CMS National Quality Strategy

With the Centers for Medicare & Medicaid Services (CMS) National Quality Strategy, CMS will set and raise the bar for a resilient, high-value health care system that promotes quality outcomes, safety, equity, and accessibility for all individuals, especially for people in historically underserved and under-resourced communities. Quality in Motion: Acting on the CMS National Quality Strategy (PDF) emphasizes connections across the CMS National Quality Strategy and details how CMS is putting quality goals into action through collaborative efforts with key partners.

What is the CMS National Quality Strategy?

CMS leverages a number of approaches to improve health care across the country, including quality measurement; public reporting; value-based payment programs and models; establishing and enforcing health and safety standards; and providing quality improvement technical assistance.

In 2022, the agency launched the CMS National Quality Strategy, an ambitious long-term initiative that aims to promote the highest quality outcomes and safest care for all individuals. The CMS National Quality Strategy focuses on a person-centric approach from birth to end of life as individuals journey across the continuum of care, from home or community-based settings to hospital to post-acute care, and across payer types, including Traditional Medicare, Medicare Advantage, Medicaid and Children’s Health Insurance Program (CHIP) and Marketplace coverage.

The CMS National Quality Strategy builds on previous efforts to improve quality across the health care system, incorporates lessons learned from the COVID-19 Public Health Emergency (PHE), and addresses the urgent need for transformative action to advance towards a more equitable, safe, and outcomes-based health care system for all individuals.

• Quality Mission: To achieve optimal health and well-being for all individuals.
• Quality Vision: CMS, a trusted partner, in shaping a resilient, high-value American health care system that delivers high-quality, safe, and equitable care for all.

CMS National Quality Strategy Priority Areas and Goals

The CMS National Quality Strategy has 4 priority areas, each with two goals. Each goal has associated objectives and targets to support successful implementation. Within each goal, we highlight actions in progress to demonstrate current and planned work.

Promote Aligned and Improved Health Outcomes

Outcomes: Improve Quality and Health Outcomes Across the Care Journey

Objective: Improve quality in high-priority clinical areas and support services.

Key Actions to Improve Health Outcomes and Health Care Quality:

• Drive improvements on high-priority outcomes. CMS operates quality reporting and value-based payment programs and alternative payment models to promote accountability through payment and public reporting for safe, high-quality care for all. These programs, along with the Quality Improvement Organization (QIO) Program , catalyze quality efforts on the most pressing health topics, such as behavioral health, maternal health, long-term services and supports (LTSS), and oral health.
• Leverage quality measures to improve health outcomes. Quality measures are a key tool for CMS to identify opportunities for improvement and evaluate progress. CMS is shaping a measure ecosystem that focuses on improving outcomes, driving value-based care, and reducing provider reporting burden.
• Set benchmarks to track progress. Clear targets and increased reporting transparency help CMS advance improvement efforts around a shared objective. CMS conducts a triennial assessment of quality measures used across its programs to monitor clinical improvements and track progress on narrowing disparities.

Objective: Increase alignment by focusing provider and health care system attention on high-priority clinical areas and support services.

Key Actions to Increase Alignment Across Quality Efforts:

• Develop aligned approaches across quality programs. When more providers focus on the same quality priorities and have similar measurement approaches, the Agency can improve coordination and comparisons across programs and across the continuum of care. Alignment also builds the evidence base for quality interventions and assists in identifying disparities in care.
• Align quality measures through the Universal Foundation. Alignment through the Universal Foundation focuses the attention of health care providers and systems on important clinical areas and support services. CMS released the initial adult and pediatric measure sets and is collaborating across the Agency to identify “add-on” measure sets for specific populations or settings of care.
• Streamline measure development and selection. Addressing alignment early in the measure lifecycle improves efficiency and increases the adoption of aligned measures into programs. CMS is increasing its internal coordination on measure development and implementation activities to achieve a more parsimonious measure portfolio, simplify compliance with reporting requirements, and reduce provider reporting burden.
• Collaborate across the nation for greater impact. Achieving optimal health for all individuals requires active partnership across the health care ecosystem. CMS actively collaborates with partners and other payers to advance quality through measurement and other levers.

