MAP report finds that fragmented dual eligible care makes quality measures difficult

Posted on October 4, 2011 | No Comments
Filed under Disparities, Health Care Quality and Delivery System Reform, Health Insurance, Library, Medicaid and CHIP, Medicare, Third Party Resources

PDF Version

Details

Key Developments

Library

Implementation Briefs

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.

No Comments

CMS takes steps to improve transparency of demonstration waiver process

April 30, 2012

The Centers for Medicare & Medicaid Services (CMS) issued guidance on Friday, April 27 regarding the process the agency will use to review and approve state demonstration projects under Medicaid and the Children's Health Insurance Program (CHIP). The guidance outlines how CMS plans to implement requirements for improving public input and transparency with regard to the demonstration projects. These "1115 Waivers" authorize states to test new coverage and delivery models after obtaining appropriate waivers from CMS. The guidance, accompanied by a letter to state Medicaid directors, also introduces the user guide that CMS is providing for stakeholder organizations.

HHS releases Medicaid quality measures

January 6, 2012

The Department of Health and Human Services (HHS) December 31, 2011 released a set of 26 quality measures to help track and improve health care delivered to Medicaid enrollees. The 26 quality measures are grouped into six major categories: 1) prevention and health promotion (e.g., flu shots for adults); 2) management of acute conditions (e.g., follow-up after hospitalization); 3) management of chronic conditions (e.g., controlling high blood pressure); 4) family experiences of care (e.g., surveys); 5) care coordination (e.g., timely transmission of records among providers); and 6) availability of care (e.g., prenatal and postpartum care). The development of these quality measures is mandated under the Affordable Care Act (ACA). Initially, HHS released a set of 51 proposed measures on December 31, 2010 and accepted public comments for two months. HHS reportedly received about 100 comments, many of which pertained to the overwhelming volume of quality measures. The Agency for Healthcare Research and Quality (AHRQ), the Centers for Medicare & Medicaid Services (CMS), and other agencies within HHS were involved in pairing down the final core set to 26 quality measures.

ACA Demonstration to provide home care for Medicare patients

December 20, 2011

The Centers for Medicare & Medicaid Services (CMS) announced today a new Demonstration under the Affordable Care Act (ACA) that will enable up to 10,000 Medicare beneficiaries with chronic conditions to receive most of their necessary care at home. The new Independence at Home Demonstration, a provision of the ACA, significantly expands the scope of in-home care that Medicare patients are eligible to receive. If they choose to opt into the Demonstration, beneficiaries with have access to a wide range of primary care services. Participation is optional. The Demonstration will reward providers with an incentive payment if they offer high-quality care care and reduce Medicare expenditures. CMS will implement quality measures to ensure beneficiaries experience high quality care under the new Demonstration.

HHS announces new initiatives to improve care for duals

July 11, 2011

The Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health of Health and Human Services (HHS) has announced a new round of initiatives to help improve quality and cost of care for individuals who are eligible for both Medicare and Medicaid. CMS has issued three fact sheets, along with preliminary guidance in the form of a State Medicaid Director Letter (SMDL), further outlining these initiatives. They involve upcoming demonstrations on new financial models for improved care coordination, efforts to improve nursing home care quality, and information on a new technical assistance resource center that will help states better serve high-cost, high-need beneficiaries.

RWJF and Urban Institute paper addresses patient-centered care in the ACA

March 12, 2012

The Robert Wood Johnson Foundation (RWJF) and Urban Institute recently released a paper examining the increased emphasis on a patient-centered care system under the Affordable Care Act (ACA). According to the Institute of Medicine (IOM), patient-centeredness means "care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions." Through provisions requiring quality of care measurements, public reporting, and performance payments, the ACA reflects the movement toward patient-centered care. Although the ACA provisions are a significant milestone in the development of patient-centered health care delivery, rhetoric will need to be matched with funding for data collection, building consensus on measure use, and the integration, alignment, and harmonization of measures in different programs.

