David Kelley, MD, is the chief medical officer for the Pennsylvania Department of Human Services Office of Medical Assistance Programs, managing clinical and quality aspects of the programs. The office includes oversight of eight managed care organizations and a fee-for-service program. Previously, David served as a medical director for Aetna Health Inc. and as an assistant professor and director for Clinical Quality Improvement at Penn State’s Hershey Medical Center. David is board certified in Internal Medicine and Geriatrics. NQF spoke with him recently about Medicaid and quality.
NQF: Medicare and Medicaid celebrate their 50th anniversary this year. It’s often noted that Medicare is a driving force for the transformation of healthcare delivery, but so is Medicaid. Can you talk about Medicaid’s role in healthcare quality improvement?
DK: Because of the number of Americans—some 70 million—that now have Medicaid coverage, the program’s involvement in quality improvement is vitally important. We’ve seen a lot of activity from a national perspective, with CMS’ adoption of core sets of healthcare quality metrics for children and adults. CMS has worked with state programs to push quality improvement to the foreground, and to standardize, as much as possible, core measures. The accomplishments in quality improvement have come a long way, and NQF has had a role in that.
NQF: Tell us about Pennsylvania’s Medicaid population. How do you work to ensure quality care for these individuals, and what’s the role of quality measurement in these efforts?
DK: In Pennsylvania, Medicaid now provides healthcare coverage for about 2.6 million people, up from about 1.4 million people when I joined the Department in 2004, and this number is growing. Most of our Medicaid population is insured under managed care plans.
We have been measuring the quality of care and publicly reporting quality metrics for many years. We have specific goals for different patient populations, but across all populations we want to see good access to care and patients receiving high-quality care.
One example of improvements we’ve measured is greater blood pressure control. The proportion of hypertensive adults who have been able to control their high blood pressure increased from 55.5 percent in 2005 to 60.5 percent in 2013. Another example is that more children and adolescents are seeing their physicians. The proportion of adolescents getting well child visits increased from 45.3 percent in 2004 to 58.9 percent in 2013.
NQF: What opportunities do you foresee for Medicaid, both in Pennsylvania and nationally, in the next 50 years?
DK: In the short term, the next 3 to 5 years, I hope we can really start to leverage health information technology and the electronic extraction and reporting of quality metrics to facilitate more rapid, real-time quality improvement. I also hope we can improve the exchange of health information to reduce redundant care and better identify gaps in care. Finally, I’d like to see even more standardization of metrics across programs. I know this is challenging, but CMS has taken a great first step toward this by defining core sets of measures for adults and children.