Linking to Quality Measures

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Improving quality of care and general health status for all people is in the forefront of health care in the United States. One method to demonstrate this objective is with a common set of quality measures. These quality measures are increasingly used to determine payment to hospitals, physicians, and other health care providers.

DSMES is relevant to many important quality measures. Brief descriptions and resource links are provided below for some of the most common quality data measurement sets.

Healthcare Effectiveness Data and Information Set (HEDIS)

Medicaid Adult Health Care Quality Measures

2021 Core Set of Adult Health Care Quality Measures for Medicaid (Adult Core Set)

Medicare Five-Star Quality Rating System

Measure Applications Partnership (MAP)

Merit-based Incentive Payment System (MIPS)

Medicare Shared Savings Program

Accountable care organizations and patient-centered medical homes are two models of coordinated care with common goals of lowering costs and improving quality.

Accountable Care Organizations (ACO)

Patient-Centered Medical Home (PCMH)

Consumer Assessment of Healthcare Providers and Systems (CAHPS)

DSMES May Help Meet Quality Measures

There is a link between DSMES services and the national quality measures listed above. DSMES may help PCMHs and ACOs meet these standards.

One way to show the value of a DSMES service is to demonstrate how the DSMES service addresses the quality measures that PCMHs and ACOs must meet.

ACOs are required to meet and report on data that are used to calculate and assess their quality performance in four domains: patient/caregiver experience, care coordination/patient safety, preventive health and screening, and at-risk populations.55

DSMES service staff should ensure that PCMHs and ACOs are aware of the full spectrum of DSMES service outcomes recommended in the 2022 National Standards for DSMES that are tracked, monitored, and reported, including:

  • Knowledge
  • Behavior change
  • Clinical change
  • Quality of life
  • Satisfaction

Additional Resources

Medicare Shared Savings Program Accountable Care Organization (ACO) 2018 Quality Measures

NCQA’s Diabetes Recognition Program

Diabetes Educators in Accountable Care Organizations