Clinical Services Team: Quality Improvement & Clinical Integrity Unit

% of the total measures in the Medicaid Adult & Child Core Measure Sets reported to Centers for Medicaid & Medicare Services (CMS)

87.5%2019

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Notes on Methodology

  • Please note that HEDIS performance measures capture data from the previous calendar year.
  • For example, the 2018 data point is the # of 2018 HEDIS performance measures reported.  These measures capture data from CY2017 claims.
Partners
  • DVHA Data Unit
  • Contractor to produce the performance measures
Story Behind the Curve

Medicaid provides coverage to low-income adults, children, elderly persons, pregnant women, and people with disabilities.  In short, Medicaid covers some of the most high-need populations in the country.

Accordingly, federal legislation called for the creation of core sets of healthcare quality measures to assess the quality of care for adults and children enrolled in Medicaid. The U.S. Department of Health & Human Services established the Adult and Child Core Sets to standardize the measurement of healthcare quality across state Medicaid programs, assist states in collecting and reporting on the measures, and facilitate use of the measures for quality improvement. 

The Adult and Child Core Sets are often used to provide a snapshot of quality within Medicaid. They are not comprehensive, but prior to their creation and implementation, performance measurement varied greatly by state, and it was not possible to glean an overall picture of quality. Statute requires CMS to release annual reports on behalf of the Secretary on the reporting of state-specific adult Medicaid quality information.

The DVHA was awarded Adult Medicaid Quality Grant funding starting in CY 2013 through CY 2015. A portion of this funding was used to facilitate quality improvement projects, as well as to assist in collecting and reporting on these core measures. The DVHA focused some of the funding on producing measures that require medical record review in order for results to be accurate and complete. This funding was no longer available to the State starting in 2016, so the Department was not able to produce the measures that require record review, thus the drop in the trend line above. We strive to build this funding back into our budget in years to come, as the production of measures that require record review will be key to the state’s ability to keep pace with other state Medicaid plans and to evaluate the effectiveness of our payment reform models. These models are required to report out on key health indicators (hypertension for example) for their attributed populations. In order to achieve alignment and a comparison cohort, we need to produce these same measures for the general Medicaid population.

Last updated:  10/15/19

 

Strategy

As we strive to report on all performance measures within the CMS Adult and Child Medicaid Quality Core measure sets, the Quality Improvement team:

  • continues to partner with the Data Unit in order to maintain an already high level of accurate and complete reporting;
  • fosters new partnerships with staff who work closely with the Vermont Clinical Registry so that we can think creatively about the best use of our resources moving forward; 
  • actively engages in annual budgetary conversations related to performance measure set reporting.
Scorecard Result Container Indicator Measure Action Actual Value Target Value Tag S R I P PM A m/d/yy m/d/yyyy