The National Quality Forum (NQF) continues its efforts to improve healthcare for the more than 74 million adults and children enrolled in Medicaid and CHIP by recommending standardized measures to evaluate quality of care across states.
The NQF Measure Applications Partnership (MAP) issued its recommendations on Medicaid’s core measures in a series of three new reports. NQF also for the first time provided measure recommendations specifically for four high-cost, high-need areas of care for the Medicaid population. These recommendations, issued in a fourth NQF report, aim to support federal efforts to help states tie payments—which totaled $553 billion in 2016—to improved value.
“The National Quality Forum is committed to health equity for all, and particularly for our most vulnerable populations—low-income children and the elderly, pregnant women, and people with disabilities,” said Elisa Munthali, NQF’s senior vice president of quality measurement. “Our work strengthens the nation’s ability to assess progress toward better care across states in key areas, so we can focus quality improvement where it’s needed most and improve the value of services.”
NQF’s newest MAP reports are the latest in several years of guidance to the U.S. Department of Health and Human Services on measures for adults and children on Medicaid and CHIP, as well as measures to assess care quality for individuals who are eligible for both Medicaid and Medicare. The Centers for Medicare & Medicaid Services (CMS) released an initial core set of children’s healthcare quality measures (the Child Core Set) in 2011, and published an initial core set of adult healthcare quality measures (the Adult Core Set) in 2012. The 2017 Child Core Set contains 27 measures, and the 2017 Adult Core Set contains 30 measures. States are increasingly using these parsimonious measure sets to assess quality in Medicaid programs.
MAP has begun its next annual review of core measures for adults and children in Medicaid with two new workgroups. The results are due to CMS by the end of August 2018.
In separate work for CMS, NQF recommends measures that address key quality issues in each of the Medicaid Innovation Accelerator Program’s four areas of focus. These overlapping and interrelated areas of care include reducing substance use disorders, improving care for beneficiaries with complex needs and high costs, promoting community integration through long-term services and supports, and supporting physical and mental health integration. The report, Quality Measurement in the Medicaid Innovation Accelerator Project, notes the following measure recommendations that all state Medicaid agencies and stakeholders can immediately begin leveraging for better, more efficient care:
“Measurement that addresses critical issues for beneficiaries and enables care quality to be evaluated across states will be critical to lowering costs and improving quality,” said Jennifer Moore, PhD, RN, executive director of the Institute for Medicaid Innovation, and co-chair of the NQF Medicaid Innovation Accelerator Project Coordinating Committee, which oversaw the work of four technical expert panels that NQF convened for this project.
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