HHS Publishes Medicaid Quality Measures

Recently, the Department of Health and Human Services (HHS) published a notice finalizing the initial core set of 26 care quality standards for Medicaid adult beneficiaries, as mandated by the Section 2701 of the Patient Protection and Affordable Care Act (PPACA), which added new section 1139B to the Social Security Act (the Act). 

The standards, which states can use to report on care quality, focus on six key clinical areas: prevention and health promotion, management of acute conditions, management of chronic conditions, family experiences of care, care coordination, and availability of care.  Another provision of the health care reform law requires HHS to create a uniform reporting format for these quality measures by Jan. 1, 2013. 

Background 

Section 2701 directs the Secretary of HHS to identify and publish for public comment a recommended initial core set of health care quality measures for Medicaid-eligible adults.  Additionally, the statute requires the initial core set recommendation to consist of existing adult health care quality measures in use under public and privately sponsored health care coverage arrangements or that are part of reporting systems that measure both the presence and duration of health insurance coverage over time and that may be applicable to Medicaid-eligible adults.  

By January 1, 2012, the Act requires the Secretary to Establish a Medicaid Quality Measurement Program to fund development, testing, and validation of emerging and innovative evidence-based measures. 

By January 1, 2013, the Act requires the Secretary to Develop a standardized reporting format for the core set of adult quality measures and procedures to encourage voluntary reporting by the States. 

By January 1, 2014 the Act requires the Secretary to Annually publish recommended changes to the initial core set that shall reflect the results of the testing, validation, and consensus process for the development of adult health quality measures. The Secretary must also include in the report to Congress the quality of health care of children in Medicaid and the Children’s Health Insurance Program (CHIP) similar information for adult health quality with respect to measures. This report must be published every 3 years thereafter in accordance with the statute. 

By September 30, 2013, the Secretary must Collect, analyze, and make publicly available the information reported by the States. 

HHS noted that, “States that chose to collect the initial core set will be better positioned to measure their performance and develop action plans to achieve the three part aims of better care, healthier people, and affordable care as identified in HHS’ National Strategy for Quality Improvement in Health Care. 

Medicaid Quality Measures 

The initial core set of quality measures for voluntary annual reporting by States has been determined based on recommendations from the Agency for Healthcare Research and Quality’s (AHRQ) Subcommittee to the National Advisory Council for Healthcare Research and Quality, as well as public comments, before being finalized by the Secretary. 

Over the next year, CMS will phase in components of the Medicaid Adult Quality Measures Program that will help to further identify measurement gap areas and begin testing the collection of some of the initial core measures. The Medicaid Adult Quality Measures Program will focus on developing and refining measures, where needed, so that future updates to the initial core set can meet a wider range of States’ health care quality measurement needs. 

By September 2012, CMS will release technical specifications as a resource for States that seek to voluntarily collect and report the initial core set of health care quality measures for Medicaid-eligible adults. Additionally, as required in statute, by January 1, 2013, CMS will issue guidance for submitting the initial core set to CMS in a standardized format. Lastly, the Secretary will launch a Technical Assistance and Analytic Support Program to help States collect, report, and use the voluntary core set of adult measures. 

To draft the measures, a subcommittee was broken into four groups, which represent the main dimensions of healthcare related to adults in Medicaid: 

• Adult health
• Maternal/reproductive health
• Complex health care needs
• Mental Health and Substance Use

A total of 35 measures received a majority vote from the full Subcommittee. The measures voted upon by the Subcommittee included recommendations from each workgroup that were based on the original 51 measures as well as new measures identified through public comment that were brought forth by each workgroup. The Adult Health work group recommended eleven measures for inclusion in the initial core set. The Maternal/Reproductive Health work group recommended six measures. The

Complex Health Care Needs work group recommended nine measures and the Mental Health and Substance Use recommended nine measures.

In the final round of voting, 24 measures ultimately received a majority vote by Subcommittee members. In order to ensure priority populations were fully represented and that the goals of planned initiatives could be monitored, we then added two measures originally proposed for the draft core set (PC-01 Elective Delivery and Timely Transmission of Transition Record). The Subcommittee deferred the decision to CMS and AHRQ on which of the two HIV-related measures under consideration (HIV/AIDS Screening: Members at High Risk of HIV/AIDS and HIV/AIDS: Medical Visits) would be included in the core set. Upon discussion with colleagues from the Centers for Disease Control and Prevention and the Health Resources and Services Administration, the decision was made to include the measure originally proposed for the core set, HIV/AIDS: Medical Visit.

A total of 26 are included in the initial core set including:

–          Breast cancer screening

–          Cervical cancer screening

–          Flu shots for adults ages 50-64

–          Controlling high blood pressure

–          Adherence to antipsychotics

Overall the list of quality measures is an step towards better quality in Medicaid patients this is a fairly truncated list for the most part attached to HEDIS measures.  It will be interesting to see how they are applied and implemented in the coming months.