Executive Summary

The Alliance for Screening Measurement Modernization (ASMM) was convened to close the gap between rapidly evolving screening technologies—which may offer greater accuracy or more patient-centered approaches—and the slow adoption of these technologies into the quality measures used to assess physician, clinic, and health plan performance. This cross-sector initiative operates through two separate but coordinated councils: a Quality Council comprised of representatives from guideline setting organizations, clinicians, measure developers and stewards, and other nonprofit stakeholders, and an Industry Council comprised of diagnostic innovators and a patient advocacy organization. The ASMM met from June through December 2025 to develop the ASMM series of briefs and design a practical framework for more timely measure modernization.

Background

The United States Preventive Services Task Force (USPSTF) issues evidence-based recommendations on preventive services, including diagnostic screening tests. USPSTF recommendations are influential but resource intensive; updates often take years, meaning new FDA cleared or approved screening technologies often wait long periods of time before formal USPSTF review and update. Many measure developers and stewards voluntarily align their screening quality measures with USPSTF updates, leading to a delay in the modernization of measures.
Quality measures are key aspects of how health plans evaluate performance, reward providers, and structure value-based contracts. When quality measures are not updated to reflect current standards of care, providers may not be incentivized to use new technologies, even though they may offer advantages. This resulting misalignment between regulatory approval, quality measurement, and clinical practice can lead to consequences for patients and decreased access to modern screening modalities.

The ASMM Framework

The ASMM Framework is intended to establish an evidence threshold for measure developers and stewards to determine when to recognize a new screening modality within existing quality measures, especially where USPSTF updates are delayed.
A key component of the ASMM Framework is the Decision Tree included in Brief 2, that describes when a measure update should be considered. The Decision Tree provides the following steps to help determine whether to include a new technology in a screening measure:

• Step 1: Is the technology covered in a USPSTF “A” or “B” recommendation?

If the modality is in a USPSTF “A” or “B” recommendation, measure developers and stewards may treat that as a default trigger to consider updating the measure. “C” ratings call for case-by-case evaluation, and “D” and “I” ratings are generally excluded unless new evidence supports inclusion.

• Step 2: Is the technology included in a CMS National Coverage Determination (NCD)?

If not in an “A” or “B” recommendation, measure developers and stewards should consider if CMS has issued an NCD. A positive NCD alone provides sufficient evidence to justify considering a measure update.

• Step 3: Has the USPSTF initiated an update to their recommendation?

If there is no NCD, measure developers and stewards should determine if the USPSTF has started an update to their recommendation, and, if so, wait up to 18 months from the posting of the draft research plan before acting independently.

• Step 4: Additional evidence for measure reconsideration

If neither a USPSTF recommendation nor NCD provides guidance, measure developers and stewards are directed to rely on robust independent evidence (such as meta-analyses or robust guidelines), ideally seeking at least two strong, conflict-free sources.

Because later steps in the Decision Tree rely on guidelines and evidence from various sources, the ASMM recommends using established standards and independent rating tools to determine guideline quality; measure developers and stewards are asked to focus on transparency and evidentiary rigor. When two or more highly rated guidelines or meta-analyses from different organizations endorse the same screening modality, that may serve as a strong signal that a measure update is appropriate.

Implementation and Authorities

Brief 3 outlines how key actors can operationalize the Framework:

• Device manufacturers: Use the Framework to determine when evidence thresholds are met and submit structured, well-supported requests for measure inclusion or updates.
• Measure developers and stewards: Apply the Framework on an ongoing basis, accept evidence-based requests year-round, and initiate formal reconsiderations within six months when thresholds are met, advancing qualified updates for endorsement and CMS adoption.
• CMS: Use statutory and contractual authority to ensure measures in federal programs reflect current evidence and covered technologies.
• USPSTF: Meet statutory expectations to review and update recommendations at least every five years, use early topic updates when appropriate, and publish schedules and evidence queues to enable measure alignment.
• HHS: Consider regulatory guidance that sets expectations for timeliness and evidentiary standards across quality programs.
• Congress: Provide resources and oversight to support timely USPSTF reviews and encourage CMS and HHS to hold measure stewards accountable for updating measures in line with current evidence.

Conclusion

Taken together, the ASMM series of briefs offers measure developers and stewards a practical, evidence-based framework to ensure national screening measure alignment with modern technologies. By translating existing evidence and regulatory decisions into clear triggers for action, unnecessary delays between innovation, measurement, and clinical adoption can be reduced. For Congress and other stakeholders, supporting the uptake and use of this framework can help ensure that federal quality programs promote timely access to preventive health care.

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Download ASMM Briefing Report March 2026