentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a current or prior left ventricular eject ion fract ion (LVEF) <40% who were prescribed beta-blocker therapy either within a 12 month period when seen in the outpatient setting OR at each hospital discharge


Adult18 & older


Use of Spirometry Testin g in the Assessment and Diagnosis of COPD

The percentage of patients 40 years of age and older with a new diagnosis of COPD or newly act ive COPD, who received appropriate spirometry testing to confirm the diagnosis .


Adult40 & older

Persistence o f Beta-Blocker Treatment After a Heart Attack

The percentage of patients 18 years of age and older during the measurement year who were hospitalized and discharged alive from 6 months prior to the beginning of the measurement year through the 6 months after the beginning of the measurement year with a diagnosis of acute myocardial infarction (AMI) and who received persistent beta-blocker treatment for s ix months after discharge.


Adult18 & older

The percentage of individuals with coronary artery disease (CAD ) who are prescribed statin therapy that had a Proport ion of Days Covered (PDC) for statin medicat ions of at leas t 0.8 during the measurement period (12 consecutive months)


Use of Imag ing Studies for Low Back Pain

Percentage of patients 18-50 years of age with a diagnosis of low back pain who did not have an imaging study (plain X-ray, MRI, CT scan) within 28 days of the diagnosis.


Adult18-50

Avoidance of Antibiotic Treatment in Adults with Acute Bron chitis

The percentage of adults 18–64 years of age with a diagnos is of acute bronchit is who were not dispensed an ant ibiotic presc ription.


Adult18-64

Appropriate Treatment forChildren with Upper Resp iratory In fection

Percentage of children 3 months-18 years of age who were diagnosed with upper respiratory infect ion (URI) and were not dispensed an antibiotic prescription on or three days after the episode.


Pediatric3mths - 18

Ischemic Vascular Disease (IVD): Use o f Aspirin or Another Antithrombotic

Percentage of patients 18 years of age and older who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous coronary interventions (PCI) in the 12 months prior to the measurement period, or who had an ac tive diagnosis of ischemic vascular disease (IVD) during the measurement period, and who had documentation of use of aspirin or another ant ithrombotic during the measurement period.


Adult18 & older

Follow-U p Care for Child ren Prescrib ed Attentio n- Deficit/Hyperactivity Disorder Medication

Percentage of children newly prescribed ADHD medicat ion that had at least three follow-up care visits within a 10-month period, one of which was within 30 days from the time the first ADH D medication was dispensed, including two rates: one for the init iat ion phase and one for the continuat ion and maintenance phase

Behavioral Health

Pediatric6-12

Depressio n Remission at Twelve Mo nths

MN Community Measurement

Adult patients age 18 and older with major depression or dysthymia and an initial PHQ-9 score > 9 who demons trate remission at twelve months defined as a PHQ-9 score less than 5. This measure applies to both patients with newly diagnosed and exist ing depression whose current PH Q-9 score indicates a need for t reatment. The Patient Health Questionnaire (PHQ-9) tool is a widely accepted, standardized tool [Copyright © 2005 Pfizer, Inc. All rights reserved] that is completed by the patient, ideally at each visit, and ut ilized by the prov ider to monitor treatment progress. This measure addit ionally promotes ongoing contact between the pat ient and provider as pat ients who do not have a follow-up PHQ-9 score at twelve months (+/- 30 days) are also included in the denominator.

Behavioral Health

Adult18 & older

Child and Adolescent Majo r Depressive Disorder: Su icide Risk Assessment

Percentage of patient vis its for those patients aged 6 through 17 years with a diagnos is of major depressive disorder with an assessment for suicide risk

Behavioral Health

Pediatric6-17

Unhealthy alcohol use - screenin g

Percentage of patients aged 18 years and older who were screened for unhealthy alcohol use at leas t once within 24 months using a systematic screening method**

Behavioral Health

Adult18 & older

Elective Delivery Prior to 39 Completed Weeks Gestation (PC-01)


This measure assesses patients w ith elect ive vaginal deliveries or elect ive cesarean sec tions at >= 37 and < 39 weeks of ges tation completed. This measure is a part of a set of five nat ionally implemented measures that address perinatal care (PC-02: Cesarean Sec tion, PC-03: Antenatal Steroids, PC-04: Health Care-Assoc iated Bloodstream Infections in Newborns, PC-05: Exclusive Breast Milk Feeding)



