Preparing for Measurement Selection: Landscape of Measures

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Overview. Performance Measurement in MedicaidQuality of Care for Adults in MedicaidMeasures Inventory Key Challenges. 2. Performance measurement in medicaid. . 3. State of Measurement in Medicaid. There is no national reporting of Medicaid quality data representing all different populations e

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Preparing for Measurement Selection: Landscape of Measures

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1. Preparing for Measurement Selection: Landscape of Measures Sarah Hudson Scholle Sepheen Byron 1

2. Overview Performance Measurement in Medicaid Quality of Care for Adults in Medicaid Measures Inventory Key Challenges 2

3. Performance measurement in medicaid 3

4. State of Measurement in Medicaid There is no national reporting of Medicaid quality data representing all different populations enrolled (that’s why we are here…) Two new reports shed light on current efforts Managed care: NCQA’s Medicaid Benchmarking Project Report FFS: CHCS’ Performance Measurement in Fee-for-Service Medicaid: Emerging Best Practices 4

5. NCQA Medicaid Benchmarking Report Purpose: Test the feasibility of collecting comparable performance measure results from state Medicaid agencies and combining these data with existing HEDIS data in NCQA’s database to develop robust benchmarks for Medicaid Why Focus on Managed Care and HEDIS? 71% of the Medicaid population in states that use managed care arrangements including PCCM and MCOs 37 states contract with MCOs Nearly 90 percent of state Medicaid programs reported using HEDIS measures for evaluate quality of children’s care No comparable data available for adults 5

6. How Do States Use HEDIS? States use HEDIS measures to meet the federal requirements for performance measurement in Medicaid States may use the HEDIS data plans have submitted to NCQA, require plans to submit data directly to the state or the EQRO, or calculate performance rates themselves Twenty-five Medicaid programs use or require NCQA Accreditation 6

7. Medicaid Programs & HEDIS

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