Recently, the National Quality Forum (NQF) released its annual report on opportunities to strengthen the child core set of quality measures in Medicaid and CHIP. The initial core set was released in 2010 and its underlying legislative mandate requires CMS to update the core set annually. NQF partners with CMS and a multi-stakeholder Medicaid workgroup to provide guidance on the child core set. This guidance includes recommendations for measures to be added to or removed from the core set, as well as identifying gaps in measures. It is important to note that the 2018 child core set has already been confirmed, so none of the recommended changes will be adopted until 2019 or later.
This year’s recommendations suggest phasing in the following measures and details of each are included in the report:
- Antibiotic Prophylaxis Among Children with Sickle Cell Anemia (NQF #3166)
- Pediatric All-Condition Readmission Measure (NQF #2393)
- Metabolic Monitoring for Children on Multiple Antipsychotics (NQF #2800)
- Depression Response at Twelve Months – Progress Towards Remission (NQF #1885)
- Transcranial Doppler Ultrasonography Screening Among Children with Sickle Cell Anemia (NQF #2797)
- Child Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCHAHPS) (NQF #2548)
Although the group discussed the potential removal of four measures, it chose to support continuation of the current measures to allow states more time to build resources and improve infrastructure to support reporting.
In this year’s annual review, the Medicaid workgroup focused on incorporating a broader population health perspective in assessing gap areas where quality measurement lacks fully developed metrics. I was pleased to see that measuring social determinants and adverse childhood experiences were specifically identified as gap areas. Also the need to measure duration of child health insurance coverage over 12 months sparked my interest as it is difficult to assess quality without continuous coverage.
For its final report, the workgroup agreed on two primary gap domains and 11 priority gap areas where new measure development is needed. Gap areas in the public health domain include behavioral health, social determinants of health, adverse childhood experiences, maternity care (including experience of care and breastfeeding), cost for behavioral health, duration of child health insurance coverage over 12 months, and care coordination. Under the behavioral health domain, the group identified screening abuse and neglect (part of primary care as well), substance abuse, mental health (including primary care integration), and care coordination/integration as gap areas.
Earlier this year, the CHIP 10-year funding extension earmarked $150 million dollars to the pediatric quality measures program. Hopefully, HHS will focus this funding on the development of pediatric measures to address these gaps.
Child core set reporting is voluntary; however, mandatory reporting will take effect in 2024. In 2016, the most recent year for which CMS has published state level data, it noted that 50 states reported at least one measure while two states reported all 23 measures in the 2016 core set; the median number reported was 18. State level data is released only if at least 25 states report the measure and these data can be downloaded from Medicaid.gov. CMS continues to work with states to increase the number of measures reported and to encourage the states to use the child core set measures to drive quality improvement. For more information on quality measurement and reporting, check out our primer for child health stakeholders.