Identifying Health Care Quality Measures for Medicaid-Eligible Adults: Background Report
On March 23, 2010, the Patient Protection and Affordable Care Act (Affordable Care Act) (Pub. L. 111 148) was signed into law. Section 2701 of the Affordable Care Act added new section 1139B to the Social Security Act (the Act); section 1139B(a) of the Act now mandates that the Secretary of Health and Human Services (HHS) identify and publish for public comment a recommended initial core set of health quality measures for Medicaid-eligible adults. Section 1139B(b) of the Act, as added by section 2701 of the Affordable Care Act, requires that a recommended initial core set be published for public comment by January 1, 2011, and that an initial core set for voluntary reporting by State programs be published by January 1, 2012. The Affordable Care Act also requires that HHS establish an Adult Medicaid Quality Measurement Program to fund development, testing, and validation of emerging and innovative evidence-based measures. The overall goal is for States to use these measures to produce information that can provide insight on the quality of health care provided to Medicaid-eligible adults.
On behalf of the Secretary, the Centers for Medicare & Medicaid Services (CMS) partnered with the Agency for Healthcare Research and Quality (AHRQ) to identify the initial core set. Working through AHRQ's National Advisory Council, a Subcommittee was created in the fall of 2010 to evaluate candidate measures for the core set. A total of 51 measures were recommended to CMS and posted for public comment in January 2011. This report documents public comment results and the process and deliberations of the Subcommittee in developing final recommendations to CMS regarding the core set. In addition, the Subcommittee identified gap areas for further research or development for quality measures. Information on the Subcommittee's preliminary work leading to the measures posted for public comment are detailed in a separate report.1
The list of 51 recommended draft measures for the initial core set were posted for public comment from December 30, 2010, to March 1, 2011. The public submitted 100 comments. Public comment results suggested there was an overall concern over the large size of the proposed set, with many requesting as much alignment as possible with existing Federal initiatives. In addition to comments on the recommended list of measures, an additional 43 measures were also suggested.
In order to be responsive to the public comment, the Subcommittee sought to recommend measures for the initial core set that ensured representativeness for a wide range of health care quality issues relevant to Medicaid-eligible adults while decreasing the number of measures in the set. AHRQ and CMS identified five criteria against which to evaluate the proposed core measures: importance; scientific evidence around the issue; scientific soundness of the measure; current use in and alignment with existing programs; and feasibility for State reporting. The criteria represented attributes desired for State-level measurement that would represent Medicaid-eligible adults. In order to be as responsive as possible to public comment and other State requests to ensure that feasibility was prioritized while burden of reporting for States was minimized, two criteria—alignment with existing programs and feasibility for State reporting—were emphasized.
As in the initial meeting, the Subcommittee broke into workgroups focusing on four dimensions of health care related to adults in Medicaid: Maternal/Reproductive Health, Overall Adult Health, Complex Health Care Needs, and Mental Health and Substance Use. Workgroups were assigned two sets of measures that related to their specific areas: originally recommended measures and measures proposed in public comment. Based on each measure's technical specifications, scientific evidence available, past performance, and other information, the workgroups ranked each of their measures as High, Medium, or Low on each of the five criteria. These results were reported back to the full Subcommittee, which discussed and then voted on each measure.
A total of 24 measures ultimately received a majority vote by Subcommittee members (at least 50 percent). In order to ensure priority populations were fully represented, CMS and AHRQ added two additional measures2 to the initial core set. By January 1, 2012, the final set of 26 measures will be released publically through a Federal Register Notice.
1. Agency for Healthcare Research and Quality National Advisory Council Subcommittee: Identifying Quality Measures for Medicaid-Eligible Adults: Background Report. December 2010.
2. PC-01 Elective Delivery (The Joint Commission) and Care Transition: Transition Record Transmitted to Health Care Professional (American Medical Association—Physician Consortium for Performance Improvement).