PCO measures work in tandem with clinical care to help people living with complex health needs make progress toward a health goal that matters to them. PCO measures have three components:

• Identify a goal and document it in a structured way, using goal attainment scaling or a patient-reported outcome measure.
• Follow up on the goal.
• Assess achievement of the goal.

Clinicians across the care continuum and in community-based services can use this approach to identify what’s important to a person and support age-friendly care. Defining a person’s goals—and ensuring that their care is consistent with those goals—can reduce unwanted treatment, improve patient activation and lead to meaningful improvement.

Why It Matters

NCQA is currently moving the PCO measures for C-SNPs and D-SNPs through the HEDIS^® approval process, with the goal of incorporating the measures in Measurement Year (MY) 2027.  We are beginning with special needs plans because they have an existing practice to build on—they already include goal documentation as part of their care models. Plus, the Centers for Medicare & Medicaid Services (CMS) issued a new rule in August 2025 that requires goals to be person-centered and for care teams to follow up on the goals, which aligns with PCO measures.

“In the past ten years, NCQA has tested the PCO measures with over 30,000 patients and over 750 clinicians in a variety of care settings across 17 states,” says Daniela Lawton, NCQA’s Assistant Vice President of Quality Sciences Integration. “We’ve shown that clinicians are able to implement this approach and organizations are able to document and report the necessary data elements for the measures. We are excited to work toward incorporating the PCO measures into HEDIS.”

In Their Own Words: Partner Perspectives on PCO Measures

Our partners explain why they chose to participate in the D-SNP testing.

“Person-centered outcome measures are crucial for our membership as they empower members to take control of their health. This approach fosters better engagement and collaboration, ultimately leading to improved health outcomes. We volunteered for this testing process because our mission is to make a lasting difference in our members’ lives. Supporting our membership in developing their specific, member-driven goals and needs aligns perfectly with this mission. Through this testing, we have recognized that while members may fall within the same category, their individual needs can vary significantly. Generalized goals do not adequately address these unique needs. By focusing on member-driven and specific objectives, we can truly understand our members and provide the support they need to achieve their goals.”

Meghan Crane, MSW, LISW-S, CCM, Manager, Case Management, Integrated Care, CareSource

“Person-centered outcome measures represent a strategic evolution in how we define value and accountability in healthcare. For the D-SNP populations we serve, quality must extend beyond clinical indicators to reflect the goals, preferences and lived experiences that shape each member’s health journey. Our participation in NCQA’s testing initiative reflects our broader commitment to advancing a more integrated, person-centered model of care. By contributing insights from the communities we serve, we are helping shape the future of quality measurement while strengthening how person-centered principles are embedded across our long-term strategy, partnerships and performance framework.”

Dr. Christy Valentine Theard, President, Anthem Blue Cross and Blue Shield Medicaid, New York

“Person-centered outcome measures are especially important for the vulnerable populations we serve because they center care around what matters most to our members—their personal goals and lived experiences. Person-centered outcome goals help ensure we are supporting quality of life, independence and dignity.”

Esther Elefant RN, BSN, CRC, Director II of Health Care Management Services, Anthem Blue Cross and Blue Shield, New York

Lessons Learned from D-SNP Testing

NCQA evaluated PCO measures with two D-SNPs to assess whether goal conversations and documentation are feasible and can be integrated into existing SNP workflows. We provided technical assistance and reviewed data submissions to identify areas for improvement.

“Our testing confirms that the PCO measures are feasible, adaptable to diverse systems and capable of driving person-centered care,” says Lawton. “Goal identification had the highest compliance among D-SNPs. Performance rates for goal follow-up and goal achievement were lower, which is consistent with our past testing efforts.”

Here are some of the lessons learned that can help clinicians as they prepare to implement PCO measures:

1. Focus on what matters to the person. A patient managing diabetes may be more motivated to feel well so they can attend a family event, rather than focusing solely on lab numbers. Ask probing questions to understand why the goal matters to them.
2. Identify a specific task or activity. Singular goals give people a clear focus. Rather than “get more active,” a person with diabetes might choose walking as the specific activity they want to increase.
3. Set a realistic time frame. All goals should be timebound. For example, walking 10–14 minutes daily for the next two months is more actionable than an open-ended commitment to move more.
4. Don’t expect perfection. Build wiggle room into the patient’s goal, so a missed day doesn’t mean failure. Adding “on average” can also help it feel less daunting. For example, setting a goal to walk 10 minutes daily, on average, over two months leaves wiggle room for a 5-minute or a 15-minute daily walk—giving the patient options without derailing progress.
5. Document all follow up discussions. Goal progress should be documented at every visit—even when the patient hasn’t advanced. During testing, we discovered that some clinicians were not documenting the follow-up conversation if the patient did not make enough progress toward their goal. If progress is stalling, check in: Is the goal still realistic? Use that conversation, not just the outcome, as the clinical record.