ACAP releases article on dual eligibles

January 12, 2012

Jane Hyatt Thorpe and Katherine Jett Hayes recently released an article funded by the Association for Communication Affiliated Plans (ACAP), "A New State Plan Option to Integrate Care and Financing for Persons Dually Eligible for Medicare and Medicaid," which reviews barriers to clinical and financial integration in services for dual eligibles prior to passage of the ACA, identifies models used by states to integrate care through contract and waiver authorities available to CMS prior to passage of the ACA, describes two new demonstrations proposed by CMS through the Medicare-Medicaid Coordination Office and Innovation Center, and introduces a state plan option as a new model for consideration by federal and state policymakers. This new model draws on experience from existing programs and waivers to provide a permanent state plan option for a fully integrated, capitated care model that could be made available to states prior to the completion of the demonstration process begun by the Medicare-Medicaid Coordination Office and Innovation Center.

AHIP proposal calls for Medicare/Medicaid integration for dually eligible beneficiaries

October 14, 2011

The current lack of coordination between Medicare and Medicaid creates barriers for dual eligibles to access care. Additionally, although they comprise only 15% of all Medicaid beneficiaries, dual eligibles account for nearly 40% of Medicaid expenditures. America's Health Insurance Plans (AHIP), a national trade association which represents much of the health insurance industry, recently released a proposal to address the serious fiscal and access challenges associated with dual eligibility. AHIP provides a menu of models for Medicare/Medicaid integration, which groups six models into three alternative approaches suited to States with varying readiness for integration. To learn more about dual eligibles, click here.

Urban Institute paper says duals should be Medicare's responsibility

October 5, 2011

"Refocusing Responsibility For Dual Eligibles: Why Medicare Should Take The Lead," a new paper authored by researchers at the Urban Institute and funded by the Robert Wood Johnson Foundation, explores why Medicare, as opposed to the States or Medicaid, should take responsibility for dual eligibles. The authors rationalize that acute care, where savings and quality improvement are most readily achievable, best falls under Medicare's umbrella. According to the paper, enhancing State responsibility for overall spending, on the other hand, would increase the risk of cost-shifting to Medicare, which could potentially undermine the quality of care for vulnerable beneficiaries.

Update: Release of Medicare Data for Performance Measurement

February 24, 2012

Health policy experts and lawmakers believe that measuring and publicly reporting information about the performance of physicians, hospitals, and other health care providers is critical to improving health care quality and controlling costs. Advancing health information access and transparency is a goal of the Patient Protection and Affordable Care Act (ACA) ^[1], which includes a number of provisions to incentivize quality measurement and reporting and to enable more informed consumer decision-making. Across the country, community organizations, such as the Alliances participating in the Robert Wood Johnson Foundation’s Aligning Forces for Quality initiative, have been demonstrating the power of using private payer and Medicaid medical claims data to measure and publicly report on provider performance. Their work could be further strengthened by access to Medicare claims data because it is the single largest pool of information about how health care is delivered in America. Combining Medicare data with data from other public and private payers such as Medicaid and employer sponsored plans, holds the potential to generate more complete and accurate provider performance measurement information, thereby further empowering consumer engagement and quality improvement.

Dual-eligible Medicare/Medicaid Beneficiaries

August 10, 2011

According to the Centers for Medicare and Medicaid Services (CMS), in 2008 there were an estimated 9.2 million individuals who were eligible for and enrolled in both the Medicare and Medicaid programs (commonly referred to as “dual eligibles”). Two-thirds of dual eligibles qualify because they are over age 65, while the other third qualify because of a disability. Dual-eligible beneficiaries typically have multiple chronic conditions that require a higher level of care and result in increased spending relative to other Medicare and Medicaid beneficiaries; however, their care is not usually coordinated. Policymakers have expressed concern that the lack of coordination between the two programs results in higher costs and poorer health outcomes than would be achieved if Medicare and Medicaid services were better integrated.