When I was the CHIP Director in New Hampshire, we thought that achieving a 95% rate of coverage for kids was the high bar. As a country, we are not only closing in on that goal, but leading states have raised the bar to 98% and beyond. And while we must continue to eliminate disparities and be ever vigilant about protecting the gains our country has made in covering children, increasingly child health advocates and stakeholders are looking to build on the foundation of coverage by improving access and the quality of care. So, where to start? To help orient child health policy and advocacy organizations, we have created a primer on health care quality measurement and improvement for children in Medicaid and CHIP.

The goal of the primer is to help stakeholders better understand the current state of quality measurement and improvement, and how they can effectively engage on this front. It covers a brief history of health care quality efforts, explains the basics of quality measurement and improvement, discusses the challenges of data collection and analysis; and describes how quality improvement initiatives work. Importantly, it examines the key roles that child health policy and advocacy organizations play in making sure that our public coverage programs for children deliver high quality health care in a way that advances health outcomes and strives for continuous improvement.

Key findings in the report:

• As the country’s largest and fastest growing insurer, Medicaid has significant leverage in driving health care quality improvements that can lead to systemic change.
• When quality efforts largely focus on bending the cost curve, children may be overlooked because they are generally healthy and account for the lowest per-capita spending on health care.
• Improving the quality of health care will help eliminate health disparities and further boost the broader, long-term impacts of public coverage on children as evidenced by studies showing that Medicaid leads to better health, higher educational achievement, and greater economic success later in life.
• Child health policy and advocacy organizations have a meaningful role to play to ensure that improving children’s health care is a public policy priority. 

Quality measurement and improvement is highly technical but child health stakeholders need not be “experts” in order to make a meaningful contribution. In fact, CMS guidance to states on stakeholder engagement emphasizes its importance: “Stakeholder engagement in designing and implementing each of these components is critical [in reference to these five key components: (1) goals, (2) interventions, (3) metrics, (4) targets, and (5) transparency and feedback]. From consumers, to providers, to patients, multi-stakeholder approaches to quality are not only necessary for viability but have historically been a key to the success of quality improvement initiatives. Stakeholder perspectives and values should be incorporated into this process from the initial conception of a quality improvement model, and should be reflected in the programmatic goals and measurement approaches.”

We know that Medicaid improves access to care for children and leads to longer-term impacts, including better health, higher educational achievement, and greater economic success later in life. But we also know there is always room for improvement. We hope you find the primer helpful as you take stock of your state’s efforts to measure and improve the quality of care for kids in Medicaid and CHIP in your state.

A special thanks to the Robert Wood Johnson Foundation for its support of our work to measure and improve the quality of health care coverage for children in Medicaid and CHIP.