What’s Next

NCQA recently completed a public comment period for HEDIS MY 2027, which included a recommendation to add PCO measures for D-SNPs and C-SNPs. Institutional SNPs are not included. Next, the recommendation will move through NCQA’s committee process for consideration and approval.

We also see movement toward digitalization of goal-directed care through Health Level Seven (HL7^®), which presents opportunities to standardize the documentation required for the PCO measures. NCQA is participating in the HL7 Patient Care Work Group and co-developed the Person-Centered Outcome Implementation Guide (IG). The IG defines the standards for transmission of data in an interoperable format, such as Fast Interoperability Healthcare Resources (FHIR^®). It includes the steps to document goal-directed care, such as recording a goal, using goal attainment scaling or patient-reported outcome measures to track goals over time and goal follow-up. The IG should be released in the spring.

Learn More

The graphic below provides a high-level overview of PCO measures and how they work. Visit our resource page to learn more about PCO measures and how to implement them in your organization.

Acknowledgements

NCQA developed person-centered outcome measures with support from The John A. Hartford Foundation, The SCAN Foundation and the Gordon and Betty Moore Foundation.

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA).

HL7^® and FHIR^® are the registered trademarks of Health Level Seven International and their use does not constitute endorsement by HL7.

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“We started developing PCO measures in 2015 to improve healthcare for patients with complex care needs,” says Julie Seibert, NCQA’s Assistant Vice President, Behavioral Health. “This project builds upon that work by updating the measures for adults with IDD and providing practitioners with tools to incorporate quality measures that align with person-centered goals into the treatment process.”

This initiative stems from NCQA’s partnership with IEC (Institute for Exceptional Care) on the IIDDEAL (Individuals with IDD Engaged, Aligned and Leading) project to conduct an environmental scan and work with self-advocates to build consensus on which quality measures are most appropriate and applicable for people with IDD. Read our blog post to learn more about our work with IIDDEAL.

How Can PCO Measures Support People with IDD?

Healthcare for adults with IDD is fragmented, costly and may not reflect what matters most to them. Quality measures can help improve care, yet NCQA’s environmental scan for the IIDDEAL project found only two quality measures that focus on adults with IDD—and many measures that exclude this population.

“Narrowly focused clinical outcome measures fail to capture the full range of treatment needs for people with IDD,” says Seibert. “That’s why it’s important to focus on person-centered goals.”

What Are the Goals of the Project?

Funding from the WITH Foundation will help NCQA collaborate with self-advocates and IEC to refine and adapt the PCO measures and resources for practitioners serving adults with IDD.

The project has three goals:

1. Equip practitioners with tailored tools and training to integrate the PCO approach.
2. Empower adults with IDD to identify person-centered goals.
3. Use PCO measures to assess care provided to adults with IDD.

NCQA will convene expert work groups that include individuals with IDD, caregivers, payers and clinicians serving adults with IDD to review updates to the PCO measures and resources and provide feedback. We will also develop online continuing education to show practitioners how to use the PCO measures and apply best practices for working with adults with IDD.

“We are working toward broad adoption of PCO measures and we’ve already incorporated them into some of our Accreditation and Recognition programs,” says Seibert. “We are grateful to the WITH Foundation for helping us advance the use of PCO measures to provide effective, high-quality, person-centered care for people with IDD.”

Learn more about NCQA’s PCO measures and their impact.

About the WITH Foundation

The WITH Foundation is committed to transforming healthcare to make it more inclusive and equitable for people with IDD. Since 2002, it has awarded over $17 million in funding to support organizations and projects that promote comprehensive and accessible healthcare for adults with IDD. Visit the WITH Foundation website to learn more.

The post NCQA Receives WITH Foundation Grant to Expand Use of Person-Centered Outcome Measures appeared first on NCQA.

The use of digital tools, combining software and hardware technologies to monitor patients remotely, is gaining traction,³ and is proving to be effective at not only managing therapy complications, but also at improving patients’ quality of life and satisfaction.² One such example is the use of Electronic Patient-Reported Outcomes (ePRO), digital tools that let patients report symptoms, side effects and quality-of-life indicators in real time. These tools have shown remarkable promise in oncology settings that can lead to better identification of patients’ needs, improving patient-provider communication, care management, and patient satisfaction, as well as decreased emergency department visits.⁴

At the federal level, in 2023 the Centers for Medicare & Medicaid Services (CMS) launched the Enhancing Oncology Model (EOM), a voluntary, value-based payment model covering Medicare beneficiaries. Lessons learned from a previous model, the Oncology Care Model, led CMS to require the use of ePROs by EOM⁴ participants beginning in performance period 5 (PP5), which corresponds to measurement year 3⁴, to monitor symptomatic toxicities, physical functioning, behavioral health and health-related social needs. Patients submit data via smartphones, tablets, or even voice response systems. The information is then integrated into EHRs, enabling care teams to respond quickly to concerning trends.^4,5