DATA DROPDOWN DATA DROPDOWN DATA DROPDOWN DATA DROPDOWN DATA DROPDOWN DATA DROPDOWN DATA DROPDOWN DATA DROPDOWN DATA DROPDOWN DATA DROPDOWNDO NOT EDIT OR DELETE DO NOT EDIT OR DELETE DO NOT EDIT OR DELETE DO NOT EDIT OR DELETE DO NOT EDIT OR DELETE DO NOT EDIT OR DELETE DO NOT EDIT OR DELETE DO NOT EDIT OR DELETE DO NOT EDIT OR DELETE DO NOT EDIT OR DELETESelect Criterion A: Select Criterion B: Select Criterion C: Select Criterion D: Select Criterion E: Select Criterion F: Select Criterion G: Select Criterion H: Select Criterion I: Select Criterion J:Evidence-based and scientifically acceptable Evidence-based and scientifically acceptable Evidence-based and scientifically acceptable Evidence-based and scientifically acceptable Evidence-based and scientifically acceptable Evidence-based and scientifically acceptable Evidence-based and scientifically acceptable Evidence-based and scientifically acceptable Evidence-based and scientifically acceptable Evidence-based and scientifically acceptableHas a relevant benchmark Has a relevant benchmark Has a relevant benchmark Has a relevant benchmark Has a relevant benchmark Has a relevant benchmark Has a relevant benchmark Has a relevant benchmark Has a relevant benchmark Has a relevant benchmarkNot greatly influenced by patient case mix Not greatly influenced by patient case mix Not greatly influenced by patient case mix Not greatly influenced by patient case mix Not greatly influenced by patient case mix Not greatly influenced by patient case mix Not greatly influenced by patient case mix Not greatly influenced by patient case mix Not greatly influenced by patient case mix Not greatly influenced by patient case mixConsistent with the goals of the program Consistent with the goals of the program Consistent with the goals of the program Consistent with the goals of the program Consistent with the goals of the program Consistent with the goals of the program Consistent with the goals of the program Consistent with the goals of the program Consistent with the goals of the program Consistent with the goals of the programUseable and relevant Useable and relevant Useable and relevant Useable and relevant Useable and relevant Useable and relevant Useable and relevant Useable and relevant Useable and relevant Useable and relevantFeasible to collect Feasible to collect Feasible to collect Feasible to collect Feasible to collect Feasible to collect Feasible to collect Feasible to collect Feasible to collect Feasible to collectAligned with other measure sets Aligned with other measure sets Aligned with other measure sets Aligned with other measure sets Aligned with other measure sets Aligned with other measure sets Aligned with other measure sets Aligned with other measure sets Aligned with other measure sets Aligned with other measure setsPromotes increased value Promotes increased value Promotes increased value Promotes increased value Promotes increased value Promotes increased value Promotes increased value Promotes increased value Promotes increased value Promotes increased valuePresent an opportunity for quality improvement Present an opportunity for quality improvement Present an opportunity for quality improvement Present an opportunity for quality improvement Present an opportunity for quality improvement Present an opportunity for quality improvement Present an opportunity for quality improvement Present an opportunity for quality improvement Present an opportunity for quality improvement Present an opportunity for quality improvementTransformative potential Transformative potential Transformative potential Transformative potential Transformative potential Transformative potential Transformative potential Transformative potential Transformative potential Transformative potentialSufficient denominator size Sufficient denominator size Sufficient denominator size Sufficient denominator size Sufficient denominator size Sufficient denominator size Sufficient denominator size Sufficient denominator size Sufficient denominator size Sufficient denominator sizeRepresentative of the array of services provided b Representative of the array of services provided by Representative of the array of services provided by Representative of the array of services provided b Representative of the array of services provided by Representative of the array of services provided b Representative of the array of services provided by Representative of the array of services provided b Representative of the array of services provided by Representative of the array of services provided by the programRepresentative of the diversity of patients served Representative of the diversity of patients served Representative of the diversity of patients served Representative of the diversity of patients served Representative of the diversity of patients served Representative of the diversity of patients served Representative of the diversity of patients served Representative of the diversity of patients served Representative of the diversity of patients served Representative of the diversity of patients served by the programNot unreasonably burdensome to payers or providers Not unreasonably burdensome to payers or providers Not unreasonably burdensome to payers or providers Not unreasonably burdensome to payers or providers Not unreasonably burdensome to payers or providers Not unreasonably burdensome to payers or providers Not unreasonably burdensome to payers or providers Not unreasonably burdensome to payers or providers Not unreasonably burdensome to payers or providers Not unreasonably burdensome to payers or providers



