This content provides information about measure construction and measure reporting for cost and resource use measures. Developing specifications for cost and resource use measures require a slightly different execution than developing specifications for traditional structure, process, and outcome measures. This content supplements the information found in the Measure Specification webpage.
The CMS goals include providing better care and lower cost of care for all Americans. The goals address affordable care by aiming to reduce the cost of quality health care for individuals, families, employers, and government. Measure developers can use measures of cost and resource use to assess variability in health care costs. Policy makers can, in turn, use these measures to direct efforts to make health care more affordable. Some terms related to measures addressing affordable care include

• Resource use: A resource use measure counts the frequency of defined health system resources. Some measure developers may monetize the health service or resource use units by applying a dollar amount (e.g., allowable charges, paid amounts, standardized prices) to each unit of resource use. Resource use measures can be valuable building blocks to drive efficiency and value.
• Cost: A cost measure addresses health care spending, by payer or consumer, for a health care service or group of health care services, associated with a specified patient population, time period, and clinically accountable entities. A cost measure can assess cost in various ways, such as assessing total cost of care or assessing a specific set of costs.
• Efficiency: Efficiency refers to cost of care associated with a specified level of care and to the resource use or cost associated with a specific level of performance and is related to the five Institute of Medicine (IOM) domains of quality (IOM 2001).
• Quality of care: Although cost and resource use measures are distinct from other quality measures, health care quality is still a crucial consideration. Quality is often the top of the ratio in the value equation (value = quality/cost), such that quality and cost go hand in hand when trying to assess value in the health care system.
• Value of care: Value of care takes into consideration a specified interested party’s preference-weighted assessment of a combination of quality and cost of care performance. The interested party could be an individual patient, consumer organization, payer, provider, government, or society. The value of care would be the combination of quality and cost, weighted by the interested party’s preference.

The United States has much higher health care costs than the rest of the Organisation for Economic Co- operation and Development (OECD) countries, but poorer than expected health outcomes (OECD, 2021). The challenge for CMS, the largest payer for health care in the country, is to identify the best, most efficient means by which to improve care, while ensuring care remains patient-centered and of equal quality for all populations. Figure 1 illustrates the relationships among resource use, efficiency, and value.

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Figure 1. Relationship between Resource Use, Value, and Efficiency

Measure developers should weigh the relationships among resource use, efficiency, and value to develop meaningful measures addressing efficiency while maintaining a focus on patient-centeredness and access for all. In doing so, measure developers should

• Link cost and resource use measures to quality outcomes and to the required processes to achieve those outcomes. Examples of strong links are sharing a common patient cohort or care processes, or an observational period as an existing quality measure.
• Consider how to pair cost with resource use measures as cost measures incorporate resource use.
  Methodologies for adding the interested party preference factors necessary to measure value are still in the definition stages. There also remain challenges to identify benchmarking cohorts for accountability comparisons accurately.