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Medicaid IAP’s Quality Measurement Efforts and Request for Public Comment on Medicaid Quality Measure Concepts

Medicaid IAP’s quality measurement portfolio is focused on supporting states in the selection, use, and alignment of quality measures related to Medicaid delivery system reform efforts. There are three areas of foci to our IAP quality measurement work, all of which are designed to complement existing measurement-related efforts (e.g., Medicaid Child and Adult Core Sets, Core Quality Measure Collaborative). First, we are kicking off a collaboration in October with the National Quality Forum to identify existing measures that can be used to support delivery system reform efforts related to IAP’s four program areas. Second, we have been tackling quality measurement-related issues and challenges such as working with the National Committee for Quality Assurance to develop a Medicaid risk adjustor for a health plan readmissions measure that is part of the Medicaid Adult Core Set. Third, for the past year, we have been developing measures that state Medicaid agencies can use related to their delivery system reform efforts. This month’s commentary is focused on our quality measurement development activities.

Despite the availability of Medicaid-relevant quality measures, there are key quality domains that lack standardized quality measures. Unsurprisingly, many of these gap areas overlap with the IAP's four program areas (substance use disorders; beneficiaries with complex needs and high costs; community integration – long-term services and supports; and physical and mental health integration).

To begin to address these measurement gaps, the IAP, in coordination with Medicare-Medicaid Coordination Office and CMCS’s Disabled and Elderly Health Programs Group, initiated a measure development contract with Mathematica Policy Research and its partners in the fall of 2015. This three-year contract entails development or refinement of a small number of measures, and a portion of the contract entails addressing measurement gaps in each of the four IAP program areas.

As part of CMS's measure development process (see the Blueprint for the CMS Measures Management System), we are seeking public comment on draft measure specifications and justifications for quality measures currently under development and testing for the first contract year. The measure concepts address the following areas and/or populations:

  • Medicare-Medicaid (dual) beneficiaries and Medicaid beneficiaries using home and community-based services
  • Medicaid beneficiaries:
    • in managed long-term services and supports programs
    • with complex needs and high costs
    • with substance use disorders
  • Medicaid beneficiaries and Medicare-Medicaid (dual) beneficiaries with physical-mental health integration needs

These measures will be available to all states to support their quality measurement efforts. Therefore, we encourage states and other interested stakeholders to review these measure concepts and provide comments – multi-stakeholder input is a critical component in the measure development process.

The public comment period runs from September 15, 2016 to October 7, 2016. If you wish to submit comments or questions on any of these measures, please do so by close of business October 7, 2016 to MedicaidQualMeasures@mathematica-mpr.com

We look forward to receiving your comments on these important measurement concepts.

IAP Commentary
Juliet Kuhn, Social Science Research Analyst, Division of Quality & Health Outcomes, CMCS and Karen LLanos, Director, Medicaid IAP


Collections: IAP Commentary