While large hospitals and health systems are often better equipped to implement remote monitoring and use of ePROs for patients, and have the ability to integrate care across specialties, community oncology practices—where most cancer patients get treatments⁶—face unique challenges to ensure integrated, coordinated care. For community oncologists, remote patient monitoring is a scalable way to extend care beyond the clinic. For rural or underserved populations, it bridges the gap between clinic visits and real-world needs, ensuring continuity of care. Data can be shared across teams, improving communication between oncologists, nurses and navigators, and patients report feeling more in control of their care and more connected to their providers.⁶

In a study of a large community oncology practice, the combination of ePRO and other remote monitoring tools demonstrated significant reductions in hospitalizations (39%), emergency department visits and overall cost of care ($1,146 per member per month in average savings per ePRO-monitored patient per month).⁷

The integration of ePROs and remote patient monitoring (RPM) into transitional oncology care represents a shift toward truly patient-centered models. These technologies can empower patients to be active participants in their treatment, reduce unnecessary utilization, enhance communication across providers and improve outcomes across the board.

This blog is brought to you by Johnson & Johnson and the views expressed are solely those of the sponsor.

¹ Patient Satisfaction and Quality of Surgical Care in U.S. Hospitals. Accessed at: https://pmc.ncbi.nlm.nih.gov/articles/PMC4248016/. September 15, 2025

² The association between care integration and care quality, Health Services Research. Volume 59, Issue 6, December 20204. Accessed at: https://onlinelibrary.wiley.com/doi/10.1111/1475-6773.14214. October 25, 2025.

³ Ochsner Chemotherapy Care Companion. Vol. 38, No.3, 2023. Accessed at: www.accc-cancer.org/docs/documents/oncology-issues/articles/2023/v38-n3/ochsner-chemotherapy-care-companion.pdf. September 16, 2025.

⁴ CMS Enhancing Oncology Model ePRO implementation Fact Sheet. Accessed at https://www.cms.gov/priorities/innovation/media/document/eom-epros-fs. September 15, 2025.

⁵ Reflections on the Oncology Care Model and Looking Ahead to the Enhancing Oncology Model. JCO Oncology Practice. Volume 18, No. 10. Accessed at: https://ascopubs.org/doi/10.1200/OP.22.00329#:~:text=One%20of%20the%20primary%20goals,requirements%20and%20drive%20quality%20improvement. September 16, 2025.

⁶ National Cancer Institute. Accessed at: https://www.cancer.gov/research/areas/disparities/chanita-hughes-halbert-clinical-trials-community-access#:~:text=Approximately%2085%25%20of%20cancer%20patients,the%20quality%20of%20their%20care. September 17, 2025

⁷ JCO Clinical Cancer Informatics. Impact of Remote Symptom Monitoring with Electronic Patient-Reported Outcomes on Hospitalization, Survival, and Cost in Community Oncology Practice: The Texas Two-Step Study. Patt, et. Al. Accessed at: https://ascopubs.org/doi/10.1200/CCI.23.00182. October 30, 2025.

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“Presenting at the AcademyHealth ARM allows us to share our research with thought leaders from around the country, and get their feedback and reactions,” says Rachel Harrington, NCQA’s Senior Product Strategist. “This event demonstrates the power of collaboration and dialogue within the research community.”

Putting Quality Into Practice

NCQA’s research isn’t just theoretical—it’s grounded in the realities health care organizations face every day. “We’re not testing ideas in a vacuum,” Harrington explains. “We’re focused on what works in practice.”

Race and Ethnicity Data Collection. Harrington joined a panel to discuss how NCQA is adapting its HEDIS^® and Accreditation programs in response to updated federal standards for race and ethnicity data collection. Updates for HEDIS MY 2026 were recently announced in our blog.

Social Needs Screening. NCQA evaluated social needs screening and intervention rates for more than 500 commercial and Medicaid plans, and identified barriers that limit adoption: lack of standardized screening questions, challenges transferring data from HIEs to health plans, inconsistent state and federal policy guidance and incentives.

• View the poster: Improving Policy and Systems for Social Needs Measurement: Key Insights from First Year of National Health Plan Performance.

Person-Centered Outcome (PCO) Measures. Our latest research compares implementation of PCO measures in Certified Community Behavioral Health Clinics (CCBHC) and long-term services and supports/primary care settings (LTSS/PC) including 197 clinicians and 7,867 patients. We found that CCBHCs performed well in goal identification, while LTSS/PC achieved better follow-up and goal achievement. Staff turnover was a barrier to implementation in all settings.

• View the poster: Distinct Pathways: Comparative Analysis of PCO Implementation Outcomes in Certified Community Behavioral Health Clinics and Long-Term Services and Supports/Primary Care Settings.

Partnering With The Community to Improve Care for People with Disabilities

NCQA is focused on ways to define and enable high-quality care for people with disabilities. Our research highlights the importance of partnering with community-based organizations to help ensure that all community members have a voice in health care quality.

