Health Home Quality Measure Reporting and Evaluation Activities
A goal of Medicaid health home programs is to improve health outcomes for beneficiaries with chronic conditions through coordinated care provided by an interdisciplinary team linking primary, behavioral health, and long term services and supports. The Centers for Medicare & Medicaid Services (CMS) established a core set of health home quality measures that states will report through the MACPro system according to the schedule below. These quality and utilization measures will be used for ongoing monitoring and evaluation purposes across all state health home programs and the results will be reported to Congress. In addition to the core measures, CMS expects that states will report specific goals and measures identified by their individual programs.
- For technical assistance related to calculating, reporting, or using the health home quality measures, submit your questions to the TA Mailbox at MACqualityTA@cms.hhs.gov.
- For assistance with using MACPro, contact the MACPro Helpdesk at MACPro_Helpdesk@cms.hhs.gov.
General Resources for Reporting Health Home Quality Measures
- Health Homes SMD Letter 13-001 (PDF, 236.71 KB) (CMS/January 2013) - Describes the core quality measures and approach to reporting.
- Substance Use Disorder (SUD)-focused Health Homes Informational Bulletin (PDF, 154.51 KB) (November 2019) - Provides a description of new Quality Measures for SUD-focused Health Homes.
- 2020 Core Set of Health Care Quality Measures for Medicaid Health Home Programs (Health Home Core Set) (PDF, 165.35 KB) - Provides an overview of the quality and utilization measures for FFY 2020 Health Home Core Set reporting.
- 2019 Core Set of Quality and Utilization Measures (PDF, 99.39 KB) - Provides a quick look at the seven quality measures and three utilization measures for FFY 2019 Health Home Core Set reporting.
- Technical Assistance Webinar: Introduction to the Core Set of Health Care Quality Measures for Medicaid Health Home Programs (PDF, 253.71 KB) (CMS/April 2014) - Provides an introduction to health homes quality measurement, the 2013 core measures set, and the 2013 reporting process.
- Expected Health Home Core Set Reporting Periods, by Effective Date of SPA (PDF, 322.84 KB) - Provides a list of states, by SPA, required to report in each of the following years: FFY 2018 - FFY 2020
- Screenshots of Health Home Quality Template in MACPro (PDF, 7.78 MB) (Truven/December 2015) - Shows screenshots from the MACPro system to provide users with a visual orientation to the system’s contents.
- 2019 Health Home Core Set HEDIS Value Set Directory (ZIP, 2.59 MB) Provides value sets and codes needed to calculate and report HEDIS measures included in the 2019 Health Home Core Set
- 2019 PQ192-HH Value Set (XLSX, 109.04 KB) - Provides ICD-10 codes needed to calculate and report PQI92: Chronic Conditions Composite (PQI92-HH) measure included in the 2019 HealthHome Core Set.
- 2019 AIF-HH Value Set (XLSX, 25.95 KB) - Provides codes needed to calculate and report Admission to an Institution from the Community (AIF-HH) measure included in the 2019 Health Home Core Set.
- Technical Assistance Resource – Guidance for Calculating the Plan All-Cause Readmissions (PCR) Measure in the 2019 Adult and Health Home Core Sets.
- Archived Health Home Core Set Measure Lists and Reporting Resources (ZIP, 2.82 MB) - For technical specifications and value set directories from previous reporting years, please email MACQualityTA@cms.hhs.gov.
|Reporting Start Date (Targeted)||September 2019|
|Measurement Year (Generally, see Technical Specification for specifics)||January 1, 2018 to December 31, 2018|
|Technical Specifications Manual||Health Home Core Set of Quality Measures: Technical Specifications and Resource Manual 2019 (PDF, 514.07 KB)|
|Summary of Changes||Summary of Changes in FFY 2019 (PDF, 197.05 KB)|
|Data Quality Checklist||Data Quality Checklist for States 2019 (PDF, 344.85 KB)|
|Core Set Measurement Period Table||Health Home Core Set Measurement Period Table 2019 (PDF, 115.7 KB)|
Resources for Using MACPro
- MACPro Portal – Describes the Medicaid and CHIP Program (MACPro) portal and functionality
- Training and Help – Provides trainings, reference materials, and a Help Desk to assist MACPro users in learning the system.
