NQF’s Measure Applications Partnership Issues Report on Quality Measures for Children Enrolled in Medicaid/CHIP 

Washington, DC — Expanding its work on measures of quality of care for low-income and vulnerable populations, the National Quality Forum’s (NQF) Measure Applications Partnership (MAP) recently provided input to the U.S. Department of Health and Human Services (HHS) on a core set of healthcare measures used to monitor and improve the quality of services provided to children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP), which extends coverage to children in middle-income families.

Medicaid and CHIP are vital supports for the health of low-income Americans. Together, these programs cover more than 43 million children in the United States, which is more than 1 in every 3, and about 40 percent of all births. All 50 states and the District of Columbia voluntarily participate in reporting measures from the Core Set of Health Care Quality Measures for Children Enrolled in Medicaid/CHIP, also known as the Child Core Set.

Informed by direct feedback from state Medicaid programs and other stakeholders, the report, Strengthening the Core Set of Healthcare Quality Measures for children Enrolled in Medicaid and CHIP, 2014, supports continued use of all but one of the current 23 measures contained in the Child Core Set.

Specifically, MAP recommends removal of the measure, Percentage of Eligibles that Received Dental Treatment Services, because it is unclear if an increase or decrease in the rate is desirable. The report concludes that there are other NQF-endorsed oral health measures that are better suited to the needs of the Medicaid and CHIP quality reporting program.

In addition, MAP recommends six measures for phased addition, prioritizing the top three measures as follows:

1. # 2508 Prevention: Dental Sealants for 6-9 Year Old Children at Elevated Caries Risk to the Child Core Set to replace the current dental treatment measure in the Child Core Set, Percentage of Eligibles That Received Dental Treatment Services. This measure more accurately captures the quality of care delivered and is linked to improved outcomes. It also addresses a legislative mandate to HHS.
    
2. # 2548 The Consumer Assessment of Healthcare Providers and Systems Hospital Survey – Child Version (Child HCAHPS) is a pediatric-specific tool that is part of the CAHPS suite of surveys that address patient and family experience of care.
    
3. # 2509 Prevention: Dental Sealants for 10-14 Year-Old Children at Elevated Caries Risk provides a continuation in age range to #2508. This second, similar measure is necessary to evaluate the application of sealants to the second set of molars, which develop at a later age.


The report prioritizes the remaining three measures as follows:

4. (tie) # 1365 Child and Adolescent Major Depressive Disorder: Suicide Risk Assessment targets a high prevalence mental health condition that can result in severe outcomes without appropriate treatment. It helps to address a potential gap in measures related to behavioral health.
    
5. (tie) # 0477 Under 1500g Infant Not Delivered at Appropriate Level of Care measures an important missed opportunity to provide treatment and guidance for high-risk pregnancies in a regional manner that promotes care coordination across facilities.
    
6. # 0480 PC-05 Exclusive Breast Milk Feeding is part of a set of five measures that address perinatal care (PC-01: Elective Delivery, PC-02: Cesarean Section, PC-03: Antenatal Steroids, PC-04: Health Care-Associated Bloodstream Infections in Newborns) and complements other perinatal measures in the Child and Adult Core Sets.

In addition to its work on the Medicaid Child Core Set, MAP recently completed its second report on measures to improve care for Medicaid-eligible adults, as well as a new report on improving care for Americans who are eligible to be covered by both Medicare and Medicaid.

MAP will continue to provide annual input on the Initial Core Set of Health Care Quality Measures for Adults Enrolled in Medicaid as well as measurement topics of health-related quality of life for the Medicare-Medicaid dual eligible beneficiary population. As part of this effort, NQF will begin gathering stakeholder experience in applying performance measures in Medicare and Medicaid programs to inform future recommendations to HHS. In this work, MAP will continue to align, when possible and appropriate, key measures across the Medicaid Adult and Child Core Sets as well as measures related to Medicare-Medicaid dual eligible beneficiaries.

###

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