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OVERVIEW

OVERVIEW. Core Program Performance Indicators Quality Performance Measurement Quality Indicators Current Quality Measurement Efforts Measurement Issues Facing States Key Approaches to Quality Measurement Technical Assistance for States.

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OVERVIEW

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  1. OVERVIEW • Core Program Performance Indicators • Quality Performance Measurement • Quality Indicators • Current Quality Measurement Efforts • Measurement Issues Facing States • Key Approaches to Quality Measurement • Technical Assistance for States

  2. PROGRAM INDICATORS AND QUALITY PERFORMANCE MEASUREMENT • Program Indicators 1. Baseline 2. Decrease in Uninsured Children 3. Expenditures • Quality Performance Measurement

  3. CORE PERFORMANCE MEASURES • For Example: • Kids to be covered by CHIP as a % of kids eligible for CHIP

  4. PROGRAM INDICATORS • Financial Expenditures • Counts of Children by Age • Counts of Children by Service Delivery Network

  5. DATA TRACKING • Number of Children Served • Through CHIP • CHIP: Medicaid Expansion • Medical assistance program • Age • Under 1 • 1 to 5 • 6 to 12 • 13 to 18 • 19 to 20

  6. DATA TRACKING (cont.) • Unduplicated Number of Children Ever Enrolled in the Quarter • Unduplicated Number of New Enrollees in the Quarter • Unduplicated Number of Disenrollees in the Quarter • Number of Member Months of Enrollment in the Quarter • Average Number of Months of Enrollment (Line 4 Divided by Line 1) • Unduplicated Number of Children Ever Enrolled in the Year

  7. DATA TRACKING (cont.) • Service Delivery • Managed Care • PCCM • FFS • Countable Income Level

  8. TOOLS • Performance Measurement Tools • RFP/Contract Specifications • Quality Improvement Oversight System Tool (QISMC) • Grievance/Complaint Guidance • Enrollment Parameters • Consumer Information Models/Guides • Data/Information System Guidance • Validation Tools

  9. MEASURING QUALITY • Structure • Are the right elements in place to be able to provide quality? • Process • Are the right things done to the right people at the right time? • Outcome • Is the result as good as it should have been, given the current knowledge?

  10. QUALITY • Access • Clinical Effectiveness • Integration of Services: Coordination and Continuity • Cultural Competence • Comprehensiveness

  11. CHILD RELATED QUALITY MEASUREMENT EFFORTS • NCQA’s HEDIS • 9 measures directly related to children and adolescents • CONQUEST Data Base • 40 measures directly for children/adolescents • CAHPS • Child health modules • QARI/QSMIC • 9 clinical areas directly related to children and adolescents

  12. QISMC Projects HEDIS and CAHPS RELATIONSHIP TO HEDIS AND CAHPS • Standardized measures for public information and minimum performance levels (HEDIS, CAHPS) • Quality measures for improvement efforts need not be comparable between plans

  13. ISSUES • Data Sets • Data Definition • Performance Measurement Tools • Information Systems

  14. KEY APPROACHES Special Needs Population • Engagement of key stakeholders in design, implementation, and monitoring • Enrollment and marketing • Benefits and “medical necessity” • Coordination of services • Financial risk adjustment • Databases • Quality management

  15. TECHNICAL ASSISTANCE • What Kind of Assistance Do States Want?

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