Business Case Development

The business case supports the importance to measure evaluation criterion , in part, by creating a model that predicts measure performance and the impact it will have on health and financial outcomes. As such, the measure developer should refer to the importance criterion in the most recent CMS CBE evaluation criteria before developing a business case.

Once the measure developer has narrowed the list of candidate measures, they should develop a business case for each remaining concept. The business case documents anticipated impacts of a quality measure , including health and health care outcomes, financial outcomes, and resources required for measure development, implementation, and maintenance. Despite what the name suggests, the measure developer should not limit the business case to a description of economic benefits and costs.

The measure steward considers whether measure development or maintenance should proceed based on information provided in the business case. Measure development should only proceed if anticipated benefits made explicit in the business case outweigh the costs and burden of measure development, data collection, implementation, and maintenance for the quality measure.

Key Points of the Business Case

The business case should demonstrate

• The need for the measure, i.e., the performance gap the measure is intended to address
• How the measure will further the aims and objectives of the project
• The value of the measure
• Why this measure provides an appropriate balance of cost, benefits, and risks relative to no measure or a related or competing measure
• Whether the measure is sensitive to changes in behavior or policy such that improvements in measure performance reflect improvements in care delivery
• Whether the costs of implementation are realistic
• Whether the health care system has sufficient capacity to implement the measure

Business Case in the Measure Lifecycle

Development of the business case starts early during measure conceptualization. The measure developer should evaluate the business case periodically during measure development and maintenance, and especially as additional or primary data become available. Evaluating the strength of the business case is ongoing during measure development because the business case helps to justify continued development of the measure. T he measure developer uses it to compare anticipated to actual results during measure reevaluation and maintenance. While the CMS consensus-based entity (CBE) does not require a formal business case, the measure developer may use many of the elements outlined in the business case in the CMS CBE measure submission forms.

Examples of business case activities in the Measure Lifecycle stages:

• Measure Conceptualization
  • Gather data to assess pros and cons of measure implementation and to inform continued measure development
  • Begin drafting business case
  • Initial business case developed based on information collection including technical expert panel input and public comments
  • Business case update(s) based on empirical data collected during testing
  • Further business case update(s) based on implementation
  • Assess measure performance pertaining to the business case
  • Determine whether the business case adequately captures benefits, outcomes, costs, and non-financial resources