NQF Issues 2017 Measurement Guidance for Medicaid and CHIP 

Washington, DC—The National Quality Forum (NQF) continues its efforts to improve healthcare for the more than 74 million adults and children enrolled in Medicaid and the Children's Health Insurance Program (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 acting 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.

• In Strengthening the Core Set of Healthcare Quality Measures for Adults Enrolled in Medicaid, 2017, MAP recommends the addition of four measures to the Adult Core Set to address care of patients with asthma, patients’ feedback about the quality of long-term services received in a community setting, opioid use, and contraceptive care. MAP supports the removal of two measures, citing states’ reporting challenges regarding data collection for one measure and encouraging the addition of a more meaningful replacement measure for the other, which focused on counting office visits, rather than the content of the visits that address patient outcomes.
• In Strengthening the Core Set of Healthcare Quality Measures for Children Enrolled in Medicaid and CHIP, 2017, MAP recommends the addition of five measures to the Child Core Set to address access to care, behavioral health, and care of patients with asthma. MAP supports the removal of five measures, citing the need for better measures that focus on care quality, not frequency of services.
• In Promoting Integrated and Coordinated Care that Addresses Social Risk for the Dual Eligible Beneficiary Population, MAP recommends the addition of five measures to the MAP Dual Eligible Beneficiaries Family of Measures. These measures address functional change, hospital discharges to community settings, patients’ feedback about the quality of long-term services received in a community setting, and population-level HIV viral load suppression. MAP supports the removal of eight measures from the Family of Measures because they are no longer NQF-endorsed.

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:

• Reducing substance abuse disorders: 24 measures and five measure concepts, such as screening and brief intervention, medication-assisted treatment, and continuity of care.
• Improving care for beneficiaries with complex care needs and high costs: 18 measures and one measure concept, such as care utilization, follow-up care, and medication reconciliation.
• Promoting community integration through long-term services and supports: 10 measures and four measure concepts, such as quality of services, access to care, and medication reconciliation.
• Supporting physical and mental health integration: 30 measures and one measure concept, such as coordination of treatment among providers, screening for physical and mental health conditions, and care follow-up.

“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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The National Quality Forum leads national collaboration to improve health and healthcare quality through measurement. Learn more at www.qualityforum.org.