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organizations, employers and others to identify quality and compare plan performance (NCQA, HEDIS

Data Submission, 2022).

Stages of the quality measure process are related but not fully stepwise (Figure 2). In general,

once a quality measure completes the development process it then may be put forward for

endorsement by NQF. While NQF endorsement is not required per se, it is viewed as a gold standard

following measure development (NQF, What We Do, 2022). After development and endorsement,

quality measures may advance to the stage of implementation by healthcare organizations, such as CMS

and NCQA, that collect data on quality measures performance and use them for plan and program

comparisons. Quality measures are fully adopted after they are assigned to specific quality payment

programs, followed by reporting, where data are collected and compared year over year.

Figure 2. Full Quality Measures Process, Stages, and Key Organizations

Timeline of Obesity Quality Measure Development Efforts

Several obesity quality measures have reached various stages of the development process over the

years, but very few have been implemented and used (Zvenyach & Pickering, 2017). Major milestones in

obesity quality measure development are depicted in Appendix Table 3 and Figure 1. In the 2000s, one

of the first measures developed and implemented for obesity was developed by CMS, called

“Preventative Care and Screening: Body Mass Index (BMI) Screening and Follow up.” Another measure

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