Medicaid Quality Measuresfor Persons with Disabilities

Peg Mastal, PhD, RN Susan Palsbo, PhD Delmarva Foundation George Mason University Principal Co-Investigator Principal Investigator

The work on this project is funded bythe National Institute on Disability and Rehabilitation Research Office

of Special Education and Rehabilitation ServicesU. S. Department of Education

Delmarva Foundation

Scope of the Project

• 5 Year Research Grant from the National Institute on 5 Year Research Grant from the National Institute on Disability and Rehabilitation Research (NIDRR), U.S Disability and Rehabilitation Research (NIDRR), U.S Department of EducationDepartment of Education

• Project is in the 5th and last year of the scope of workProject is in the 5th and last year of the scope of work

• Ultimate Goal: Quality reporting system for programs Ultimate Goal: Quality reporting system for programs serving Medicaid or dual-eligible beneficiaries with serving Medicaid or dual-eligible beneficiaries with disabilitiesdisabilities

Delmarva Foundation

Criteria: Quality Measures Selection

General Criteria

• Relevant to multiple stakeholders

• Scientifically strong (derive from comparable data sources and there is published information on the impact of risk adjustment)

• Feasible – data collection can be precise, easily collected, and within reasonable costs

• Point direction/s for continuous quality improvement

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Strategic Approach: Model Existing Types of Quality Measures

Consumer Assessment of Healthcare Providers and Systems (CAHPS)

• Developed by the Agency for Health Research and Quality (AHRQ)

• “Gold standard” for assessing quality of care and services in managed care programs from the member perspective

• Multiple versions (adults, children, children with special needs, Medicaid, etc.)

• NCQA-accredited health plans must conduct CAHPS annually

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Strategic Approach: Model Existing Types of Quality Measures

Healthcare Effectiveness Data Information Set (HEDIS)

• Set of database-retrievable quality measures that are developed, maintained by and reported to the National Committee for Quality Assurance (NCQA)

• “Gold standard” for assessing and reporting quality care and services and some outcomes in managed care programs.

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Grant Activities: Identifying Relevant Database Retrievable Quality Measures

Measures Advisory Panel (MAP) – 19 experts

• Membership: Consumers, Executives and Medical Directors from Medicaid HMOs and Special Needs Plans, psychiatrist, physiatrist, scientist, MR/DD, MAA rep.

• Identified 42 HEDIS-like quality measures important to monitor and report in programs serving persons with disabilities

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Types of Measures Selected by the MAP

HEDIS Measures

• Member demographics

• Types of outpatient encounters, hospitalizations

• Screening (chlamydia, breast cancer, colorectal, cervical)

• Disease management (asthma, diabetes)

• Mental illness management

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Types of Measures Selected by the MAP

Non-HEDIS Measures Specific to Disabled Populations

• Access to care coordination

• Timeliness: Admission interview and Individual Service Plan

• Institutional vs. community living arrangement

• Timely access to durable medical equipment (DME)

• Incidence of pressure ulcers, urinary tract infections, bowel disorders, spasticity

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Important Quality Measures: Retrievable Only by Other Methods

Quality of Benefits and Services (Adequacy of DME, medical supplies, OT/PT/Speech therapy, adequacy of transportation)

Management of Function and Physical Status (changes in functional status, medication, pain and weight)

Self-determination, Community Integration, Health and Safety (Choice of services, daily routine, residence, participate in life of community, free from abuse/neglect, feel secure in their residence)

Satisfaction levels (Consumers, providers, staff)

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Scope of Work: Fourth and Fifth Years

Determine the challenges and solutions for collecting and reporting information on the quality measures identified by the Measurement Advisory Panel (MAP)

DFMC Project Team working with 2 managed care programs

• Inland Empire Health Plan (MediCal plan, 250, 000+ members, NCQA accredited, experienced with HEDIS)

• Community Living Alliance, Madison WI (500 member plan, no experience as yet reporting HEDIS or HEDIS-like measures)

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Challenges: Community Living Alliance

• Studied HEDIS methodology

• Completed NCQA’s Baseline Assessment Tool (BAT)

• Brought claims data base into internal operations

• Are fairly certain they can report on all the MAP measures

• Will run the quality measures against their population in October-November time frame

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Challenges:Inland Empire Health Plan

Able to report on all the HEDIS measures

Not able to report on the non-HEDIS-like measures having to do with type of living arrangements

• Would only know if the member was in a hospital or nursing home, no knowledge of types of community residential living arrangements

• Do not collect data on the type of residence only the address

• Would require a plan-wide survey to determine type of residence (not cost-effective)

• Medicaid beneficiaries change addresses frequently

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Project Goal: Disseminate Quality Reporting System for Persons with Disabilities

Dual System – quality measurement and reporting in terms of:

• Consumer-reported measures

Assessment of Health Plans and Providers by People with Activity Limitations (AHPPPAL)

Developed by Dr. Sue Palsbo and others in a CAHPS-like model

Currently in the field being pilot -tested

• Provider-reported measures – quality measures specific to Disability Care Coordination Organizations (DCCOs) retrievable from databases

Manual of technical specifications for quality measures to be developed that are not specified in HEDIS