Julie Seibert, NCQA’s Assistant Vice President, Behavioral Health, spoke on a panel about NCQA’s role in an IEC (Institute for Exceptional Care) project to develop a quality measurement framework to address persistent health inequities among people with intellectual and developmental disabilities (IDD). “With more than 200 stakeholders, this project is a perfect example of community engagement in action,” says Seibert. “NCQA is honored to be a part of this initiative to identify quality measures that focus on the things that matter most for people with IDD and their families.” Read our blog to learn more about this important work.

NCQA also presented research on quality measurement priorities for people with disabilities and the current status of disability data collection in health care settings. The key takeaway: We need to work toward improving and standardizing data collection if we want to understand the needs and challenges to accessing care that people with disabilities face.

• View the poster: Current State of Disability Status Collection in Health Settings.
• Read the article: Improving Care for People With Disabilities Starts With Collecting Data.

Improving Outcomes for People with Chronic Conditions

Helping people manage chronic conditions can improve their quality of life, and reduce health care utilization and costs. NCQA’s research identifies gaps between clinical practice guidelines and current care delivery models where health care organizations can focus quality improvement efforts.

Delivering Better Asthma Care. NCQA found that, among a sample population of Medicaid and commercial plan members with asthma, fewer than half received timely follow-up care after an emergency department visit. Follow-up rates (including outpatient or telehealth visits within 30 days) varied by race, gender, COPD comorbidities and socioeconomic factors. This research informed NCQA’s new HEDIS measure, Follow-Up After Acute Care and Urgent Care Visits for Asthma (AAF-E), which encourages guideline-based health care utilization for asthma as a starting point for delivering better care.

• View the poster: National Trends in Post-ED Follow-Ups for Asthma.

Harrington also moderated a panel, Randomized Evaluations to Improve Care Delivery: From Deprescribing Tools to Collaborative Dementia Care. “This panel was an opportunity for NCQA to be part of a larger dialogue about making the health care system safer and more effective,” says Harrington. “When health plans and health care delivery systems collaborate and share their unique perspectives on quality improvement, everyone benefits.”

The Future of Quality

NCQA’s research is pushing boundaries and defining the future of quality, and that includes assessing the environmental impact of health care. The health care sector accounts for 8.5% of all greenhouse gas emissions, but is less engaged in reducing its carbon footprint than other industries. NCQA developed the Resilient Health Systems model to guide climate health initiatives within health care organizations.

“This framework integrates climate sustainability and resilience as a core outcome of health care quality—a distinction increasingly recognized by health care stakeholders as critical to overall system performance and readiness for long-term impact on health,” said Adrianna Nava, Applied Research Scientist for Quality Sciences.

Health plans can accelerate progress by focusing on strategies within their control and developing clear accountability models.

• View the poster: The Resilient Health Systems Model: Practical Actions for Health Plans to Reduce Carbon Footprints.

Work With Us!

NCQA welcomes and appreciates support from corporations and foundations that share our values and want to join us to advance our mission to improve the quality of health care. For more information about partnership opportunities, contact Erin Oganesian, AVP, Corporate & Foundation Relations at eoganesian@ncqa.org.

The post NCQA Researchers Share Findings on Emerging Topics in Health Care appeared first on NCQA.

“We’re thrilled that so many of our research presentations were accepted by AcademyHealth,” says NCQA’s Karen Sheares, Vice President of Quality Sciences. “It shows the breadth and depth of our capabilities, and validates that we are focusing on the topics people care about. We’re grateful for the support from funding organizations who are aligned with our mission to improve the quality of health care.”

Below are the research topics NCQA will present at the ARM.

Panel and Podium Sessions

NCQA staff will present at four sessions at ARM.

• Julie Seibert, AVP, Behavioral Health, will join a panel presentation: Community-Led Quality Measures to Improve Outcomes for People with Intellectual and Developmental Disabilities.
• Yazhini Ramesh, Manager, Health Equity Sciences, will give a podium presentation: Understanding Priorities of Quality Measurement in the Disability Equity Space.
• Rachel Harrington, AVP, Health Equity Sciences, will join a panel presentation: Multi-Sector Responses to Updated Federal Standards for Race and Ethnicity Data Collection.
• Rachel will also moderate Randomized Evaluations to Improve Care Delivery: From Deprescribing Tools to Collaborative Dementia Care.

Poster Sessions

NCQA staff will share their research in five poster presentations.