Advance Equity and Engagement for All Individuals

Equity: Advance Health Equity and Whole-Person Care

Objective: Reduce health disparities and promote equitable care for all by using standardized methods for collecting, reporting, and analyzing health equity data across CMS quality and value-based programs.

Key Actions to Advance Equity in Health Care Quality and Outcomes:

• Incorporate equity into the design of all quality programs and policies. To maximize impact, equity must be woven into all aspects of program and policy design from the start. CMS is developing strategies and resources to guide policy and program design toward improving the quality of care for people who are at higher risk for poor health outcomes and to ensure providers have the resources to address their needs.
• Use effective incentives to advance equity within CMS programs. Quality incentive and value-based programs reward providers who deliver excellent care to underserved populations by linking payment to performance on quality measures. CMS also tests innovative payment models that incorporate incentives to encourage and sustain participation of safety net providers to assess novel ways of delivering high-quality and cost-efficient care.
• Improve health equity data collection, standardization, and analysis. CMS is strengthening data collection and analysis of race and ethnicity data as well as standardized data elements on social determinants of health (SDOH). With improved health equity data, CMS can better understand existing disparities and how policy changes can improve health equity.

Objective: Ensure individuals and caregivers have the information needed to make the best choices for their health, as well as a direct, significant, and equitable contribution to how CMS evaluates quality and safety.

Key Actions to Ensure Engagement to Improve Health Care Quality:

• Incorporate individual and community input into strategy and policy. CMS ensures it hears the voices of the individuals and communities it serves through listening sessions, advisory committees, and expert panels and considers their perspective in shaping program policies and participation requirements.
• Expand use of person-reported outcomes and experience measures. CMS is moving toward a more person-centered approach to evaluating quality that incorporates the experiences of individuals, families, and caregivers. CMS is committed to developing and implementing more person-reported outcome measures and experience of care surveys across quality programs and innovation models.
• Give individuals access to their own health data and meaningful information. CMS is working to ensure individuals have access to their own medical records and health data. Access to one’s personal health data makes individuals, families, and caregivers more effective partners in their care.
• Provide a platform for public reporting. Public reporting of quality and safety measures promotes transparency. CMS provides several tools to empower individuals, families, and caregivers to use this available information to make meaningful decisions about their care.

Ensure Safe and Resilient Health Care Systems

Safety: Achieve Zero Preventable Harm

Objective: Improve performance on key patient safety metrics through the application of CMS levers such as quality measurement, payment, health and safety standards, and quality improvement support.

Key Actions to Drive Improvements in Safety and Reduce High-Priority Harms:

• Expand transparency to increase accountability for safety. Public reporting on quality and safety empowers individuals to make decisions about where to go for care and encourages providers to improve care by understanding their performance in comparison to others. CMS recognizes that individuals, families, and caregivers are critical partners in their care and that expanding their access to information is a key step toward improved safety.
• Drive improvements in safety through meaningful incentives, quality initiatives, and regulatory oversight. Safety events are rarely the result of individual error, but rather reflect system-level flaws. CMS continues to support efforts to promote a holistic safety culture. CMS leverages meaningful incentives, technical support through QIOs, and health and safety standards to reduce harm and achieve safety goals.
• Promote safety initiatives that protect the health care workforce. CMS provides oversight and technical assistance interventions to ensure that health care workers have a safe working environment.
• Improve safe use and security of electronic health records (EHRs) and personal data. The safe and efficient use of EHRs can facilitate safety by ensuring that providers have the most complete data at the point of care. CMS continues to focus on the advancement and safe use of EHRs through technology requirements and incentive programs.

Objective: Foster a more resilient health care system that is better prepared to respond to future emergencies.

Key Actions to Support Health Care System Resiliency:

• Build resiliency by addressing staffing and infrastructure needs. CMS leverages payment and incentive policies as well as technical assistance to strengthen the health care workforce and ensure adequate resources to deliver needed care.
• Support emergency response activities to enable providers to continue providing high-quality care through times of crisis. Public health emergencies (PHEs) and disasters can lead to unprecedented quality and safety concerns. CMS partners with states, communities, and providers and can provide flexibility in program requirements to ensure sufficient health care services are available during emergencies.
• Address population and health care system needs during climate events. PHEs caused by extreme weather events include extreme heat, floods, storms, and poor air quality days, which create additional demand for health services and stress infrastructure. CMS safety and oversight regulations allow for innovation to address emissions reduction, increase operations sustainability, improve infrastructure resiliency and other climate adaption and resilience goals, while program flexibility can address health needs caused and exacerbated by the effects of climate change.

