Douglas B. Jacobs, M.D., M.P.H.,  Michelle Schreiber, M.D.,  Meena Seshamani, M.D., Ph.D.,  Daniel Tsai, B.A.,  Elizabeth Fowler, Ph.D., J.D.,  and Lee A. Fleisher, M.D.

New England Journal of Medicine 2/1/2023

We — the leaders of many CMS centers — aim to promote high-quality, safe, and equitable care. We believe aligning measures to focus provider attention and drive quality improvement and care transformation will catalyze efforts in this area. Since there is tension between measuring all important aspects of quality and reducing measure proliferation, we are proposing a move toward a building-block approach: a “universal foundation” of quality measures that will apply to as many CMS quality-rating and value-based care programs as possible, with additional measures added on, depending on the population or setting.

The Universal Foundation is part of CMS’s efforts to implement the vision outlined in our National Quality Strategy¹ and is fundamental to achieving several of the agency’s quality and value-based care goals.^2,3 It is intended to focus providers’ attention on measures that are meaningful for the health of broad segments of the population; reduce provider burden by streamlining and aligning measures; advance equity with the use of measures that will help CMS recognize and track disparities in care among and within populations; aid the transition from manual reporting of quality measures to seamless, automatic digital reporting; and permit comparisons among various quality and value-based care programs, to help the agency better understand what drives quality improvement and what does not. To select measures for the Universal Foundation, CMS prioritized measures that were most likely to achieve these goals and have minimal unintended consequences (e.g., promoting overtreatment of certain

Our intention is that the Universal Foundation will eventually include selected measures for assessing quality along a person’s care journey — from infancy to adulthood — and for important care events, such as pregnancy and end-of-life care. We started by identifying preliminary measures for the Universal Foundation’s adult and pediatric components (see table). The streamlined measures included here would be used across CMS programs and populations, to the extent that they are applicable and in keeping with legislative statutes.conditions).

Looking ahead, CMS intends to move toward aligning measures while collecting feedback by means of listening sessions, requests for information and proposed rulemaking, and other interactions with the medical community and general public. We will incorporate this feedback into future iterations of the Universal Foundation. For Medicaid and the Children’s Health Insurance Program specifically, any changes to measure sets will be made in partnership with states and other stakeholders. CMS will also continue to engage in discussions about broader alignment of quality measures outside CMS, for instance as part of the Core Quality Measures Collaborative, state efforts, and the Health Care Payment Learning and Action Network, to identify future opportunities for alignment.

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