Quality measurement is essential to improving the quality and value of healthcare for the growing Medicaid population, which includes the nation’s most vulnerable individuals, including low-income pregnant women and children, people with disabilities, and low-income elderly Americans. State Medicaid expansions and the Affordable Care Act have driven much of Medicaid’s recent growth.

“State policymakers are increasingly choosing to report standardized quality measures, and this trend is gaining traction,” said Marcia Wilson, NQF’s senior vice president of quality measurement. “An important goal of NQF’s work on behalf of Medicaid and CHIP is to help foster reporting on core measures, which strengthens the nation’s ability to compare performance across states, reduces states’ burden of collecting and reporting data, and focuses quality improvement in the most needed areas.”

The Centers for Medicare & Medicaid Services (CMS) released a core set of children’s healthcare quality measures, known as the Child Core Set, in 2011, and published an initial core set of adult health care quality measures, the Adult Core Set, in 2012. States are increasingly using these core measure sets. All states and the District of Columbia (DC) reported on at least one Child Core Set measure in 2014, and the completeness of Child Core Set data is improving, with more states reporting measures for both Medicaid and CHIP enrollees. Meanwhile, 33 states and DC reported on Adult Core Set measures in 2014, up from 30 states in 2013, the first year in which states began reporting on Adult Core Set measures.

NQF’s new reports are the latest in several years of guidance to the U.S. Department of Health and Human Services on these measure sets, as well as on measures to assess the quality of care for Americans who are eligible for both Medicaid and Medicare.

• In Strengthening the Core Set of Healthcare Measures for Adults Enrolled in Medicaid, 2016, MAP recommends the phased addition of six measures to the Adult Core Set to help address high-priority areas including substance abuse, diabetes care for people with mental illness, and medication management for people with asthma.
• In Strengthening the Core Set of Healthcare Measures for Children Enrolled in Medicaid and CHIP, 2016, MAP recommends the phased addition of five measures to the Child Core Set to address high-priority areas including maternity care, behavioral health, and care for individuals with sickle cell disease. MAP recommends the removal of two measures, citing one as an ineffective tool for improvement and another as presenting a limited opportunity for improvement because performance is very high overall. Addressing an opportunity to better align the Medicaid core measure sets, MAP recommends that a Child Core Set medication management measure for people with asthma be added to the Adult Core Set.
• In Advancing Person-Centered Care for Dual Eligible Beneficiaries through Performance Measurement, 2016, MAP recommends the addition of four measures to address pressure ulcer monitoring, patient-reported functional status, and kidney care, all of which can have a major impact on a beneficiary’s ability to remain healthy and independent.

NQF’s MAP Medicaid Task Forces and Dual Eligible Beneficiaries Workgroup represent more than 50 expert volunteers appointed by NQF. Together, they identified the growing role of community supports and services in helping vulnerable individuals—especially those with multiple chronic conditions—remain as healthy and independent as possible. MAP calls for the development of measures that capture the importance of connection to and coordination of both medical and social services for medically complex patients, using data that are portable and accessible by all types of care providers.

For more information, please contact measureapplications@qualityforum.org.