Commercial and State Measure Sets Federal Measure Sets Primarily Focused on Ambulatory CareNational Hospital Measure Sets Select State Measure Sets

Commercial Measures State Measures (version date: 03/2015) (version date: 04/2015) (version date: 03/2014) (version date: 04/2015) (version date: 01/2015) (version date: 03/2014) (version date: 01/2013) (version date: 10/2014) (version date: 07/2014 & 12/2014) ( version date: 05/2015)

5

yes Yes (46) Yes (321) 2014 EHR & Cross-Cutting Yes Yes

Yes (32) Yes (ACO 39) Yes (CMS68 - adult) Yes (130) 2014 EHR & Cross-Cutting

Not Found Not Found Not Found Not Found Not Found Not Found Not Found Not Found Not Found Not Found Not Found Not Found Not Found Not Found Not Found Not Found Not Found Not Found Not Found

Yes Yes (PCR) Yes Yes Yes Yes Yes

Yes (58)

No NQF Number No NQF Number No NQF Number No NQF Number No NQF Number No NQF Number No NQF Number No NQF Number No NQF Number No NQF Number No NQF Number No NQF Number No NQF Number No NQF Number No NQF Number No NQF Number No NQF Number No NQF Number No NQF Number



Yes (66) Yes Yes (ACO 09) Yes Yes Yes

Yes (67) Yes Yes (ACO 10) Yes



Yes (70) Yes Yes




Yes Yes Yes (C01: 2016 only)

Yes Yes Yes (309) 2014 EHR Yes Yes Yes

Yes Yes Yes (CMS153 - pediatric) Yes (310) 2014 EHR Yes Yes Yes

Yes Yes (6) Yes (ACO 19) Yes Yes (113) 2014 EHR Yes Yes Yes Yes Yes

Yes (3) Yes (ACO 14) Yes Yes (CMS147) Yes (110) 2014 EHR & Cross-Cutting Yes

Yes Yes

Yes Yes Yes (9) Yes (CMS155 - pediatric) Yes (239) 2014 EHR Yes Yes

Yes Yes (10) Yes (uses ABA) Yes (uses ABA) Yes (ACO 16) Yes (CMS69 - adult) Yes (128) 2014 EHR & Cross-Cutting Yes Yes

yes Yes Yes Yes Yes

Yes yes Yes Yes (7) Yes

Yes yes Yes Yes (8) Yes Yes

Yes yes Not Found Not Found Not Found Not Found Not Found Not Found Not Found Not Found Not Found Not Found Not Found Not Found Not Found Not Found Not Found Not Found Not Found Not Found Not Found

Yes (5) Yes (ACO 17) Yes Yes (CMS138 - adult) Yes (226) 2014 EHR & Cross-Cutting Yes Yes


Yes Yes (Postpartum Care Rate) Yes Yes

Yes Yes Yes (29)

Yes

Yes (25) Yes Yes Yes (ACO 18) Yes Yes Yes (134) 2014 EHR & Cross-Cutting Yes Yes Yes Yes Yes

Yes (372) 2014 EHR


yes Yes

Yes Yes (108)

Yes Yes Yes (ACO 27) Yes Yes (001) 2014 EHR & Cross-Cutting Yes Yes Yes Yes Yes

Yes yes Yes (12) Yes (ACO 41) Yes (117) 2014 EHR Yes Yes

yes Yes Yes Yes

Yes (14) Yes (119) 2014 EHR Yes Yes

Yes Yes (37) Yes Yes Yes (ACO 28) Yes Yes (CMS165 - adult) Yes (236) 2014 EHR & Cross-Cutting Yes Yes Yes Yes Yes

