Each year, a multi-stakeholder group is selected through a nomination process to review and make recommendations on the child and adult core sets of health care quality measures in Medicaid and CHIP. This year, I was pleased to participate as a member of the workgroup, which was facilitated by a great team at Mathematica. It’s not easy herding a group of stakeholders like this but Mathematica did a great job. And we had fun with a nifty clicker voting system that I hear is popular on college campuses.
A draft of the workgroup’s report “Recommendations for Improving the Core Sets of Health Care Quality Measures for Medicaid and CHIP: Summary of a Multi-Stakeholder Review of the 2020 Child and Adult Core Sets,” has been released for public comment. The report is available at: https://www.mathematica-mpr.com/features/MACCoreSetReview.
This year, the workgroup considered 56 measures, including 14 measures suggested for removal and 42 measures suggested for addition. The draft report details the process followed by the workgroup, the criteria for removing or adding measures, and which measures were considered. It also describes the measures that are recommended for addition or removal and why. Cross-cutting themes in measure discussions included feasibility, appropriateness, readiness and actionability.
Recommended for removal from the child core set include: Access to Primary Care Practitioners; Weight Assessment and Counseling/Body Mass Index Assessment; Pediatric Central Line—Associated Bloodstream Infections and Use of Multiple Concurrent Antipsychotics. Measures recommended for removal from the adult core set include: Body Mass Assessment; Comprehensive Diabetes Care: Hemoglobin A1c Testing; and Annual Monitoring for Patients on Persistent Medications. Before you say wait – those are important measures, be sure to read the report to understand why at least two-thirds of workgroup members voted in favor of removing these measures.
Measures recommended for addition to the child core set include: Appropriate Antibiotic Prophylaxis for Children with Sickle Cell Anemia and Metabolic Monitoring for Children and Adolescents on Antipsychotics. Recommendations for additions to the adult set include, Use of Pharmacotherapy for Opioid Use Disorder; and the National Core Indicators Adult Consumer Survey and National Core Indicators for Aging and Disabilities Adult Consumer Surveys.
The workgroup also discussed and identified gap areas to potentially be included in future core sets, including measures addressing adverse childhood experiences; child social and emotional development; trauma informed care; provider accountability; network adequacy, social determinants of health. The group also identified the need for stratification by race and ethnicity.
Public comments may be submitted via email to MACCoreSetReview@mathematica-mpr.com by 8 PM ET on Monday, August 5, 2019. Please include “2020 Core Set Review Public Comment” in the subject line. The Center for Medicaid and CHIP Services will use the public comments, together with the workgroup’s recommendations, to inform decisions for modifying the core sets for 2020.