| Measure ID |
Title |
Description |
Weight |
Subcategory ID |
|
IA_BE_23
|
Integration of patient coaching practices between visits
|
Provide coaching between visits with follow-up on care plan and goals.
|
Medium |
Beneficiary Engagement |
|
IA_BE_22
|
Improved practices that engage patients pre-visit
|
Provide a pre-visit development of a shared visit agenda with the patient.
|
Medium |
Beneficiary Engagement |
|
IA_BE_21
|
Improved practices that disseminate appropriate self-management materials
|
Provide self-management materials at an appropriate literacy level and in an appropriate language.
|
Medium |
Beneficiary Engagement |
|
IA_BE_20
|
Implementation of condition-specific chronic disease self-management support programs
|
Provide condition-specific chronic disease self-management support programs or coaching or link patients to those programs in the community.
|
Medium |
Beneficiary Engagement |
|
IA_BE_2
|
Use of QCDR to support clinical decision making
|
Participation in a QCDR, demonstrating performance of activities that promote implementation of shared clinical decision making capabilities.
|
Medium |
Beneficiary Engagement |
|
IA_BE_19
|
Use group visits for common chronic conditions (e.g., diabetes).
|
Use group visits for common chronic conditions (e.g., diabetes).
|
Medium |
Beneficiary Engagement |
|
IA_BE_18
|
Provide peer-led support for self-management.
|
Provide peer-led support for self-management.
|
Medium |
Beneficiary Engagement |
|
IA_BE_17
|
Use of tools to assist patient self-management
|
Use tools to assist patients in assessing their need for support for self-management (e.g., the Patient Activation Measure or How's My Health).
|
Medium |
Beneficiary Engagement |
|
IA_BE_16
|
Evidenced-based techniques to promote self-management into usual care
|
Incorporate evidence-based techniques to promote self-management into usual care, using techniques such as goal setting with structured follow-up, Teach Back, action planning or motivational interviewing.
|
Medium |
Beneficiary Engagement |
|
IA_BE_15
|
Engagement of patients, family and caregivers in developing a plan of care
|
Engage patients, family and caregivers in developing a plan of care and prioritizing their goals for action, documented in the certified EHR technology.
|
Medium |
Beneficiary Engagement |
|
IA_BE_14
|
Engage patients and families to guide improvement in the system of care.
|
Engage patients and families to guide improvement in the system of care.
|
Medium |
Beneficiary Engagement |
|
IA_BE_13
|
Regularly assess the patient experience of care through surveys, advisory councils and/or other mechanisms.
|
Regularly assess the patient experience of care through surveys, advisory councils and/or other mechanisms.
|
Medium |
Beneficiary Engagement |