yes Yes (18) Yes (ACO 31) Yes Yes (008) 2014 EHR Yes

Yes Yes

Yes


Yes Yes (CMS166 - adult) Yes (312) 2014 EHR Yes

Yes Yes (116) Yes Yes Yes

Yes Yes (CMS154 - pediatric) Yes (065) 2014 EHR

Yes (19) Yes (ACO 30) Yes (204) 2014 EHR Yes

Yes Yes Yes (CMS136 - pediatric) Yes (366) 2014 EHR Yes Yes

Yes (ACO 40) Yes (370) 2014 EHR

Yes Yes (382) 2014 EHR


Yes (38) Yes Yes Yes Yes Yes Yes

Instructions:Enter (Row 2, Column AW thru BC) the name of commercial or state measure set in use in your state.Enter "Yes" if the measure is used by the commercial or state measure set. Enter "Yes" if the measure is used by the commercial or state measure set.

Note:These fields will be automatically populated for measures with a known NQF#. You may check Measure Crosswalk tab for measures for which the NQF# is unknown.

Note:These fields will be automatically populated for measures with a known NQF#. You may check Measure Crosswalk tab for measures for which the NQF# is unknown.

Note:These fields w ill be automatically populated for measures with a known NQF#. You may check Measure Crosswalk tab for measures for which the NQF# is unknown.

( version date: 10/2014 and 02/2015)

Medicaid Set B







Meaningful Use Clinical Quality Measures (CQMs) for 2014


PQRS

EP EHR Incentive Clinical Quality Measures (eCQMs)

Cross-Cutting Measures

CCMI SIM Recommended Model Performance Metrics CMS Medicare Part C &

D Star Ratings Measures

Joint Commission Medicare Hospital Value-Based Purchasing (FY's 2015 &2016)

Medicare Hospital Compare

Oregon CCO Incentive Measures- Year Two, July 2014

Oregon CCO State Performance “Test” Measures- Year Two, July 2014

VT ACO Pilot Core Performance Measures for Payment and Reporting in Year One (January 16, 2014)

Washington State Performance Measures

Version date: 12/17/2014

Maine ACO Payment Measures

Version date: 1/7/2015

YesACO 01 (NQF #0005): Gett ing Timely Care, Appointments, and Information ACO 2 (NQF #0005): How Well Your Providers Communicate ACO 3 (NQF #0005): Patient Rating of Provider ACO 4 (NQF #0005): Access to Specialist ACO 5 (NQF #0005): Health Promotion and Education ACO 6 (NQF #0005): Shared Decision Making

Yes (C22: 2015 and C19: 2016)

Yes (C01: 2015 and C02: 2016)

Yes (C08: 2015 and C07: 2016)

Yes (Timeliness of Prenatal Care)

Yes (CMS2 - adult & pediatric )

Yes (C19: 2015 and C17: 2016)

Yes (C16: 2015 and C15: 2016)

Yes (C14: 2015 and C13: 2016)

yes (C15: 2015 and C14: 2016)

Yes (C18: 2015 and C16: 2016)

Measure Set Version Date Summary Description of Measure Set Link to Measure Set Link to Measure Specifications Notes

March 2015

April 2015 http://innovation.cms.gov/

March 2014

April 2015

January 2015

August 2014


The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) included provisions to strengthen the quality of care provided and health outcomes of children in Medicaid and CHIP. CHIPRA required HHS to identify and publish an initial core measure set of children’s health care quality measures for voluntary use by State Medicaid and CHIP programs.

CMS released the 2015 Child Core Set in a December 2014 CMS Informational Bulletin. The core set includes a range of children’s quality measures encompassing both physical and mental health, including chronic conditions, such as asthma, attention deficit hyperactivity disorder, and diabetes.

www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Quality-of-Care/Downloads/ChildCoreMeasures.pdf http://www.medicaid.gov/medicaid-chip-program-information/by-topics/quality-of-care/chipra-initial-core-set-of-childrens-health-care-quality-measures.htmlhttp://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Quality-of-Care/Downloads/Medicaid-and-CHIP-Child-Core-Set-Manual.pdf

CMMI Priority Measures forMonitoring and Evaluation

In an effort to enhance understanding of Innovation Center initiatives and to establish a consistent framework for performance measurement and evaluation, the Research and Rapid Cycle Evaluation Group aims to align measures used for monitoring and evaluation across the Innovation Center where applicable. Appropriate measurement alignment is necessary for the Innovation Center to examine the overall impact of its initiatives on the health of populations, quality, and efficiency of care, and to compare the effectiveness of different models.

