We were thrilled to see release of the latest Child Core Set measures late last week. Say Ahhh! readers know we are closely following this state-reported data as a means to measure quality of care for children—especially since states will be required to report all Child Core Set measures starting in 2024, thanks to the most recent CHIP extension.
We see quality improvement in Medicaid/CHIP as an important strategy to align early childhood and health system priorities– the upcoming requirement for states to report all Child Core Set measures offers a new hook. One key early childhood measure is developmental screening for children under age three. The year 2016 was the first year in which enough states reported the measure for CMS to publish the data it collected. For 2017, a total of 27 states—up from 26 in 2016— reported the measure. Arizona and North Carolina started reporting on developmental screening, while Wyoming stopped.
Once again, reported developmental screening rates varied widely for 2017, from less than 4% in Alaska to 81% in Vermont, with a median of 40% (see map below from Chart Pack p. 33). Based on our analysis between 2016 and 2017, 20 of the 25 states reporting the measure two years in a row show a one-year increase in developmental screening rates for Medicaid and/or CHIP. Vermont, already performing relatively well, jumped from 75% to 81%! (See page 67 of the Chart Pack for some cautions re year-to-year trend data that also apply here regarding possible changes in data methods that may affect rates.)
Of course, measurement is an imperfect and evolving process. Medicaid administrative data, specifically billing data, can provide a helpful picture of which Medicaid services children receive. But like any measure, it has limitations. In this case, if a state does not have a specific reimbursement code dedicated to developmental screening, it would likely reflect an undercount. Not to mention that claims data will not reflect screenings provided in early childhood or other settings that may not be paid for by Medicaid (for more on this topic, see p. 5 in our piece on Medicaid and developmental screenings from earlier this year). On the other hand, the more we start to measure and seek to improve its effectiveness and utility, the more we can identify gaps and areas for improvement. (Now would be a good time for the 24 states that didn’t report on developmental screenings to get a head start before the next reporting round.)
So let’s not let the perfect be the enemy of the good. This is a helpful, if imperfect, start to state data reporting that could have a big impact on children’s health in the future. States are doing a better job reporting Medicaid/CHIP developmental screening rates and most of them appear to be getting more kids screened. That’s certainly a step in the right direction.
(Want to learn more on this topic? See our recent webinar on developmental screenings in Medicaid/CHIP and stay tuned for more!)