Medicaid and CHIP Strategies for Improving Child Health

July 10, 2009

Authors: Vernon K. Smith, Ph.D., Jennifer N. Edwards, Dr. P.H., Esther Reagan, and Dennis Roberts, J.D.

Contact: VSmith@healthmanagement.com
Editor: Christopher Hollander

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Overview

Medicaid and Children’s Health Insurance Program (CHIP) leaders are  assessing and improving the quality of care provided to children and adolescents, but many states are finding the resources available to them are inadequate for the job. This report identifies states' priorities for measuring and improving child and adolescent health outcomes and points to opportunities for foundation and government support of states' needs. States see a need for measures that focus on outcomes, not processes; measures that are standardized across programs and agencies serving children; and measures that indicate progress toward specific program goals. In addition, state officials want to be able to compare their state's performance against others in national data sets, using common metrics and methodologies. They would like additional strategies for tying their quality improvement efforts to reimbursement methodologies for health plans and individual providers, to encourage higher performance.

Executive Summary

Medicaid and the Children's Health Insurance Program (CHIP) are at a turning point in their efforts to improve the health and well-being of children and adolescents. In each state, program officials are working with existing national measurement systems or state-developed tools to assess health care quality, and they have developed sufficient baseline data to show where improvements are needed. They are trying out new strategies, and take pride in their efforts to improve health outcomes for children and adolescents.

At the same time, states would like to do better. They believe their quality goals would be achieved more quickly if they had access to specialized technical assistance that allows them to learn from experts and from the experience of colleagues in other states. With states ready to push forward, new federal funding to support the advancement of child quality measurement and improvement would come at an opportune time.

This study is based on findings from a national survey of Medicaid and CHIP programs as well as focused discussions with selected program officials. Conducted by Health Management Associates, the survey and discussions addressed current approaches being used by states to improve quality of care and health outcomes for children and adolescents, the barriers states experience as they pursue quality improvement activities, and their assessment of what resources or strategies would lead to further improvements. Three compelling messages emerged:

  1. The currently available set of measures is inadequate to fully address quality of care for children. States see a need for measures that focus on outcomes (as opposed to processes), measures that are standardized across health programs and across agencies serving children, and measures that would indicate progress in reaching their specific program goals.
  2. State officials want to be able to compare their state's performance against others in national data sets, using common metrics and methodologies. Comparative data can be useful to states in prioritizing resources and managing provider and health plan contracts. Knowing the gap between current performance and best performance on valued measures can help mobilize quality improvement efforts.
  3. State officials would like to enhance their quality improvement efforts by incorporating data on quality and performance into reimbursement methodologies for health plans and individual providers, to encourage and reward higher performance. States would like to hear more about experiences of other states working with plans and providers in order to replicate or adapt best practices to their states.

 The Centers for Medicare and Medicaid Services, the Agency for Healthcare Research and Quality,  and other organizations have an opportunity to accelerate the pace of change. Medicaid and CHIP officials indicated that the strategies they would value most would include targeted technical assistance, improved opportunities to learn from each other and from experts in quality improvement, and participation in an active coaching process that includes expert guidance to the states and to their health plan partners.

 

Citation

V. Smith, J. Edwards, E. Reagan et al., Medicaid and CHIP Strategies for Improving Child Health, The Commonwealth Fund, July 2009.