Monday Morning Medicaid Must Reads: October 29th, 2018

Helping you consider differing viewpoints. Before it’s illegal. 


Article 1:  

Report Asks About Quality Assurance in Medicaid Managed Care for Children, AJMC, Allison Inserro, 2/27/2018

Clay’s summary: Studies like this are strong support for the national Medicaid Quality Rating System (still to be implemented under the Mega Reg as of the time of writing)

Key Passage from the Article

A new report questions what metrics policy makers are using to evaluate whether or not children enrolled in Medicaid managed care organizations (MCOs) are receiving quality care, given the public investment these programs receive.

The report, from the nonpartisan Georgetown University Center for Children and Families (CCF), said that state Medicaid agencies and CMS do not use 1 common measurement for measuring quality of care.

Data and transparency about the quality of care for children are scant, the report said. There is no publicly accessible national database with information on how well individual MCOs are serving enrolled children.

For instance, there is no national database regarding the performance of individual MCOs with respect to Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services, which are a guaranteed benefit providing care to children with special needs.


Read it here 

Article 2:   

How HEDIS, CMS Star Ratings, CQMs Impact Healthcare Payers, HealthPayer Intelligence, Thomas Beaton, 12/21/2017

Clay’s summary: Good overview for those just beginning to learn about quality rating systems in the space.

Key Passage from the Article

Quality performance metrics such as HEDIS, CMS Star Ratings, and standardized core quality measures (CQMs) can give consumers an objective indication of healthcare payer quality.

Standardized quality measures aggregate how well a payer has performed based on the regularity of services performed, improvements in patient health, and consumer satisfaction.  

Commercial, Medicaid, and Medicare payers can leverage quality metrics in order to position and market their health plans as ideal insurance options for beneficiaries.

HEDIS, CMS ratings, and CQMs measure similar healthcare services and consumer-facing operations, but some quality datasets are more specialized, including metrics such as consumer satisfaction rates or chronic disease screening activities.


Read it here 




Article 3:   

CMS Scorecard for Medicaid, CHIP Measures Draws Scrutiny From State Directors, AJMC, Allison Inserro

Clay’s summary: So what’s your alternative? That the available data doesn’t support a meaningful dashboard is sort of the point, class…

Key Passage from the Article

CMS Monday released a scorecard that reports quality metrics voluntarily reported by states for Medicaid and the Children’s Health Insurance Program (CHIP), as well as federally reported measures, but the association that represents state Medicaid directors expressed some concerns with the scorecard’s data and what sorts of conclusions may be drawn from them, given the huge variability of state programs, essentially giving it a score of “needs improvement.”

CMS said that it is the “first time” it is publishing state and federal administrative performance metrics; the first 3 areas to be included are state health system performance, state administrative accountability, and federal administrative accountability. Health metrics include things like well-child visits, mental health conditions, children’s preventive dental services, and other chronic health conditions.


Read it here