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Measures Aim to Boost Quality of Care for Adults in Medicaid

By John Reichard, CQ HealthBeat Editor

January 4, 2012 -- What is the quality of the health care that adults get in Medicaid? And how good will it be as the program expands in 2014 to enroll millions of uninsured adults?

Quality of care measures federal officials released this week aim to answer those questions and to lay down markers for continual improvement.

Many doubt the quality of care in Medicaid. That’s because of the relatively low reimbursement rates doctors, hospitals, and other providers get. But beyond vague doubts about the quality of treatment, what are the specific problems with the services provided?

A set of 26 measures of quality of care released this week by the Centers for Medicare and Medicaid Services (CMS) could generate lots of data to help pinpoint the problems.

“Improving quality is very high on the list of priorities of Medicaid directors,” said Matt Salo, executive director of the National Association of Medicaid Directors. He noted that of the 15 million more Americans projected to join Medicaid under the health law starting in 2014, “the vast majority is going to be adults.”

CMS said in a Federal Register notice that “states that choose to collect the initial core set of data will be better positioned to measure their performance and develop action plans to achieve the...aims of better care, healthier people, and affordable care.”

The measures complement a similar program already in effect to assess the quality of care given to children in Medicaid and in the Children’s Health Insurance Program (CHIP).

Issued under the health overhaul law (PL 111-148, PL 111-152), the adult measures are part of a new “Medicaid Quality Measurement Program,” which is also responsible for developing and testing additional measures.

By Jan. 1 of 2013, HHS must develop a standardized format to be used by states to report the data generated using the measures. The department also must develop procedures by then to encourage voluntary reporting of the data by the states.

By Jan. 1, 2014, HHS must begin annually publishing any changes it makes to the initial set of 24 measures based on its research program to identify and test any new measures that are needed.

Also on that date, HHS must include information on the status of adult health care quality based on the new measures in a report to Congress on the quality of care for children in Medicaid and CHIP. That report must then be published every three years.

And by Sept. 30, 2014, HHS must make public data reported by the states based on the measures of adult health care quality.

The initial set of measures will be used to assess the quality of health care in Medicaid for enrollees 18 years and older “and across all health care delivery systems” including managed care plans and fee-for-service providers, the notice states.

The measures will determine, for example, the levels of breast and cervical cancer screening in adult Medicaid enrollees in a given state. They will assess admission rates to the hospital related to complications from diabetes and from asthma.

They’ll evaluate how good a state Medicaid program is in getting schizophrenic patients to take anti-psychotic drugs. And they’ll determine how well a program does in controlling high blood pressure, in getting people with addiction problems started in treatment programs and in getting them to stick with those programs.

Salo wouldn’t predict how many states will participate in the voluntary program but said that interest in improving quality is strong among state Medicaid directors. “I think the general sense is this is a pretty reasonable first step,” he said.

CMS said it took pains to ease the burden on states by reducing the initial number of measures from the 51 initially proposed to 26. And “to the degree possible, measures that require medical record review were excluded in large scale from the initial core set,” the agency said in its Register notice.

CMS said it also “will provide technical assistance as well as additional guidance and tools to increase the feasibility of voluntary reporting.”

Salo said that data generated could be much more detailed than simple statewide measures of the percentage of Medicaid enrollees getting breast cancer screening, for example. “It’s going to allow providers compare themselves to other providers” treating Medicaid patients in a state, he said. In addition, “you can now have apples-to-apples comparisons across states.” And the data could allow policy analysts to learn “How is Medicaid doing compared to Medicare?”

John Reichard can be reached at [email protected].  

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