• Current State of Disability Status Collection in Health Settings. This study shares results of NCQA’s survey on data collection of disability status, variation across health care organizations and the impact on development of measures and standards for people with disabilities.
  • Authors: Polina Lissin, Amena Keshawarz, Yazhini Ramesh

• Distinct Pathways: Comparative Analysis of PCO Implementation Outcomes in Certified Community Behavioral Health Clinics and Long-Term Services and Supports/Primary Care Settings. This study compares the implementation of person-centered outcome measures across care settings—197 clinicians and 7,867 individuals receiving care—and examines differences in goal identification, follow-up and goal achievement.
  • Authors: Xiaofei Zhou, Daniela Lawton, Sarah Sweeney, Caroline Blaum, Julie Seibert

• Improving Policy and Systems for Social Needs Measurement: Key Insights from Year One. This study summarizes the performance of NCQA’s Social Need Screening and Intervention HEDIS measure—introduced in 2023—and presents results across commercial, Medicare and Medicaid plans.
  • Authors: Adrianna Nava, Polina Lissin, Kathleen Gruschow, Ryan Acton, Caroline Blaum, Rachel Harrington

• National Trends in Post-ED Follow-Ups for Asthma: Characterizing the Gaps Between Clinical Guidelines for Asthma Care and Health Care Utilization Patterns Across Commercial Health Plans. This study examined commercial claims data to gain new insights into the frequency of outpatient follow-up after ED visits for asthma, and the patient demographics and other factors that impact follow-up care.
  • Authors: Michael Cocchiola, Danielle Rainis, Amena Keshawarz, Haley Malone, Ashley Moss, Ryan Acton, Caroline Blaum

• The Resilient Health Systems Model: Practical Actions for Health Plans to Reduce Carbon Footprints. The health care sector accounts for 8.5% of all greenhouse gas emissions, but is less engaged in reducing its carbon footprint than other industries. This study identifies practical strategies for health plans to mitigate their environmental impact.
  • Authors: Adrianna Nava, Laura Zwolinski, Keirsha Thompson, Justine McLaughlin, Karen Sheares

“The AcademyHealth annual research meeting is a place to engage in productive conversations about health services research and policy,” says Sheares. “We look forward to sharing our findings and learning about the work others are doing that will impact the health of individuals and communities in the U.S. for years to come.”

Join Us in Minneapolis!

If you’d like to hear our presentations in person, register for the 2025 AcademyHealth ARM.

We’ll highlight some of our ARM presentations in the NCQA blog following the event, so stay tuned!

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NCQA developed recommendations for the Trump administration in three core areas.

1. Implementation of value-based care models that prioritize care integration.
2. A strong digital health infrastructure that facilitates seamless data exchange, promotes adoption of digital quality measures and maximizes the full potential of interoperable health care data.
3. Integration of behavioral and physical care and removal of barriers to behavioral health and substance-use disorder treatment.

Below is a summary of our recommendations.

Optimize Value-Based Care and Alternative Payment Models

Patients who seek care—especially the 133 million people living with chronic disease—encounter poorly coordinated, redundant services that create unnecessary burden. Payers often exacerbate the problem with care management initiatives and administrative barriers that cause more fragmentation. Clinicians spend hours documenting data for administrative purposes, which pulls them away from providing care.

NCQA Recommendations

Prioritize the patient experience by removing administrative barriers and burden. Modernizing payment structures by accelerating the transition to value-based care could help eliminate the disjointed, costly care many people experience in the fee-for-service model.

• Commit to helping ensure that all Medicare beneficiaries are in value-based care arrangements by 2030.
• Create payment models that prioritize integration through technology and dynamic care plans. For example:
  • Focus on conditions and procedures with significant cost variability, large patient volumes and clear opportunities to reduce complications, hospital readmissions and unnecessary utilization.
  • Require collaboration in developing AI-driven models targeting problematic conditions and procedures.
  • Adopt AI-powered, evidence-based, shared care plans to build trust and empower patient choice.
• Introduce Medicare Advantage Star Ratings metrics that promote standardized data exchange between health plans, care delivery networks and patients.
• Prioritize more effective use of patient-generated data, including person-reported outcome measures, which offer valuable insights for improving health outcomes.

By expanding value-based payment arrangements, we can invest in solutions to help prevent and manage chronic diseases, align incentives to promote health and wellness and reduce health care costs.

Create a Lasting Digital Health Infrastructure

Private and government investments have increased the availability of electronic health data, but the use and exchange of these data to support health care innovation—and reap the benefits of investments—is hindered by misaligned policy incentives and payment programs. Quality measurement programs rely on labor-intensive, fragmented, inconsistent systems with incomplete data.

Policy groundwork was established through the CMS interoperability rules (CMS-0057), the United States Core Data for Interoperability Plus (USCDI+) and the efforts of standard-setting communities, but stronger support from the administration can drive industry implementation, accelerate exchange of health data and spur health care innovation.

NCQA Recommendations

Create a clearer framework for a national digital health data ecosystem where all participants in care can innovate and benefit, building on existing mandates for FHIR^® APIs, USCDI and industry innovation in patient-generated data. This is a critical opportunity to reduce care fragmentation and lower costs—and to improve health care for all Americans.

