At the conclusion of my last blog post I posed the question that since State Medicaid programs are currently deficient in assuring compliance with quality standards in the delivery of HCBS in ALF settings, is it reasonable to assume that MCOs will be better suited to not only that task, but also with regards to the delivery of HCBS in residential setting
A recent webinar convened by the National Council on Aging (NCOA) provided relevant content to help address this question. The webinar focused exclusively on the world of quality measurement and its relationship to Medicaid managed HCBS programs. In his opening remarks, the moderator Joe Caldwell, observed that States are not waiting for better Federal guidance on quality and performance measures of HCBS services, before they move their Medicaid beneficiaries into managed care. Although CMS regulations and the AARP scorecard provide a framework, the reality is that MCO enrollment is moving forward across the nation with only a hodge-podge of State-based quality measure initiatives in place.
What Gets Measured Gets Improved
The webinar's first speaker, Sarah Scholle, MPH, DrPH from the National Committee on Quality Assurance (NCQA) began her remarks by making the obvious, but necessary point, that if we don't measure quality, then we won't be able to tell where we are and we won't be able to tell if we are getting to where we want to be in the future. NCQA is a nonprofit, whose mission is to improve America's healthcare, by measuring and publicly reporting quality so that it can be used to hold healthcare providers accountable and improve quality. NCQA is one of a number of organizations that develop quality measures and its best known quality measure is HEDIS: a tool used by more than 90 percent of America's health plans to measure performance on important dimensions of care and service.
To develop quality measures, NCQA's process engages multiple stakeholders (e.g. health plans, healthcare providers, consumers, patients, etc.) to help it weigh the options for what to measure. Dr. Scholle's presentation provided a context for understanding the complexity of developing useful measures which can be used for multiple functions (e.g. public reporting, quality improvement, etc.). Unfortunately, NCQA has not done any work in the HCBS space and HEDIS only has limited utility when employed to evaluate performance related to HCBS for the Medicaid population. However, Dr. Scholle's presentation did illustrate what methodology could be utilized by NCQA if it chose to initiate the development of quality measures for Medicaid financed HCBS.
The second speaker, Alice Lind, RN, MPH from the Center for Health Care Strategies (CHCS) reaffirmed the comments of Dr. Scholle: that we are really at the beginning stages of knowing what quality measures are relevant when talking about HCBS for the folks who are now being moved into the managed care system. Like NCQA, CHCS is a nonprofit health policy resource center dedicated to improving health care access and quality. They work with state and federal agencies, health plans, providers, and consumer groups to develop innovative programs that better serve low-income Americans, especially those with complex and high-cost health care needs. Ms. Lind noted that gaps exist with the existing measurement tools (e.g. OASIS, CAHPS surveys) but on a positive note she commented that states are beginning to build their overall quality strategy off of the HHS national quality strategy.
Additionally, Ms. Lind reported that the Measure Applications Partnership (MAP), convened by the National Quality Forum (NQF) has already published initial recommendations regarding the development of a core measure set and she assured the audience of over 700 who participated in the webinar that a lot of work is being done in this area.
There are no villains in this tale. Similar to other dynamics within the elder care ecosystem, the search for a unified set of quality measures to evaluate the delivery of HCBS by MCOs involves a variety of stakeholders including: federal and state agencies, health plans, provider groups, advocates and consumers. All are struggling to find a way to improve care, have healthier people in communities and have more affordable care for our rapidly aging society. What do you think?
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I will be on hiatus for the remainder of 2012. Best wishes for the new year!