Accelerate Interoperability and Scientific Innovation

Interoperability: Accelerate and Support the Transition to a Digital and Data-Driven Health Care System

Objective: Support data standardization and interoperability by developing and expanding requirements for sharing, receipt, and use of digital data, including digital quality measures, across CMS quality and value-based programs.

Key Actions to Promote Interoperability for Quality Efforts:

• Champion the standards and technology needed for interoperability. Standardized and interoperable data aid in the exchange of health information to support care and improve quality. CMS partners with other federal agencies and partner organizations to develop and improve standards that leverage existing architecture to enable flexible and automated data exchange throughout the health care ecosystem.
• Transition to digital quality measurement to advance interoperability. Moving toward digital quality measurement can reduce data collection and reporting burden, while increasing the use of available data to inform treatment and help prevent medical and other errors. CMS supports this transition through incentives and program requirements to promote interoperability.
• Promote organizational shifts and collaboration for interoperability readiness. CMS commits to partnering with providers, communities, partner organizations, and federal agencies to create a health care system that leverages the vast amount of information gathered across the care journey.

Objective: Support and drive innovation and access through advanced data analytics and streamlined evidence-based reviews of novel technologies and devices for coverage decisions.

Key Actions to Drive Progress on Scientific Advancement:

• Streamline the coverage review process for promising new technologies. Strategically streamlining the coverage review process supports access to promising new medical technologies while ensuring safeguards for those who use them. CMS is taking additional steps to increase transparency and clarify the requirements for generating and evaluating evidence.
• Improve data available for research and evidence-based practice. CMS maintains and shares extensive data with the public and researchers. Initiatives to improve high-quality data collection and sharing will promote transparency and generate insights into evidence-based practices.
• Advance predictive analytics and tools, such as artificial intelligence (AI), that may inform health care decisions. AI and other predictive analytic methods have the potential to generate cost savings and produce better health outcomes. CMS continually uses, evaluates, and enhances analytical methods and models that support clinical care and quality efforts.

Implementing the CMS National Quality Strategy

The success of this Strategy relies on coordination, innovative thinking, and collaboration across all entities. A unified approach brings us all one step closer to the health care system we envision for every individual. Quality in Motion: Acting on the CMS National Quality Strategy (PDF) provides details on how CMS is putting the eight goals into action. Improving health care quality and safety requires a multifaceted approach. Through putting quality in motion, CMS emphasizes connections across the goal areas, CMS’ key actions to advance each goal, and collaborative efforts to align high-quality health care with key partners. This action plan highlights CMS’ three-part call to action on quality:

• Prioritize the use of Universal Foundation measures.
• Commit to improving health care safety and reducing harm.
• Advance health equity to improve health outcomes and eliminate disparities.

One lever central to the CMS National Quality Strategy that unifies Traditional Medicare, Medicare Advantage, Medicaid & Children’s Health Insurance Program (CHIP) coverage, Marketplace plans, and CMS Innovation Center models and demonstrations is quality measurement. The Meaningful Measure Initiative , active since 2017, remains key to shaping the entire ecosystem of quality measures that drive value-based care. Working as a one of many initiatives and activities under the CMS National Quality Strategy, Meaningful Measures 2.0 promotes innovation and modernization of all aspects of quality measurement, addressing a wide variety of settings, stakeholders, and measurement requirements. Additionally, the “ Universal Foundation ” of quality measures further focuses provider attention, reduce burden, identify disparities in care, prioritize development of interoperable, digital quality measures, allow for cross- comparisons across programs, and help identify measurement gaps by identifying a set of key quality measures to use throughout CMS programs.

Send feedback and questions to CMS by emailing QualityStrategy@cms.hhs.gov .

For Additional News

• Quality in Motion: Acting on the CMS National Quality Strategy (PDF)
• The CMS National Quality Strategy: A Person-Centered Approach to Improving Quality (Blog)

Learn More

• Universal Foundation
• Meaningful Measures 2.0
• Cascade of Meaningful Measures
• Frequently Asked Questions & Tools
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