• Expedite adoption of a digital quality measure reporting architecture.
• Develop a comprehensive health care data quality framework that fosters confidence, transparency and collaboration, and supports a fully digital health data exchange ecosystem.
• Accelerate alignment with the CMS Universal Foundation across HHS quality reporting and value-based payment programs.
• Clarify how the USCDI+ Quality dataset will interact with regulations to achieve true interoperability of quality data.
• Update the existing CMS Digital Quality Roadmap.

With national interoperability frameworks now leveraging HEDIS exchange, we look forward to collaborating with the administration to ensure the integrity and trustworthiness of data used across the nation’s health care system.

Address the Behavioral Health Crisis

Over 20% of American adults live with mental illness, and more than 5% experience serious mental illness. Recent estimates place the resulting economic strain at over $280 billion. The surge in demand for behavioral health services overwhelms state and county behavioral health systems, pushing more patients to seek services in settings that may not be adequately equipped to support them.

NCQA Recommendations

Measurement of quality in behavioral care is inadequate and is falling behind other health services, due to limited investment. We must intensify our efforts to address this crisis through increased funding for quality improvement, national standards and technological advancement.

• Collaborate with Congress to appropriate funds to incentivize adoption of certified EHRs by behavioral health providers.
• Expand access to medication for opioid use disorder as first-line, evidence-based treatment.
• Fund the creation of a quality measures cascade framework for substance-use disorder care with quality standards at every appropriate level of care.
• Require independent, third-party accreditation for SAMHSA’s CCBHC certification to ensure accountability and transparency.
• Support development and testing of behavioral health network adequacy measures for inclusion in the Medicare Advantage Star Ratings and other value-based payment programs.

We look forward to collaborating with the Trump administration to advance quality measurement for behavioral care and create a more cohesive health care system that connects behavioral and physical health to improve outcomes.

Learn More

Visit our website to download the full recommendations.

Listen to our podcast, The Next Four Years of Quality: What Trump’s Team Should Do Now.

The post NCQA’s Policy Recommendations to the Trump Administration appeared first on NCQA.

“PCO measures align with the CMS universal foundation set, which seeks to streamline quality measurement and reduce burden,” says NCQA’s Daniela Lawton, Director, Chronic Conditions. “These measures have universal appeal, and they are flexible enough to be applied to many different populations and accountability levels—including health plans, care delivery organizations and individual clinicians.”

Why Are PCO Measures Important?

Nearly 30% of Medicare beneficiaries have complex health care needs, and more than 14 million people in the U.S. need long-term services and supports. These numbers grow every year. PCO measures work in tandem with clinical care to help people living with complex health needs make progress toward a health goal that matters to them.

PCO measures have three components:

• Identify a goal and document it in a structured way, using goal attainment scaling or a patient-reported outcome measure.
• Follow up on the goal.
• Assess goal achievement.

Clinicians throughout the care continuum, and community-based services, can use this approach to identify what’s important to a person. Defining a person’s goals—and ensuring that their care is consistent with those goals—can reduce unwanted treatment and lead to meaningful improvement.

How Will PCO Measures Be Used in MIPS?

MIPS is part of Medicare’s Quality Payment Program, which rewards clinicians who provide high-quality care. Clinicians can earn performance-based payment adjustment based on four areas: quality measures, process improvement activities, cost, promoting interoperability.

Organizations and individual clinicians can choose which measures they want to report on for MIPS. PCO measures were recommended for the following categories:

• Traditional MIPS Quality Measures: Family medicine, internal medicine, geriatrics, physical medicine and neurology.
• MIPS Value Pathways: Primary care and neurology.

“There is a lot of interest in patient-reported outcomes across the industry, and many clinicians are collaborating with patients on goal setting—but are not using a structured approach to measurement,” says Lawton. “We’ve developed free training and other resources to help clinicians implement standardized PCO measures.”

How Does the Measure Approval Process Work?

Every year, CMS releases the Measures Under Consideration list of quality and efficiency measures proposed for use in the Medicare program. These measures go to public comment and are reviewed by Advisory and Recommendation Groups as part of the pre-rulemaking measure review process.

The Partnership for Quality Measurement Committee met in January to assess whether the measures under consideration are appropriate for use in CMS value-based care programs for Medicare beneficiaries. The NCQA measures were presented to the Clinician Advisory Group and Recommendation Group and NCQA staff addressed questions.

“NCQA had four measures up for review this year,” says Lawton. “In addition to the PCO measures, our Adult Immunization Status measure—which is already part of MIPS—was recommended for inclusion in the Medicare Part C Star Ratings.”

You can view the full committee report here.

Learn More

To learn more about PCO measures:

• Visit our website.
• Download our PCO measures toolkit.
• Take a free training class:
  • Identifying and Developing a Person-Centered Outcome Goal
  • Using Goal Attainment Scaling to Document and Track Person-Centered Outcome Goals
  • Using Patient-Reported Outcome Measures to Document and Track Person-Centered Outcome Goals

Acknowledgements

NCQA developed person-centered outcome measures with support from The John A. Hartford Foundation, The SCAN Foundation and the Gordon and Betty Moore Foundation.

