The National Association of Medicaid Directors (NAMD) issued a position paper today calling on federal policymakers to ensure that federal and state resources go to effective, high-value initiatives to strengthen the integrity of the Medicaid program. In addition to describing the landscape for Medicaid program integrity activities, the paper offers states’ perspective on the duplication and inefficiencies that currently exist. The report, "Rethinking Medicaid Program Integrity: Eliminating Duplication and Investing in Effective, High-Value Tools," makes four overarching recommendations: 1) Clarify the roles of the state and federal governments in Medicaid program integrity efforts; 2) Improve collaboration and communication between Medicare and Medicaid; 3) Invest in resources tailored to individual state Medicaid programs; and 4) Evaluate the return on investment and utility of existing program integrity initiatives.

The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) directed the Department of Health and Human Services (HHS) to enter into a 4-year contract with an entity to perform various activities related to health care quality measurement. In January 2009, HHS awarded a contract to the National Quality Forum (NQF), a nonprofit organization that endorses health care quality measures—that is, recognizes certain ones as national standards. In 2010, the Affordable Care Act (ACA) established additional duties for NQF. This is the second of two reports MIPPA required GAO to submit on NQF’s contract with HHS. In this report—which covers NQF’s performance under the contract from January 14, 2010, through August 31, 2011—GAO examines (1) the status of projects under NQF’s required contract activities and (2) the extent to which HHS used or planned to use the measures it has received from NQF under the contract to meet its quality measurement needs, as of August 2011. GAO interviewed NQF and HHS officials, reviewed relevant laws, and reviewed HHS and NQF documents. GAO recommends HHS: (1) use all monitoring tools required under the contract to help address NQF’s performance, (2) complete testing of retooled measures, and (3) comprehensively plan for its quality measurement needs. HHS neither agreed nor disagreed with these recommendations. NQF concurred with many of the findings in the report and provided additional context.

A Commonwealth Fund international survey of adults living with complex care needs found that patients in the United States are much more likely than those in 10 other high-income countries to forgo needed care because of costs and to struggle with medical risk. In all of the countries surveyed, patients who have a medical home reported better coordination of care, fewer medical errors, and greater satisfaction as compared to those patients without one.

As required by the Patient Protection and Affordable Care Act (ACA), the Centers for Medicare and Medicaid Services (CMS) launched Physician Compare in December 2010, where Americans can find information on physicians. The website provides information ranging from the gender of the physician to whether doctors have foreign language proficiencies, if they accept Medicare patients, and where they completed their degrees and training. A new Robert Wood Johnson Foundation brief, "Reform in Action: Can Measuring Physician Performance Improve Health Care Quality?" explores examples of public reporting websites that have caused hospitals and physicians to improve their practice patterns and the quality of care they provide.

The Measure Applications Partnership (MAP), a public-private group of stakeholders working with the National Quality Forum (NQF) submitted the report, "Strategic Approach to Performance Measurement for Dual Eligible Beneficiaries," to the Department of Health and Human Services (HHS) to detail potential health care quality measures for dual eligibles under the Affordable Care Act (ACA). Dual eligible members account for a disproportionate share of Medicare and Medicaid spending. While dual eligibles make up only 15% of Medicaid enrollees, they account for 39% of all Medicaid expenditures. Similarly, dual eligibles account for 16% of Medicare enrollees and 27% of program expenditures. The MAP report proposes a broad outline for measuring health care quality for dual eligibles and for identifying difficulties in obtaining comprehensive treatment data. The five measures of quality that HHS could use to improve care and control spending for dual eligibles include 1) quality of life, 2) care coordination, 3) screening and assessment, 4) mental health and substance abuse, and 5) structural measures.