1. Putting Patients Back at
the Center of Healthcare:
How CMS Measures
Prioritize Patient-
Centered Outcomes
HEALTH CATALYST EDITORS

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Kimberly Rawlings, MPP
Centers for Medicare & Medicaid Services (CMS)
This report is based on a 2019 Healthcare Analytics Summit presentation
given by Kimberly Rawlings, MPP, Measures Management System Lead,
CMS, titled, “Meaningful Measures: Prioritizing Patients Over Paperwork.”
Putting Patients Back at the Center of Healthcare

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Putting Patients Back at the Center of Healthcare
Two themes dominate patient and
clinician experience today:
Drastically increased clinician
screen time in the exam room
Increased regulatory burdens on
clinicians and health systems.
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Putting Patients Back at the Center of Healthcare
A primary side effect of these contemporary
trends is a loss of patient engagement.
Clinicians and organizations become so
taxed with reports and measures that what
should be their number one priority—the
patient—gets lost in the shuffle.
Without patients at the center, healthcare
organizations can miss information about
care delivery or outcomes, and thus fail to
properly align goals and resources around
patient-centered outcomes improvements
and lowered costs.

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Putting Patients Back at the Center of Healthcare
To move the patient back to the center of
care, CMS launched its Meaningful
Measures framework, including the
Patients over Paperwork initiative, in 2017.
The patient-centered effort aims to
evaluate the current regulatory practices
that hinder a productive patient-clinician
relationship and establish CMS strategies
that put patients first across all programs
(Medicare, Medicaid, and the exchanges).

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Putting Patients Back at the Center of Healthcare
Meaningful Measures works to empower
patients and clinicians in keyways:
getting patients the right care, at the
right time, in the right place and ensuring
both patients and clinicians have the
data they need to realize these goals.

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Interoperability:
The Foundation for Innovation in Patient-Centered Care
Achieving CMS’s patient-centered goals
will require innovation across all payment
models, including interoperability—the
ability to share data across disparate
systems for seamless data sharing among
patients, clinicians, payer, and providers.
Health systems must have effective, open
data sharing practices to keep patients
healthy, while payers need shared data to
tie payments to outcomes.

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Interoperability:
The Foundation for Innovation in Patient-Centered Care
As the lynchpin of patient-centered care and
Meaningful Measures objectives, inter-
operability also gives clinicians the timely
information they need to make decisions at
the point of care, versus waiting days or
weeks for critical information.

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Interoperability:
The Foundation for Innovation in Patient-Centered Care
Data sharing across patients and
clinicians enables coordinated care,
better outcomes, and reduced costs,
as providers have insights to avoid
drivers of cost and poor outcomes,
such as repeats of costly tests and
adverse drug interactions.

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From Aligning and Reducing Measures to
Incentivizing Sound Decision Making
CMS introduced Meaningful Measures
to address the problem of too many
disparate measures and a subsequent
unsustainable administrative reporting
and provider cost burden.

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From Aligning and Reducing Measures to
Incentivizing Sound Decision Making
The framework aims to simplify processes
by focusing on critical areas that matter
most for clinicians and patients and
promoting alignment and stimulating
innovation for new types of measures
to better serve patients, clinicians,
and providers.

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From Aligning and Reducing Measures to
Incentivizing Sound Decision Making
Meaningful Measures focus industry efforts on quality areas that fulfill
certain criteria:
Address high-impact measure areas that safeguard public health.
Are patient-centered and meaningful to patients, clinicians,
and providers.
Are outcome-based where possible.
Fulfill requirements in CMS statutes.
Minimize level of burden for providers.
Identify significant opportunity for improvement.
Address measure needs for population-based payment
through alternative payment.
Align across programs and/or with other payers.
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From Aligning and Reducing Measures to
Incentivizing Sound Decision Making
The framework’s introduction allowed CMS to
pause from the fast pace of measure
development and implementation to reflect
on what’s meaningful to patients, resolve
disparate measures and reporting burdens,
and promote measurement alignment with
four strategic goals (Figure 1):
1. Introduce more flexibility and local leadership.
2. Support innovation.
3. Empowering patients and clinicians.
4. Improving the customer experience.

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From Aligning and Reducing Measures to
Incentivizing Sound Decision Making
Figure 1: Four strategic goals for the CMS Meaningful Measures program.

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From Aligning and Reducing Measures to
Incentivizing Sound Decision Making
Meaningful Measures promotes patient-centered healthcare improvement in
eight areas, each with accompanying measures to support improved outcomes:
1. Preventive care.
2. Management of chronic conditions.
3. Prevention, treatment, and management of mental health.
4. Prevention, treatment, and management of opioid and
substance use disorders.
5. Risk-adjusted mortality.
6. Medication management.
7. Admissions and readmissions to hospitals.
8. Transfer of health information and interoperability.

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From Aligning and Reducing Measures to
Incentivizing Sound Decision Making
Meaningful Measures aligns with existing
quality-reporting programs and helps
those programs identify and select
individual measures.
It also allows clinicians and other providers
to focus on patients and improve care in
meaningful ways, capturing the most-
impactful and highest-priority quality
improvement areas for all clinicians
including specialists.
The initiative guides rulemaking,
measures-under-construction lists,
and impact assessments.

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The Next Steps for CMS Quality Measures
In the coming years, Meaningful
Measures will continue to focus on
engaging stakeholders in the
development of measures that matter
most to clinicians and patients.
Clinicians don’t want to report on what
they feel doesn’t matter (i.e., doesn’t
improve outcomes or reduce costs).

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The Next Steps for CMS Quality Measures
To that end and based on stakeholder input,
priorities moving forward will include
patient-reported outcomes, electronic
clinical quality measures, appropriate use of
opioids and avoidance of harm, nursing
home safety, maternal mortality, and sepsis.

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A Framework for Patient-Centered Care
Meaningful Measures established a
vision and a practical strategy for getting
patients back at the center of healthcare.
Importantly, CMS is listening to
stakeholders on the frontlines of care
delivery—including patients, clinicians,
and providers—to ensure that quality
measures work for, not against, better
care and lower costs.

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A Framework for Patient-Centered Care
As more advanced electronic infras-
tructure promises to support more data
interoperability, CMS will have further
insights into ways to remove obstacles
to patient engagement while also
advancing quality goals.

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For more information:
“This book is a fantastic piece of work”
– Robert Lindeman MD, FAAP, Chief Physician Quality Officer

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Other Clinical Quality Improvement Resources
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Kimberly Rawlings is currently the lead for the Measures Management System (MMS) within the
Quality Measurement and Value-Based Incentives Group at the Centers for Medicare & Medicaid
Services (CMS). As lead, Mrs. Rawlings manages the MMS Blueprint, organizes quality measurement
education and outreach efforts, and coordinates and aligns measure development activities across
CMS. She is also a member of the team implementing the Meaningful Measures initiative across the
agency and works to engage with external stakeholder to further the initiative. Mrs. Rawlings joined
CMS over 5 years ago after finishing her Master’s degree in Public Policy at the University of Maryland
College Park. She also holds a sociology degree from Smith College in Northampton, MA.
Kimberly Rawlings, MPP

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Other Clinical Quality Improvement Resources
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