This priority list is intended to identify a set of meaningful measures for monitoring and evaluations of Innovation Center models, and we encourage the use of additional measures within each model as necessary to fully address model-specific monitoring and evaluation needs.

http://innovation.cms.gov/Files/x/PriorityMsrMontEval.pdf


The health home provision authorized by section 2703 of the Affordable Care Act provides an opportunity to build a person-centered care delivery model that focuses on improving outcomes and disease management for beneficiaries with chronic conditions and obtaining better value for state Medicaid programs. As part of this care improvement effort and after extensive consultation with states and other stakeholders, the Centers for Medicare & Medicaid Services (CMS) is sharing a recommended core set of health care quality measures for assessing the health home service delivery model that CMS intends to promulgate in the rulemaking process.

www.medicaid.gov/State-Resource-Center/Medicaid-State-Technical-Assistance/Health-Homes-Technical-Assistance/Downloads/Health-home-core-set-manual-.pdfhttp://www.medicaid.gov/State-Resource-Center/Medicaid-State-Technical-Assistance/Health-Homes-Technical-Assistance/Downloads/Health-home-core-set-manual-.pdf


The Affordable Care Act (Section 1139B) requires the Secretary of HHS to identify and publish a core set of health care quality measures for adult Medicaid enrollees. The law requires that measures designated for the core set be currently in use. To aid in the assessment of the quality of care for Medicaid-eligible adults, the law calls for HHS to:

1. Develop a standardized reporting format for the core set of measures:

2. Establish an adult quality measurement program;

3. Issue an annual report by the Secretary on the reporting of adult Medicaid quality information;

4. Publish updates to the initial core set of adult health quality measures that reflect new or enhanced quality measures.

The 2015 Adult Core Set was released in December 2014 through an Informational Bulletin. Section 1139B of the Social Security Act, as amended by Section 2701 of the Affordable Care Act, notes that the Secretary shall issue updates to the Adult Core Set beginning in January 2014 and annually thereafter. CMS worked with the National Quality Forum's (NQF) Measures Application Partnership (MAP) to review the Adult Core Set and to identify ways to improve it.

http://www.medicaid.gov/medicaid-chip-program-information/by-topics/quality-of-care/adult-health-care-quality-measures.htmlhttp://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Quality-of-Care/Adult-Health-Care-Quality-Measures.htmlhttp://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Quality-of-Care/Downloads/Medicaid-Adult-Core-Set-Manual.pdf


On November 2, 2011, the Centers for Medicare & Medicaid Services (CMS) finalized new rules under the Patient Protection and Affordable Care Act (Affordable Care Act) to help doctors, hospitals, and other health care providers better coordinate care for Medicare patients through Accountable Care Organizations (ACOs). ACOs create incentives for health care providers to work together to treat an individual patient across care settings—including doctor’s offices, hospitals, and long-term care facilities.

The Medicare Shared Savings Program (Shared Savings Program) will reward ACOs that lower their growth in health care costs while meeting performance standards on quality of care and putting patients first. Participation in an ACO is purely voluntary.

(ACO Provider Fact sheet: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/ACO_Summary_Factsheet_ICN907404.pdf)

http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Quality_Measures_Standards.htmlhttp://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/RY2015-Narrative-Specifications.pdf

Comprehensive Primary Care Initiative (CPCI)

The Comprehensive Primary Care Initiative (CPCI) is a 4-year multi-payer program fostering collaboration between public and private health care payers to strengthen primary care. Approximately 500 primary care practices are participating in the CPC Initiative throughout 7 U.S. regional areas.

http://innovation.cms.gov/initiatives/comprehensive-primary-care-initiative/ http://www.cms.gov/eHealth/downloads/PY_2014_CPC_EHR_CQM_Manual_AUGUST.PDF

http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Quality-of-Care/Downloads/ChildCoreMeasures.pdf

http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Quality-of-Care/Downloads/Medicaid-and-CHIP-Child-Core-Set-Manual.pdf

http://innovation.cms.gov/Files/x/PriorityMsrMontEval.pdf

http://www.medicaid.gov/State-Resource-Center/Medicaid-State-Technical-Assistance/Health-Homes-Technical-Assistance/Downloads/Health-home-core-set-manual-.pdf

