Now that CMS has released the fifth annual Quality of Health Care for Children in Medicaid and CHIP, let’s take a look at the highlights of the children’s report. First, some background: the 2009 CHIP Reauthorization Act launched a wide-ranging set of initiatives to advance pediatric health care quality measurement and improvement. At the top of that list is the Child Core Set of Health Care Quality Measures (called the Child Core Set) that states voluntarily report for children in Medicaid and CHIP. The law tasked CMS with improving the mechanisms for states to report data and publishing the quality report, among other quality-related activity.
The 2015 report shows continued progress in state reporting of the 2014 Child Core Set. Two states (GA and SC) reported all 22 measures for calendar year 2014, while eight states (AL, DE, FL, IN, IA, NY, TN, WV) reported 21 of the 22 measures. The median number of measures reported – 16 – remained the same as in 2013. Sadly, ten states (NV, VA, KS, ND, MN, WI, AZ, NH, NE, SD) report only less than half of the measures.
While state-level data is not released unless at least 25 states report the measure, this threshold was met on 19 of 22 measures (up from 16 in the 2014 report). The report does a good job of summarizing the results, but if you want to look at state level data and performance, you have to dig deeper. The results are published in five domain-specific reports: 1) Primary care access and preventive care; 2) Perinatal health; 3) Care of acute and chronic conditions; 4) Behavioral health care; 5) Dental and oral health services. These reports, which must be downloaded as a zip file, include maps ranking state performance based on quartiles. But to see the actual data, you have to download these tables from another zip file and cross reference to the glossary of acronyms in the main report.
Disappointingly, only 20 states reported the key developmental screening measure, so once again, we do not have access to state level data. Developmental screenings are critical in detecting development delays in the first few years of life so a child can receive support services and better prepared to enter school ready to learn. Early intervention services for these children can reduce at-risk children’s participation in and state spending on special education. But until we consistently measure and report developmental screenings, it is difficult to know how Medicaid and CHIP are performing on this key measure. And without a baseline and trend data over time, we can’t evaluate projects aimed at improving this measure of quality health care.
The report also summarizes the External Quality Review (EQR) Technical Reports submitted to CMS by states that contract with managed care organizations or prepaid inpatient hospital plans. These reports provide insight into the strategies and efforts that states use to improve the quality of care for managed care enrollees. Overall, the level of detail presented in these reports has been more comprehensive; however, the structure and content varies considerably due to differences in state interpretation of regulatory language. We expect to see improvements on this front when the modernized Medicaid managed regulations are finalized sometime this spring. There is also additional detail on the EQR technical reports in yet another zip file.
Starting to sound like a lot of reading, huh? In the coming weeks, we’ll take a deeper look at the findings of the various reports. We also expect CMS plans to release state fact sheets, which should be helpful, but won’t provide the level of detail that can be found in the various reports. Stakeholders and advocates who want to get a better sense of how their state ranks will still need to spend some time going through the various reports.