The post NCQA’s Person-Centered Outcome Measures Recommended for MIPS appeared first on NCQA.

Health Care Costs Continue to Rise

“One major trend we are watching is that premiums are going up again. Health care is eating up a lot of the social services spending at the state level, so we’re not in a position to throw more money into the system,” says Peggy O’Kane, NCQA’s founder and president. “That’s what I’ll be thinking about in 2025—trying to figure out how to start a serious conversation about getting better value for our health care dollars.”

Cost Sharing Causes People to Delay Needed Care

“Half the people in the U.S. identify cost as a barrier to care—and one of the unfortunate side effects is that people delay getting preventive care that could resolve problems before they become serious,” says Eric Schneider, Executive Vice President of NCQA’s Quality Measurement and Research Group. “We’ve scared people away from the system by charging them high co-pays and deductibles, and we’ve added to the burden of debt for people with serious care needs.”

Value-Based Care Adoption Has Slowed

“While we’ve seen an uptick in value-based care, it seems to be leveling off,” says Schneider. “We need a renewed commitment from the federal government and other payers to implement value-based payment arrangements, and stronger partnerships between payers and practitioners to figure out how to deliver the best care at a reasonable price.”

Digital Quality Is Gaining Momentum

“There’s been a big investment in interoperability, starting with the HITECH Act and electronic health records and then creating standards for efficient data exchange throughout the health care system,” says Schneider. “The stage is set, but the actors haven’t come out and the play hasn’t started. In 2025, we’ll see those efforts pay off as digital quality takes center stage.”

Practitioners Need to Engage in Data Sharing

“Data sharing is complicated because of the ‘many-to-many’ problem—many health plans contracting with many practitioners and health delivery systems,” says O’Kane. “What we’re trying to do with digital quality is get the clinical data flowing so quality measures automatically populate as a practitioner delivers care, and the practitioner can see how they are doing.”

Specialists Can No Longer Operate in a Silo

“More than half of adults in the U.S. have at least one chronic condition, and a third have multiple chronic conditions, which means the role of specialty care is enlarging,” says O’Kane. “We have a measurement challenge when it comes to specialty care. If you measure performance of individual practitioners, you don’t see the full picture of what’s actually happening to the patient. We need to find ways to integrate primary care and specialty care to create a holistic view.”

Patient-Centered Outcomes Matter

“Health care has shifted from a more paternalistic approach, where the clinician is in control, to a system where people can take control of their own health,” says Schneider. “With that comes the expectation that what we measure also needs to change. We need to focus on person-centered outcomes and patient experiences to understand and evaluate quality and outcomes.”

NCQA Is Hopeful About the Future

“I’m hopeful because there are so many organizations taking what NCQA has done, improving on it and running with it in a bold direction,” says O’Kane. “We try to highlight those innovations because many people want to move forward, but don’t know where to start. I’ve been talking about quality since the early 1990s, so seeing these breakthroughs and new care models is really inspiring and heartening.”

The post Health Care Trends to Watch in 2025 appeared first on NCQA.

This is especially true for older adults with complex health needs—including behavioral or social needs—who may not have the opportunity to participate in authentic conversations about what matters to them and how their goals can lead to better care and health outcomes.

Clinicians also feel the frustration of being evaluated on interventions that are not always relevant to the populations they serve. They want to provide care that matters, but struggle to build it into their workflow.

The Evolution of PCOs

Over the past decade, with support from The John A. Hartford Foundation, The SCAN Foundation and The Gordon and Betty Moore Foundation, NCQA developed Person-Centered Outcome (PCO) measures to help older adults and their care teams align on goals and health outcomes that matter to the person receiving care.

“Person-centered outcome measures are about building trust and respect between the individual and the clinician,” explains NCQA’s Daniela Lawton, Director, Chronic Conditions. “When we tested these measures, we heard so many people say that no one in the health care system ever asked them what mattered most to them or followed up on it.”

PCO measures have three components:

• Identify a goal and document it in a structured way, using goal attainment scaling or a patient-reported outcome measure (PROM).
• Follow up on the goal.
• Measure achievement of the goal.

Defining a person’s goals—and ensuring that the care provided is consistent with those goals—can reduce unwanted care and lead to meaningful improvement.

PCOs Are Gaining Acceptance

NCQA began developing PCO measures for older adults in Medicare plans, but in response to the groundswell of interest in meaningful measurement, expanded the measures to include behavioral health, serious illness, primary care and long-term services and supports.

The PCO measures have been tested with more than 8,500 people and 180 clinicians at 17 care sites, including Area Agencies on Aging, Certified Community Behavioral Health Clinics, home-based primary care sites and other care coordination organizations.

“Person-centered outcome measures are a standardized, transparent and flexible approach that can be used for quality improvement and value-based payment,” says Lawton. “Forward-thinking organizations are using them now, even before they are recognized as the industry standard.”

