Aparna Higgins Discusses Implementation of AHIP's New Core Sets of Quality Measures

The 7 sets of core quality measures from America's Health Insurance Plans (AHIP) and CMS derived from looking at areas that were either high prevalence or high cost, said Aparna Higgins, senior vice president of Private Market Innovations and Center for Policy and Research at AHIP.

AHIPs 7 sets of core quality measures derived from looking at areas that were either high prevalence or high cost, said Aparna Higgins, senior vice president of Private Market Innovations and Center for Policy and Research at America’s Health Insurance Plans. However, she added that implementing these new sets may be challenging, as some of them require the use of clinical data and sharing access to this data between providers and health plans hasn’t always been very easy.

Transcript (slightly modified)

What do you expect will be the biggest challenge during implementation of the core sets of quality measures as defined by AHIP and CMS?

We anticipate the implementation will be phased in. One issue that will need to be addressed is having the data infrastructure because some of the measures we selected involve use of clinical data, which is not always easily available. So I think that’s one of the reasons we expect the implementation to be phased in because it requires an ability of the provider, either through the EHR or the registries, to be able to share that data with the health plan, let’s say. And I think that’s an issue that will need to be addressed going forward.

How were the first 7 sets of core quality measures selected?

So the collaborative actually talked about focusing in on areas that were either high prevalence, high cost or where for example we have a measure set for ACO PCMH primary care, so that’s looking at population health. So it’s primarily driven by high prevalence, high cost, where people felt that there was variability and performance.

What set do you think should get this treatment next?

We released 7 core sets in February. We’re working on 1 more core set of measures for pediatrics. That work is ongoing, it’s not completed yet. We anticipate that we will be releasing a core set for pediatrics, I’m not quite sure the timing because we started much later on that particular area, clinical practice area, than the others. I think it’s a question for the collaborative and we’ll have to have some discussions about where we go next and we’re starting to have those discussions.