- Technical Assistance to Support Adult, Child, and Health Home Core Set Reporting for FFY 2019 – October 17, 2019
- Core Set Presentation slides (PDF, 2.09 MB)
- MACPro Presentation slides (PDF, 463.64 KB)
- Pt 1: Introduction to the MACPro Quality Measures FFY 2019 State Update (12:18)
- Pt 2: Updates to Quality Measures FFY 2019 Reporting (16:53)
- Pt 3: MACPro Access and Roles for Quality Measures (10:08)
- Pt 4: MACPro FFY 2019 QM System Updates and Additional Resources (6:35)
Resources from Federal Evaluation Activities
- Report to Congress (RTC) on the Independent Evaluation of Health Homes (PDF, 400.35 KB) , the optional Medicaid State Plan benefit, conducted by the Assistant Secretary of Planning and Evaluation (ASPE) through a contract with Urban Institute.
- Interim Report to Congress: Phase II Evaluation Activities (NORC-University of Chicago) - Describes the web survey, stakeholder interviews, site visits, and focus groups that are part of Phase II of the Medicaid health home evaluation.
- Interim Report to Congress on the Medicaid Health Home State Plan Option (PDF, 364.94 KB) (NORC-University of Chicago/2014) - This baseline report describes each health home program, challenges and best practices in design and implementation, and baseline hospital admission rates.
- Section 2703 Health Home Long-Term Evaluation Activities - Describes the aims of the long-term Health Home evaluation and the types of data that will be collected by the evaluation team.
- Evaluation of the Medicaid Health Home Option for Beneficiaries with Chronic Conditions: Final Annual Report - Base Year (Urban Institute/December 2012)
- Evaluation of the Medicaid Health Home Option for Beneficiaries with Chronic Conditions: Final Annual Report - Year Two (Urban Institute/June 2014)
- Evaluation of the Medicaid Health Home Option for Beneficiaries with Chronic Conditions: Final annual Report – Year Three (Urban Institute/July 2015)
Resources from State Reporting and Evaluation Activities
States have begun to publish findings from their own health home program evaluations. View state findings from their health home program reporting and evaluation activities.
- Summary Report of the Iowa Medicaid Medical Health Home: Evaluation of a Health Home Program for Those with Chronic Illnesses (The University of Iowa Public Policy Center/March 2015)
- Outcomes for Iowa Medicaid Health Home Program Enrollees 2011-2013 (The University of Iowa Public Policy Center/March 2015)
- Iowa Medicaid Health Home Providers: A qualitative examination of the implementation of the Iowa Medicaid Health Home (The University of Iowa Public Policy Center/November 2014)
- Cost Analyses of the Iowa Medicaid Health Home Program (The University of Iowa Public Policy Center/October 2014)
- Post-Enrollment Experiences of Iowa Medicaid Health Home Program Adults and Children (The University of Iowa Public Policy Center/September 2014)
- Baseline Evaluation of the Experiences of Iowa Medicaid Health Home Program Enrollees (The University of Iowa Public Policy Center/December 2013)
- Baseline and 9-Month Follow-Up Outcomes of Health Care for Iowa Medicaid Health Home Program Enrollees (The University of Iowa Public Policy Center/November 2013)
- MaineCare Stage A Health Homes Year 1 Report: Implementation Findings and Baseline Analysis (University of Southern Maine/March 2014)
- Health Home Quarterly Report (The Hilltop Institute/May 2015)
- Health Home Quarterly Report Chartbook (The Hilltop Institute/May 2015)
- Health Home Annual Report (The Hilltop Institute/October 2014)
- 2013 Missouri Primary Care Health Homes: Interim Evaluation Review Summary (MO HealthNet/May 2014)
- 2013 Progress Report: Missouri CMHC Healthcare Homes (Department of Mental Health and MO HealthNet/November 2013)
- An Examination of New York State's Integrated Primary and Mental Health Care Services for Adults with Serious Mental Illness (New York State Health Foundation/2014)