Committee proposes quality measures for Medicaid, children's insurance

Through an intense process, a subcommittee advising the federal government has selected 24 areas by which to measure healthcare quality for children covered by Medicaid and the Children's Health Insurance Program (CHIP). Now the Department of Health and Human Services is asking for comments on this initial, core set of measures, which is for voluntary use by the state programs, health insurance issuers, and managed care entities that contract with Medicaid and CHIP and providers of items and services under these programs.

Although the measures are voluntary now, the hope is that most states will eventually use them, said Xavier Sevilla, MD, chair of the American Academy of Pediatrics (AAP) Steering Committee on Quality Improvement and Management. The idea, he said, is to select a key set of measures agreed on nationally. Sevilla, who served on the selection subcommittee, said that it would be a good idea to take a look now at how your practice is doing with these measures because in the future, the measures may be used to evaluate pediatric practices.

A subcommittee of the Agency for Healthcare Research and Quality (AHRQ) advisory council selected the measures, which were mandated by last year's CHIPreauthorization legislation. That panel included pediatricians, provider groups, experts in quality measurement, state Medicaid officials, and other stakeholders.

The measures include, for example, the extent to which children reaching their second birthday have had recommended immunizations; the number of children 2 to 18 years old who have had an outpatient visit with a primary care provider or ob/gyn during the measurement year who had a recorded body mass index assessment; the extent to which newborn children through 36 months old are screened for social and emotional development with a standardized, documented tool or set of tools; and the extent to which children get well-child visits at various age levels.

The legislation called for a selection of measures currently in use and, for example, 14 of them are from the Healthcare Effectiveness Data and Information Set (HEDIS) measures reported by Medicaid managed care plans.

The current set serves as a first step. The background document says that there are topics "for which currently available, valid and feasible measures could not be identified." These include measures of the medical home, "more valid measures of availability of services," and "a core measure of duration of enrollment and coverage for use in quality reporting." The legislation calls for an enhanced set by January 1, 2013.

The question of when the measures might come into use is still to be answered, said Sevilla. States vary a great deal in their status in using measures, he noted, and much will depend on states' budgetary status and on what happens with healthcare reform.

Rita Mangione-Smith, MD, MPH, who cochaired the subcommittee selecting the measures, also led the 2007 New England Journal of Medicine study of 1,500 children's records that showed they received about 46.5% of indicated care. The background note stated, "Little is known about the magnitude of deficits in the quality" of children's care.

Comments on the proposed measures are due March 1. Information is in the December 29, 2009, Federal Register. The AAP is also asking pediatricians to provide input on the quality measures so that the association can formulate its comments to AHRQ before March 1. Comments should be directed to jspeller@aap.org
or drsevilla@wholechildpediatrics.com.

Background documents are at http://www.ahrq.gov/chip/chipraact.htm.