mactaggartview graph # 1 overview core program performance indicators quality performance...
TRANSCRIPT
MacTaggart View Graph # 1
OVERVIEW
Core Program Performance Indicators
Quality Performance Measurement
Quality Indicators
Current Quality Measurement Efforts
Measurement Issues Facing States
Key Approaches to Quality Measurement
Technical Assistance for States
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PROGRAM INDICATORS AND QUALITY PERFORMANCE MEASUREMENT
Program Indicators
1. Baseline
2. Decrease in Uninsured Children
3. Expenditures
Quality Performance Measurement
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For Example:
- Kids to be covered by CHIP as a % of kids eligible for CHIP
CORE PERFORMANCE MEASURES
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Financial Expenditures
Counts of Children by Age
Counts of Children by Service Delivery Network
PROGRAM INDICATORS
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Number of Children Served
- Through CHIP
- CHIP: Medicaid Expansion
- Medical assistance program
Age
- Under 1
- 1 to 5
- 6 to 12
- 13 to 18
- 19 to 20
DATA TRACKING
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Unduplicated Number of Children Ever Enrolled in the Quarter
Unduplicated Number of New Enrollees in the Quarter
Unduplicated Number of Disenrollees in the Quarter
Number of Member Months of Enrollment in the Quarter
Average Number of Months of Enrollment (Line 4 Divided by Line 1)
Unduplicated Number of Children Ever Enrolled in the Year
DATA TRACKING (cont.)
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Service Delivery
- Managed Care
- PCCM
- FFS
Countable Income Level
DATA TRACKING (cont.)
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Performance Measurement Tools
RFP/Contract Specifications
Quality Improvement Oversight System Tool (QISMC)
Grievance/Complaint Guidance
Enrollment Parameters
Consumer Information Models/Guides
Data/Information System Guidance
Validation Tools
TOOLS
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Structure
- Are the right elements in place to be able to provide quality?
Process
- Are the right things done to the right people at the right time?
Outcome
- Is the result as good as it should have been, given the current knowledge?
MEASURING QUALITY
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Access
Clinical Effectiveness
Integration of Services: Coordination and Continuity
Cultural Competence
Comprehensiveness
QUALITY
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NCQA’s HEDIS
- 9 measures directly related to children and adolescents
CONQUEST Data Base
- 40 measures directly for children/adolescents
CAHPS
- Child health modules
QARI/QSMIC
- 9 clinical areas directly related to children and adolescents
CHILD RELATED QUALITY MEASUREMENT EFFORTS
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Standardized measures for public information and minimum performance levels (HEDIS, CAHPS)
Quality measures for improvement efforts need not be comparable between plans
QISMC Projects
HEDIS and CAHPS
RELATIONSHIP TO HEDIS AND CAHPS
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Data Sets
Data Definition
Performance Measurement Tools
Information Systems
ISSUES
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Special Needs Population
- Engagement of key stakeholders in design, implementation, and monitoring
- Enrollment and marketing
- Benefits and “medical necessity”
- Coordination of services
- Financial risk adjustment
- Databases
- Quality management
KEY APPROACHES
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What Kind of Assistance Do States Want?
TECHNICAL ASSISTANCE