As I noted in a blog last year, CMS reviews the Child Core Set of Health Care Quality Measures annually. 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.
Earlier this month, MAP released a draft report on recommendations to strengthen the 2017 Child Core Set of Healthcare Quality Measures. The report is worth a read for those engaged in advocacy on quality measurement and improvement. Moreover, stakeholders may submit public comments on these recommendations until 6pm ET on August 5, 2016.
Before I summarize the report’s recommendations, I wanted to signal to child health advocates who have been working on healthy early childhood development that the Development Screening Measure in the First Three Years of Life remains among the measures recommended for continued inclusion in the child core set. Advocates have been concerned because only 20 states have reported this measure for the past two years, coming up short of the minimum threshold of 25 states required for CMS to publish state-level data and rank state performance. And one of the factors that MAP considers in removing a measure is “multiple years of very few states reporting a measure, indicating that it is not feasible or a priority topic for improvement.” Child health stakeholders know how important developmental screenings are to ensuring a healthy start and success in school and life. But I digress.
For the 2017 child core set, MAP did recommend the removal of two core set measures.
- Frequency of Ongoing Prenatal Care – This measure reports the percentage of recommended prenatal visits received by pregnant women in Medicaid and/or CHIP in 5 buckets (<21%, 21–40%, 41-60%, 61 – 80%, >81%). MAP cited this measure as an ineffective tool because it “does not does not specifically assess the capacity of healthcare providers, health plans, or state Medicaid programs to provide access to prenatal care. Rather, [MAP hypothesizes that] the measure more likely reflects challenges women face when trying to obtain prenatal care such as taking time off work, transportation, and childcare. Therefore, the information collected is less actionable by state Medicaid programs. Most importantly, there is insufficient evidence to support the relationship between visit frequency and improved outcomes for mothers and babies.”
- Child and Adolescents’ Access to Primary Care Practitioners – This measure assesses the percent of children with at least one primary care visit annually for children through age 6 and every two years for ages 7 and older. Reporting on this measure is very high across states and programs – with the median among reporting states ranging from 89% to 96%. The MAP report suggests that the high rates and minimal variation between programs indicates there is little room for improvement. In turn, eliminating ‘lower value’ measures provides capacity to add ‘higher value’ metrics while maintaining parsimony – a stated goal of CMS in maintaining the child core set.
MAP also recommended that five new measures be phased in over time. These are in addition to the six measures that MAP recommended last year be phased in.
|Rank||NQF Measure Number and Name|
|1||NQF #2797: Transcranial Doppler Ultrasonography Screening Among Children with Sickle Cell Anemia Level of CareNQF #0480: PC-05 Exclusive Breast Milk Feeding (Conditional Support*)NQF #2830: PC-05 Exclusive Breast Milk Feeding (e-measure) (Conditional Support*)|
|2||NQF #2801: Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics|
|3||NQF #2902: Contraceptive Care – Postpartum (Conditional Support*)|
|* MAP conditionally supports measures that are pending NQF endorsement, undergoing a change by the measure steward, or have not received confirmation of feasibility from CMS.|
Similar to the previous version, the MAP report discusses strategic issues including gaps in pediatric quality measurement and some of the challenges that states face in quality data collection and reporting. It also notes the importance of quality metrics and performance measurement in advancing value-based purchasing. (See a related blog and report on measuring value by the United Hospital Fund’s Suzanne Brundage.)
The report briefly discusses mandatory vs. voluntary reporting of the child core set, a topic that was debated by MAP members. The Association of Affiliated Community Plans supports mandatory reporting of the child core set. The federal legislation that would require states to report has also been endorsed by another non-profit quality improvement organization – the National Committee for Quality Assurance (NCQA). I am in the camp of mandatory reporting for a number of reasons including the fact that because children are generally healthy and inexpensive to cover, they may not be the highest priority for states in their quality efforts. But I also think CMS should provide incentives to the states to measure and improve quality in the same way states should incentivize plans and providers to measure and improve health care quality for children.
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. ICYMI, child health stakeholders who want to learn more about quality measurement and improvement should check out CCF’s quality primer. In the coming weeks, we’ll also be releasing snapshots of selected state performance on the child core set similar to this Florida report.