Two years from now, millions of previously uninsured Americans will gain health coverage through the Medicaid program. With that in mind, section 2701 of the Affordable Care Act instructs officials in the Health and Human Services Department to design a voluntary quality measurement program focused on the care of new adults coming into the program. On Jan. 4, HHS published the initial core set of health care quality measures for Medicaid-eligible adults. The initial set includes 26 quality indicators that cover adult health, maternal/reproductive health, complex health care needs, and mental health and substance use. Measures were selected based on recommendations from the Agency for Healthcare Research and Quality, which convened a committee of state Medicaid representatives and health care quality experts to pare down a list of about 1,000 possible measures.
Matt Salo, executive director of the National Association of Medicaid Directors, shared his thoughts on how HHS did in assembling the list of core measures and how the quality program could affect the success of the Medicaid expansion.
Question: Participation in the program is voluntary. Does that make it less effective?
Mr. Salo: I would argue that it’s voluntary largely for political reasons. When you’re trying to push adoption of any kind of change, whether that’s changing state Medicaid programs or the behavior of physicians, making that change voluntary is a lot more politically palatable. I don’t think it makes it less effective. One of the things that we’ve learned is that quality measures are constantly evolving. The concept of measuring quality is by no means a new one; we’ve been doing this for decades. But what we measure, who we measure it on, and how we measure it is constantly changing. As a result, it’s actually very difficult for anyone to say, ‘yes, we know what the absolute answer is and we’re going to carve it into stone and everyone has to do it now.’ The voluntary nature of this is kind of a testament to that. You will see people adopting it and maybe tweaking it slightly, but they will get there.
Matt Salo
Question: Will this program help states to prepare for the 2014 Medicaid expansion?
Mr. Salo: Yes, in part. This is a very small slice of what states are going to need to do to prepare for 2014. But it is relevant because the bulk of people who will be coming into the Medicaid program in 2014 are going to be adults, which is in contrast to the bulk of people who are on Medicaid today: pregnant women and children.
Question: How do Medicaid programs currently evaluate quality of care?
Mr. Salo: Every state measures quality today; it’s just that they do it in different ways. They measure different things. They measure different populations. They measure them in different time periods and in different quantities. This program helps because it starts to give quality measurement a little bit more structure. As HHS was going about putting these measures together, they looked at thousands of different quality measures from numerous different sources and were able to sift through to find the ones that really make a difference and are accurate and effective and narrow that down to a fairly small number. By doing that, it does give states something of a road map to try to narrow down the diversity of approaches they are taking and start to provide more commonality across states and across programs and across providers.
Question: Would you add or delete anything from the core list of measures?
Mr. Salo: At this point, I wouldn’t change anything from that list. I think it’s a really solid first effort. Once put into practice, we may start to see that there’s something that was missed or a measure that isn’t really useful. But I think at this stage of the game they’ve done a really good job.
Question: Physicians are being asked to measure their performance by many payers already. Will this create an additional burden for them?
Mr. Salo: Medicaid directors are frequently inundated with new requirements from Congress or HHS, so this is something that we grapple with too. We are very sensitive to the potential for overburdening physicians on this. My sense, though, is that this is actually going to go in the opposite direction. There really aren’t, or at least there shouldn’t be, any physicians out there who aren’t participating in some kind of quality measurement. This effort should help focus and streamline the future of quality reporting for physicians. I see this as potentially reducing the burden, not increasing it. It’s going to provide some really useful tools that the states will use, that insurance plans will use, but that physicians can use too. Obviously physicians care very deeply about how they are performing compared to the practice down the street or across the state. This is going to start creating a lot more apples-to-apples comparisons that physicians are going to be able to use to find out more. I think that’s a good thing no matter how you slice it.