http://www.medicaid.gov/State-Resource-Center/Medicaid-State-Technical-Assistance/Health-Homes-Technical-Assistance/Downloads/Health-home-core-set-manual-.pdf

http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Quality-of-Care/Adult-Health-Care-Quality-Measures.html

http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Quality-of-Care/Downloads/Medicaid-Adult-Core-Set-Manual.pdf

http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Quality_Measures_Standards.html

http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/RY2015-Narrative-Specifications.pdf

http://www.cms.gov/eHealth/downloads/PY_2014_CPC_EHR_CQM_Manual_AUGUST.PDF

Measure Set Version Date Summary Description of Measure Set Link to Measure Set Link to Measure Specifications Notes

January 2013

October 2014

May 2015

Meaningful Use Clinical Quality Measures (CQMs) for 2014

The Medicare and Medicaid EHR Incentive Programs provide financial incentives for the “meaningful use” of certified EHR technology to improve patient care. To receive an EHR incentive payment, providers have to show that they are “meaningfully using” their EHRs by meeting thresholds for a number of objectives. CMS has established the objectives for “meaningful use” that eligible professionals, eligible hospitals, and critical access hospitals (CAHs) must meet in order to receive an incentive payment.

For 2014, CMS is not requiring the submission of a core set of CQMs. Instead we identify two recommended core sets of CQMs, one for adults and one for children. We encourage eligible professionals to report from the recommended core set to the extent those CQMs are applicable to your scope of practice and patient population.

www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Recommended_Core_Set.html

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/2014_CQM_AdultRecommend_CoreSetTable.pdf

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/2014_CQM_PrediatricRecommended_CoreSetTable.pdf


The Medicare-Medicaid Financial Alignment Initiative is designed to test innovative models to better align Medicare and Medicaid financing and the services provided to Medicare-Medicaid enrollees.

http://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/FinancialModelstoSupportStatesEffortsinCareCoordination.html

www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/Downloads/FinalCY2014CoreReportingRequirements.pdf

Physician Quality Reporting System (PQRS)

EP EHR Incentive Clinical Quality Measures (eCQMs)

Cross Cutting Measures

July 2014 (for 2015) December 2014

Physician Quality Reporting System (Physician Quality Reporting or PQRS) formerly known as the Physician Quality Reporting Initiative (PQRI)

PQRS is a reporting program that uses a combination of incentive payments and payment adjustments to promote reporting of quality information by eligible professionals (EPs).

The program provides an incentive payment to practices with EPs (identified on claims by their individual National Provider Identifier [NPI] and Tax Identification Number [TIN]). EPs satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS) beneficiaries (including Railroad Retirement Board and Medicare Secondary Payer).

http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html?redirect=/PQRS/

http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Electronic-Health-Record-Reporting.html

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/eCQM_Library.html

http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/PQRS_2015_Measure-List_111014.ziphttp://cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/2014eCQMs_EligibleProfessionalsTable_July2014.pdfhttp://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/MeasuresCodes.htmlListed all PQRS measures and identified (2015 Reporting Year CMS EHR Incentive Programs (eCQMs) & Cross-Cutting measures)


Model Performance Metrics: These metrics are intended to capture data on quality, cost, utilization and population health. Awardees are required to report on metrics associated with cost, utilization, quality and population health to the CMMI SIM Program on a quarterly and/or annual basis. The metrics listed in this tab are recommended by the CMMI SIM Program. Awardees are free to select alternative metrics depending on their SIM proposal and/or metrics which cover similar content areas, in consultation with their Project Officer. Furthermore, Awardees may develop or select additional performance metrics to track activities specific to their SIM initiative which are not captured in the recommended model performance metrics suggested by the CMMI SIM Program. Awardees are expected to provide baseline values and target goals in their Operational Plan. The Awardee should plan to discuss these areas further with Project Officers and engage Technical Assistance as needed.

http://innovation.cms.gov/initiatives/state-innovations/

R2_Reporting Metrics

Guidance_v1.xlsx

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Recommended_Core_Set.html

http://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/Downloads/FinalCY2014CoreReportingRequirements.pdf

http://cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/2014eCQMs_EligibleProfessionalsTable_July2014.pdf

http://innovation.cms.gov/initiatives/state-innovations/