For example, Connecticut is planning to use PCO measures for value-based payment, and CMS included person-centered care in its Universal Foundation measure set. NCQA plans to add PCO measures to HEDIS in measurement year 2027, and our next round of testing will move us closer to that goal.

Health Plans Are Testing PCOs

Implementation of PCO measures, through incentives and value-based payment, requires adoption by health plans. NCQA will begin testing the measures with Dual-Eligible Special Needs Plans (D-SNP), a type of Medicare Advantage health plan that provides benefits to individuals enrolled in both Medicare and Medicaid.

NCQA is launching a D-SNP learning collaborative. Testing the PCO measures with D-SNPs will help NCQA understand how clinicians and health plans document, track and share information, and allow us to provide support and technical assistance to participating plans.

D-SNPs provide the ideal environment for PCO measures to be tested and developed as HEDIS measures because:

• CMS requires D-SNPs to implement a Model of Care—a basic framework for providing high-quality care for enrollees.
• A key requirement of the Model of Care is an individualized care plan that documents a person’s goals.
• There are no standardized processes for D-SNPs to collect and document goals in a measurable way and health plans and clinicians have asked for guidance.

“NCQA is committed to implementing meaningful quality measures that help improve people’s lives,” says Lawton. “We are excited to work alongside our foundation partners as a catalyst for change in the industry.”

Learn More

Organizations interested in implementing PCO measures or joining the D-SNP learning collaborative can get started by:

• Emailing us at pcomeasures@ncqa.org.
• Visiting the PCO measures webpage.
• Watching the webinar, Person-Centered Outcome Measures: Measuring What Matters Most.
• Downloading the Person-Centered Outcomes Approach Toolkit.
• Taking our free, online training on identifying SMART goals and using either goal attainment scaling or PROMs to document and track goals over time. Find training sessions on the PCO measures webpage.

The post Moving Forward With Person-Centered Outcome Measures appeared first on NCQA.

• One in 20 Americans has an IDD.
• A person with an IDD is 4 times more likely to be inadequately or inappropriately treated by health care professionals than a person without one.
• 30% of people with IDD experience adverse events during hospital visits.

Accessing high-quality health care that aligns with their unique needs and preferences has been a long-standing challenge for people with IDD—but the U.S. does not have a standard process for setting health priorities and measuring quality for this population.

To build consensus on what people with IDD consider their highest-priority health and life outcomes, and to identify corresponding quality measures, IEC (Institute for Exceptional Care) launched IIDDEAL (Individuals with IDD Engaged, Aligned, and Leading): Outcomes That Matter. NCQA is proud to support this foundational work by participating in its National Consensus Workgroup and by partnering with IEC to identify quality measures that matter.

Defining National Goals for IDD Health Outcomes

The IIDDEAL project convened more than 180 contributors—people with IDD, families and caregivers, clinicians, researchers, payers and regulators—to discover what health and life outcomes should be prioritized, and how health care leaders can support those outcomes.

The result is a consensus framework that defines 43 national goals, 9 health outcome domains and 29 priority elements representing the perspectives of the IDD community. Findings were recently published as Advancing Health Policy and Outcomes for People With Intellectual or Developmental Disabilities: A Community-Led Agenda in the Journal of the American Medical Association (JAMA).

Julie Seibert, AVP of Behavioral Health at NCQA, participated in the IIDDEAL National Consensus Workgroup. “This project has brought a clear focus on what is needed to support the health and well-being of people with IDD, based on their lived experience and what matters most to them,” says Seibert. “The JAMA article presents a roadmap and a vision for the future, and NCQA is excited to be a part of it.”

Identifying Quality Measures for People With IDD

IEC was awarded a grant from the Robert Wood Johnson Foundation to identify quality measures that will support IDD health outcomes standards. NCQA will be a partner on the project.

Funding will allow NCQA to perform an environmental scan to understand:

• Which publicly available quality measures align with the priority elements identified by people with IDD, their families and stakeholders.
• Measures currently being developed.
• Where there are gaps that require new measures.

“The ultimate goal is to gain consensus on a bundle of metrics that can be applied across the lifespan of people with IDD,” says Seibert. “The measures we identify will be reviewed by stakeholders with lived experience, including people with IDD, to determine an appropriate fit.”

How This Work Impacts the IDD Community

An exciting and unique element of this project is the inclusion of people with lived experience as decision makers. IEC recognizes that people with IDD, and their families and caregivers/partners, are uniquely qualified to define the health outcomes important to them.

“It is truly inspiring to see how hard IEC works to include and elevate the perspectives of people with lived experience in this process, and ensure they have a sense of belonging and value,” says Seibert.

Understanding which health outcomes matter most is the first step toward creating a more effective, accountable care delivery model for people with IDD.

Your Next Steps

• Read the JAMA article here.
• Provide feedback on the national goals by September 30.
• Learn more about IEC.

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