MacTaggartView Graph # 1 OVERVIEW Core Program Performance Indicators Quality Performance Measurement Quality Indicators Current Quality Measurement Efforts.

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Presentation transcript:

MacTaggartView 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

MacTaggartView Graph # 2 PROGRAM INDICATORS AND QUALITY PERFORMANCE MEASUREMENT Program Indicators 1. Baseline 2. Decrease in Uninsured Children 3. Expenditures Quality Performance Measurement

MacTaggartView Graph # 3 For Example: - Kids to be covered by CHIP as a % of kids eligible for CHIP CORE PERFORMANCE MEASURES

MacTaggartView Graph # 4 Financial Expenditures Counts of Children by Age Counts of Children by Service Delivery Network PROGRAM INDICATORS

MacTaggartView Graph # 5  Number of Children Served -Through CHIP -CHIP: Medicaid Expansion -Medical assistance program  Age -Under 1 -1 to 5 -6 to to to 20 DATA TRACKING

MacTaggartView Graph # 6 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.)

MacTaggartView Graph # 7  Service Delivery - Managed Care - PCCM - FFS  Countable Income Level DATA TRACKING (cont.)

MacTaggartView Graph # 8 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

MacTaggartView Graph # 9 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

MacTaggartView Graph # 10 Access Clinical Effectiveness Integration of Services: Coordination and Continuity Cultural Competence Comprehensiveness QUALITY

MacTaggartView Graph # 11 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

MacTaggartView Graph # 12 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

MacTaggartView Graph # 13 Data Sets Data Definition Performance Measurement Tools Information Systems ISSUES

MacTaggartView Graph # 14 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

MacTaggartView Graph # 15 What Kind of Assistance Do States Want? TECHNICAL ASSISTANCE