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This overview addresses the current efforts in measuring quality performance in child health programs, focusing on various core performance indicators and quality measurement tools. It highlights challenges faced by states, including data tracking issues and the need for better engagement with stakeholders. Key approaches to quality measurement and technical assistance for states are discussed to improve enrollment, service coordination, and overall health outcomes for children. The integration of standardized measures like HEDIS and CAHPS is also examined as vital for performance improvement.
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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
PROGRAM INDICATORS AND QUALITY PERFORMANCE MEASUREMENT • Program Indicators 1. Baseline 2. Decrease in Uninsured Children 3. Expenditures • Quality Performance Measurement
CORE PERFORMANCE MEASURES • For Example: • Kids to be covered by CHIP as a % of kids eligible for CHIP
PROGRAM INDICATORS • Financial Expenditures • Counts of Children by Age • Counts of Children by Service Delivery Network
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
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
DATA TRACKING (cont.) • Service Delivery • Managed Care • PCCM • FFS • Countable Income Level
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
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?
QUALITY • Access • Clinical Effectiveness • Integration of Services: Coordination and Continuity • Cultural Competence • Comprehensiveness
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
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
ISSUES • Data Sets • Data Definition • Performance Measurement Tools • Information Systems
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
TECHNICAL ASSISTANCE • What Kind of Assistance Do States Want?
