From the Guidelines
Medicare quality measures for 2025 will prioritize value-based care, focusing on patient outcomes, cost reduction, and enhanced care coordination, as emphasized by the most recent guidelines 1. The Centers for Medicare and Medicaid Services (CMS) will continue to promote value-based care through programs like the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). Key quality measures will include:
- Patient experience metrics
- Preventive care measures, such as vaccination rates and cancer screenings
- Chronic disease management indicators for conditions like diabetes and hypertension
- Hospital readmission rates
- Appropriate medication management CMS is also expanding telehealth quality measures and placing greater emphasis on health equity metrics to address disparities in care, as recommended by recent guidelines 1. Additionally, patient-reported outcome measures will gain importance to better capture the patient perspective on treatment effectiveness. Healthcare providers should prepare by implementing robust data collection systems, focusing on care coordination, addressing social determinants of health, and engaging patients in shared decision-making, in line with the principles outlined by the American Heart Association 1. These measures reflect Medicare's ongoing shift from volume-based to value-based care, aiming to improve healthcare quality while controlling costs for the growing Medicare population, as supported by recent research 1. The most critical aspect of these quality measures is their focus on improving patient outcomes, reducing morbidity and mortality, and enhancing the overall quality of life for Medicare beneficiaries 1.
From the Research
Quality Measures for Medicare in 2025
There are no direct research papers to assist in answering this question, as the provided studies focus on diabetes, cardiovascular disease, and cost-effectiveness of quality measures. However, some studies provide information on quality measures and cost-effectiveness that may be relevant to Medicare in general:
- The study 2 analyzed cost-effectiveness evidence associated with Centers for Medicare and Medicaid Services quality measures and found that cost-effectiveness evidence was only available for 8 of 14 process measures.
- The same study 2 also found that two measures (Tobacco Screening and Hemoglobin bA1c Control) were cost-saving and quality-adjusted life-years (QALYs) improving, and 5 measures (Depression Screening, Influenza Immunization, Colon Cancer Screening, Breast Cancer Screening, and Statin Therapy) were highly cost-effective.
- Other studies 3, 4, 5, 6 discuss the importance of managing risk factors such as blood pressure, dyslipidaemia, and glucose to improve microvascular and macrovascular complications in individuals with type 2 diabetes mellitus, but do not provide direct information on quality measures for Medicare in 2025.