Measure Applications Partnership Submits Recommendations for Dual Eligible Beneficiaries to HHS 

WASHINGTON, DC (June 4, 2012) - At the request of the Department of Health and Human Services (HHS), the Measure Applications Partnership (MAP), a public-private, multi-stakeholder group of healthcare leaders convened by the National Quality Forum (NQF), has developed a quality measurement strategy for care provided to individuals dually eligible for Medicare and Medicaid. 

There are more than nine million “dual eligible beneficiaries” in the US. The diverse group includes many of the sickest and most vulnerable individuals in our healthcare system. Dual eligible beneficiaries often struggle to navigate the system’s many complexities, including the two large programs’ different benefit structures, rules, and provider networks. This fragmentation frustrates beneficiaries and their families as well as the healthcare and long-term support providers that serve them. Lack of care coordination exposes beneficiaries to shortfalls in quality and exacerbates already high costs. Combined per capita Medicare and Medicaid spending on dual eligible beneficiaries is more than four times higher than spending for others in the Medicare program, totaling $265.7 billion in 2007.

"MAP's report reveals the many challenges inherent in providing and measuring high-quality care in a complex population," said Alice Lind, MPH, BSN, chair of the MAP Dual Eligible Beneficiaries Workgroup. "Our strategy highlights the need for a collaborative approach to the coordination and delivery of services, while emphasizing the opportunity to consider quality measurement from a person-centered perspective. Helping CMS and other partners find the best measures that reflect the individual's experience of care is an important next step toward improving outcomes and bending the cost curve." 

MAP’s vision for high-quality care seeks to address the fragmented and episodic nature of the care the dual eligible population receives. Accordingly, the partnership identifies the following core aspects of measurement it believes could provide high-value signals of improvement over time:

• Individuals’ quality of life and functional status—including symptom control, progress toward treatment and recovery goals and, in time, psychosocial factors such as level of engagement in community activities.
• Individuals’ preferences and experience of care, and engagement in decisions about their care;
• The coordination of care among multiple providers and facilities, particularly when a dual eligible beneficiary transitions from one care setting to another;
• The continual need for follow-up care and the availability of community support services and systems; and
• The ongoing management of chronic health conditions and the risks for chronic conditions.

Within these and other areas, MAP identifies a set of specific measures that are sensitive to the unique needs of dual eligible beneficiaries. Notably, they include measures of detecting and treating depression, screening older adults for fall risk, and the widespread use of surveys that allow patients to give their own views of the care they receive. MAP also identified unplanned hospital readmissions within 30 days of an initial stay as a key measure of quality for the dual eligible population. In total, MAP lays out a core set of 26 specific measures, including a “starter set” of seven that are most ready for immediate implementation in the field. 

Measure developers play a major role in advancing MAP’s strategy. MAP outlines suggestions for improving and broadening many existing measures to make them more applicable to the dual eligible population. New measure development will also be essential in filling gaps in available measures, with particular focus on creating measures that assess person-centered care planning, connections between the healthcare system and community supports, a beneficiary’s sense of autonomy, screening for poor health literacy, and measures that specifically address costs of care.

“Rapid improvement in caring for dual eligible beneficiaries would in some ways represent the perfect ‘bull’s-eye’ of achieving the National Quality Strategy goals of healthier people, better care, and more affordable care,” said Tom Valuck, MD, JD, senior vice president, Strategic Partnerships at NQF. “Use of the right performance measures is crucial to understanding our progress in improving quality.” 

The full report is available online. Learn more about the work of the Measure Applications Partnership. 

The National Quality Forum operates under a three-part mission to improve the quality of American healthcare by:

• building consensus on national priorities and goals for performance improvement and working in partnership to achieve them;
• endorsing national consensus standards for measuring and publicly reporting on performance; and
• promoting the attainment of national goals through education and outreach programs.