When CHIP was reauthorized in 2009, it laid out a new agenda for measuring and improving health care quality for children enrolled in Medicaid and CHIP. CHIPRA called for the development of a Child Core Set of Health Care Quality Measures (which states voluntarily report) and launched a new Pediatric Quality Measures Program that, among other tasks, advances the development of new and emerging quality measures. Since that time, CMS has released annual quality reports, which describe states’ progress in reporting the Child Core Set and other efforts to measure and improve quality in Medicaid managed care.

Advising CMS’ quality activities is the Measure Applications Partnership (MAP), a public-private partnership convened by the National Quality Forum (NQF), a not-for-profit, nonpartisan, membership-based organization that works to catalyze improvements in health care. MAP is comprised of both voting and non-voting members that span consumers, businesses and purchasers, labor, health plans, providers, communities, states, and the federal government.

Recently the MAP released a draft report for public comment on recommendations to strengthen the Child Core Set of Healthcare Quality Measures. The report is worth a read for those engaged in advocacy on quality measurement and improvement, but I’ll share the highlights for those short on time.

CHIPRA requires that the Child Core Set be updated annually. For the past two years, MAP has been one of the resources that CMS has tapped to meet this statutory requirement. MAP applies specific (although not absolute) measure selection criteria and reviews state implementation experience in conducting an annual review of the core set, assessing gaps in measures, and recommending updates. MAP’s measure selection criteria dictate that the measures should:

• address the National Quality Strategy’s three aims (better care, healthier people, smarter spending)
• be responsive to specific program goals
• include an appropriate mix of measure types
• be NQF-endorsed® (unless no relevant endorsed measure is available to achieve a critical program objective)
• measure person- and family-centered care and services
• include considerations for healthcare disparities and cultural competency
• promote parsimony and alignment

So what is the MAP recommending for the Child Core Set? Although there have been several revisions to the core set since its introduction in 2011, MAP did not find significant implementation difficulties with the 2015 Child Core Set and recommends it continued use. A benefit of maintaining stability in the core measures is that states can focus on data accuracy and completeness, as well as quality improvement.

MAP did recommend phasing in up to six new measures, ranking them in priority order as noted below. Measures that are not yet NQF endorsed were recommended for inclusion once NQF endorsement is complete. The recommendations include:

Tied for 1^st and 2nd place:

• Measuring low birth weight infants born in hospitals not equipped to care for newborns weighing under 1,500g
• Use of multiple concurrent antipsychotics in children and adolescents (not yet NQF endorsed)

3^rd place:

• Effective postpartum contraception access (not yet NQF endorsed)

4^th place:

• Use of contraceptive methods by women aged 15-20 year (not yet NQF endorsed)

Tied for 5^th and 6^th place:

• Audiological evaluation no later than 3 months of age for newborns who did not pass hearing screening
• Pediatric inpatient readmission within 30 days (all-conditions, both acute care and children’s hospitals)

In the report, MAP notes that many important priorities for quality measurement and improvement do not yet have metrics to address them. These gaps are documented and will serve as a guide for future iterations of the Child Core Set.

The report touches on some of the challenges that states face in quality data collection and reporting. The top reason states cite for not reporting a core set measure is “data not available.” States face budget constraints, lack staff capacity, and find it difficult to access data that is not routinely collected. As savvy Say Ahhh! readers know, leadership and political will are necessary precursors to building capacity and making quality measurement and improvement a priority. And that is the key role child health advocates can play when it comes to this realm of health policy.

Children’s health policy experts and advocates don’t need to be proficient in the design and specification of quality measures, or in testing and spreading quality improvement strategies, in order to make a meaningful contribution to improving the quality of our children’s health insurance programs. Quality improvement is a key element of program integrity and advocacy is needed to assure that quality measurement and improvement activities are a priority for children enrolled in Medicaid and CHIP.