How can quality metrics like Healthcare Effectiveness Data and Information Set (HEDIS) or Medicare 5-Star Ratings serve as both a case for and tracking mechanism for Post-Fracture Care adoption?

From the Guidelines

Quality metrics like HEDIS and Medicare 5-Star Ratings can effectively drive and monitor post-fracture care adoption by creating financial incentives and providing standardized measurement frameworks, as evidenced by the most recent study in 2024 1. These metrics directly impact reimbursement and reputation for healthcare organizations, making post-fracture care a business priority.

• HEDIS includes the Osteoporosis Management in Women Who Had a Fracture measure, which tracks the percentage of women 65-85 who receive bone mineral density testing or osteoporosis medication within six months of a fracture.
• Medicare 5-Star Ratings incorporate measures for osteoporosis management, influencing Medicare Advantage plan payments. Organizations can use these metrics to establish baseline performance, set improvement targets, and track progress over time. The metrics also provide standardized definitions for what constitutes appropriate post-fracture care, including specific medications like bisphosphonates (alendronate, risedronate), denosumab, teriparatide, or abaloparatide, and the timeframes within which care should be delivered. By aligning clinical goals with financial incentives, these quality metrics create a compelling case for implementing systematic post-fracture care programs while simultaneously providing the measurement framework to track their effectiveness, as supported by the EULAR/EFORT recommendations for management of patients older than 50 years with a fragility fracture and prevention of subsequent fractures 1.

The most recent study in 2024 1 highlights the cost-effectiveness of osteoporosis interventions in men, including post-fracture care services, which were found to be universally cost-effective in Sweden and the UK.

• The study found that oral bisphosphonates have been proven cost-effective in men 55 years of age or older with a history of fracture, low bone mass, rheumatoid arthritis or use of high-dose glucocorticoids.
• Denosumab was shown to be cost-effective in comparison with bisphosphonates and teriparatide in high-risk populations.
• Calcium and vitamin D supplementation (or vitamin D-fortified dairy products) were cost-effective in all men >80 years of age and in men >60 years of age with osteoporosis.

Overall, the use of quality metrics like HEDIS and Medicare 5-Star Ratings can help drive the adoption of post-fracture care and improve patient outcomes, while also providing a framework for tracking the effectiveness of these programs, as supported by the most recent and highest quality evidence 1.

From the Research

Quality Metrics as a Case for Post-Fracture Care Adoption

• Quality metrics like Healthcare Effectiveness Data and Information Set (HEDIS) and Medicare 5-Star Ratings can serve as a case for Post-Fracture Care adoption by highlighting areas of improvement in osteoporosis care and fall prevention 2.
• These metrics can identify performance gaps, particularly in post-fracture care, and inform quality improvement initiatives 2.
• The use of HEDIS quality measures has been shown to indicate gradual improvement in osteoporosis screening, identification, and treatment, as well as documentation of fall risk assessment and plan of care 2.

Quality Metrics as a Tracking Mechanism for Post-Fracture Care Adoption

• The Medicare Star Ratings program can track the quality of care provided by Medicare Advantage plans, including their performance on measures related to post-fracture care 3, 4.
• The Star Ratings program can drive improvements in the quality of plans by awarding additional payments to plans that meet high standards, which can be used to provide additional benefits to beneficiaries or reduce cost sharing 3.
• Community pharmacists can play a critical role in improving health plan Medicare star ratings by working directly with patients to improve medication use and collaborating with payers to meet quality measures 4.
• The use of quality metrics like HEDIS and Medicare Star Ratings can help identify areas for improvement in post-fracture care and track progress over time, allowing for data-driven decision making and quality improvement initiatives 5, 6.

Benefits and Limitations of Quality Metrics

• Quality metrics like HEDIS and Medicare Star Ratings can provide a standardized way to measure and compare the quality of care provided by different health plans and providers 5, 6.
• However, issues with the Star Ratings system remain, including how performance metrics are developed, chosen, and maintained, and how differences among beneficiary populations should be recognized 3.
• Additionally, the use of quality metrics may not always accurately reflect the quality of care provided, and may be influenced by factors such as patient demographics and health plan characteristics 5, 6.