Using the Core Set of Quality Measures

Ten demonstration States are using the core set of quality measures for children to improve children’s health care.

Contents

Overview

In February 2010, the Centers for Medicare & Medicaid Services (CMS) awarded grants to 10 States under a 5-year, $100 million effort to improve health care quality and delivery systems for children enrolled in Medicaid and the Children's Health Insurance Program (CHIP). The five grant categories are projects that:

  1. Show how a core set of children's quality measures can be used to improve quality of care for children (Category A).
  2. Promote the use of health information technology to enhance service quality and care coordination (Category B).
  3. Implement new or more comprehensive provider-based models of service delivery (Category C).
  4. Demonstrate the impact of a model electronic health record format for children (Category D).
  5. Test an approach to quality improvement of a State's own design (Category E).

This page summarizes projects that States are implementing under the first category (Category A), using a set of core quality measures to enhance the quality of children's health care, and highlights some of the questions addressed by the national evaluation.

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Increased Attention to Quality Measures for Children

Accurate measures of quality provide the foundation for better and more efficient health care. In particular, nationally recognized and well-tested quality measures can drive quality improvement activities for children enrolled in Medicaid and CHIP. Moreover, Federal and State agencies can use a comprehensive set of such measures to track the performance of the health system for children and identify areas needing improvement.

When it was enacted in 2009, CHIPRA set in motion a series of initiatives that have led to a vigorous and multifaceted national effort to (a) develop valid and reliable measures of quality of care for children, (b) encourage State Medicaid and CHIP agencies to report these measures to CMS, and (c) promote the use of these measures to improve quality of care for children enrolled in Medicaid and CHIP. The CHIPRA quality demonstration projects highlighted in Table 1 are important examples of the many efforts currently underway nationwide to achieve these goals. Other important efforts include:

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Demonstration Project Activities

As Table 1 shows, 10 States are implementing projects using the initial set of 24 core quality measures for children  that was released by the U.S. Secretary of Health and Human Services in January 2010. This measure set addresses a wide range of high-priority topics including: preventive services, treatments for acute conditions, availability of care in a range of ambulatory and inpatient settings, and duration of insurance coverage. The State projects involve several different kinds of activities. Some States are using grant funds to support the collection and reporting of the entire core set; some are focusing on selected measures; and some are developing and testing additional State-specific measures. In addition to collecting and reporting these quality measures to CMS, some States are using the measures to produce performance reports for providers, families, managed care plans, and policymakers.

Table 1. Demonstration States' Activities Related to the Core Quality Measures

ActivityOR*AKWVFL*ILME*MA*SC*PA*NC*
Producing and Reporting Core Measures
Collect the full set of core measuresX XXXXXXXX
Collect a subset of the core measures XX       
Develop and test additional measuresX  XXX    
Extend quality measurement to new populations not previously included   XX     
Develop or extend a data warehouse of linked data for core measure data   XXXXXXX
Using Core Measures to Improve Quality
Produce performance reports for providersX  XXXXXXX
Produce performance reports for familiesXX   XX X 
Produce performance reports for managed care plansX    XXXX 
Produce performance reports for policymakers   XX X   
Use core measures for incentive payments    XX  X 

Source: Information gathered from the demonstration States in 2011 through telephone calls and project documents.
Note: * denotes Grantee. Oregon is partnering with Alaska and West Virginia. Florida is partnering with Illinois.

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Evaluating these Projects

In the context of multiple efforts to improve measures of the quality of health care for children, the national evaluation team will assess the demonstration projects by integrating quantitative and qualitative information from CMS reports, a multi-State physician survey, key informant interviews, focus groups with parents, and review of project documents to address a wide range of questions, such as:

  • What resources helped grantees collect and report the core measures?
  • What methods did grantees use to report core measures back to consumers and practices?
  • How did stakeholders (health plans, providers, and consumers) use these measures?
  • Compared with States that did not have CHIPRA grants, what was the impact of these demonstrations on the capacity of State systems to improve health care to children?

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Learn More

To learn more about the individual projects in this grant category, use the following links: Oregon, Alaska, West Virginia, Florida, Illinois, Maine, Massachusetts, South Carolina, Pennsylvania, and North Carolina.

This page summarizes projects that States are implementing under the first category (Category A), using a set of core quality measures to enhance the quality of children's health care. To learn about the other grant categories, please use the left navigational bar, organized by 5 areas of focus.

To learn more about the evaluation of these demonstrations, send an email to CHIPRADemoEval@ahrq.hhs.gov.

Please note: This Web site uses the term "national evaluation" to distinguish this evaluation of the entire demonstration program from evaluations commissioned or undertaken by grantees. The word "national" should not be interpreted to mean that findings are representative of the United States as a whole.

Current as of June 2013
Internet Citation: Using the Core Set of Quality Measures. June 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/policymakers/chipra/demoeval/childhealth/index.html