Medicaid Quality Measures for Persons with Disabilities
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Transcript of Medicaid Quality Measures for Persons with Disabilities
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Medicaid Quality Measuresfor Persons with Disabilities
Peg Mastal, PhD, RN Susan Palsbo, PhD Delmarva Foundation George Mason University Principal Co-Investigator Principal Investigator
The work on this project is funded bythe National Institute on Disability and Rehabilitation Research Office
of Special Education and Rehabilitation ServicesU. S. Department of Education
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Delmarva Foundation
Scope of the Project
• 5 Year Research Grant from the National Institute on 5 Year Research Grant from the National Institute on Disability and Rehabilitation Research (NIDRR), U.S Disability and Rehabilitation Research (NIDRR), U.S Department of EducationDepartment of Education
• Project is in the 5th and last year of the scope of workProject is in the 5th and last year of the scope of work
• Ultimate Goal: Quality reporting system for programs Ultimate Goal: Quality reporting system for programs serving Medicaid or dual-eligible beneficiaries with serving Medicaid or dual-eligible beneficiaries with disabilitiesdisabilities
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Delmarva Foundation
Criteria: Quality Measures Selection
General Criteria
• Relevant to multiple stakeholders
• Scientifically strong (derive from comparable data sources and there is published information on the impact of risk adjustment)
• Feasible – data collection can be precise, easily collected, and within reasonable costs
• Point direction/s for continuous quality improvement
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Delmarva Foundation
Strategic Approach: Model Existing Types of Quality Measures
Consumer Assessment of Healthcare Providers and Systems (CAHPS)
• Developed by the Agency for Health Research and Quality (AHRQ)
• “Gold standard” for assessing quality of care and services in managed care programs from the member perspective
• Multiple versions (adults, children, children with special needs, Medicaid, etc.)
• NCQA-accredited health plans must conduct CAHPS annually
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Delmarva Foundation
Strategic Approach: Model Existing Types of Quality Measures
Healthcare Effectiveness Data Information Set (HEDIS)
• Set of database-retrievable quality measures that are developed, maintained by and reported to the National Committee for Quality Assurance (NCQA)
• “Gold standard” for assessing and reporting quality care and services and some outcomes in managed care programs.
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Delmarva Foundation
Grant Activities: Identifying Relevant Database Retrievable Quality Measures
Measures Advisory Panel (MAP) – 19 experts
• Membership: Consumers, Executives and Medical Directors from Medicaid HMOs and Special Needs Plans, psychiatrist, physiatrist, scientist, MR/DD, MAA rep.
• Identified 42 HEDIS-like quality measures important to monitor and report in programs serving persons with disabilities
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Delmarva Foundation
Types of Measures Selected by the MAP
HEDIS Measures
• Member demographics
• Types of outpatient encounters, hospitalizations
• Screening (chlamydia, breast cancer, colorectal, cervical)
• Disease management (asthma, diabetes)
• Mental illness management
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Delmarva Foundation
Types of Measures Selected by the MAP
Non-HEDIS Measures Specific to Disabled Populations
• Access to care coordination
• Timeliness: Admission interview and Individual Service Plan
• Institutional vs. community living arrangement
• Timely access to durable medical equipment (DME)
• Incidence of pressure ulcers, urinary tract infections, bowel disorders, spasticity
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Delmarva Foundation
Important Quality Measures: Retrievable Only by Other Methods
Quality of Benefits and Services (Adequacy of DME, medical supplies, OT/PT/Speech therapy, adequacy of transportation)
Management of Function and Physical Status (changes in functional status, medication, pain and weight)
Self-determination, Community Integration, Health and Safety (Choice of services, daily routine, residence, participate in life of community, free from abuse/neglect, feel secure in their residence)
Satisfaction levels (Consumers, providers, staff)
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Delmarva Foundation
Scope of Work: Fourth and Fifth Years
Determine the challenges and solutions for collecting and reporting information on the quality measures identified by the Measurement Advisory Panel (MAP)
DFMC Project Team working with 2 managed care programs
• Inland Empire Health Plan (MediCal plan, 250, 000+ members, NCQA accredited, experienced with HEDIS)
• Community Living Alliance, Madison WI (500 member plan, no experience as yet reporting HEDIS or HEDIS-like measures)
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Delmarva Foundation
Challenges: Community Living Alliance
• Studied HEDIS methodology
• Completed NCQA’s Baseline Assessment Tool (BAT)
• Brought claims data base into internal operations
• Are fairly certain they can report on all the MAP measures
• Will run the quality measures against their population in October-November time frame
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Delmarva Foundation
Challenges:Inland Empire Health Plan
Able to report on all the HEDIS measures
Not able to report on the non-HEDIS-like measures having to do with type of living arrangements
• Would only know if the member was in a hospital or nursing home, no knowledge of types of community residential living arrangements
• Do not collect data on the type of residence only the address
• Would require a plan-wide survey to determine type of residence (not cost-effective)
• Medicaid beneficiaries change addresses frequently
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Delmarva Foundation
Project Goal: Disseminate Quality Reporting System for Persons with Disabilities
Dual System – quality measurement and reporting in terms of:
• Consumer-reported measures
Assessment of Health Plans and Providers by People with Activity Limitations (AHPPPAL)
Developed by Dr. Sue Palsbo and others in a CAHPS-like model
Currently in the field being pilot -tested
• Provider-reported measures – quality measures specific to Disability Care Coordination Organizations (DCCOs) retrievable from databases
Manual of technical specifications for quality measures to be developed that are not specified in HEDIS