NCQA Maps Quality Measurement Strategy for People With Both Medicare and Medicaid

A white paper released today by the National Committee for Quality Assurance (NCQA)”Integrated Care for People With Medicare and Medicaid: A Roadmap for Quality outlines how to measure efforts to integrate care for people enrolled in both public insurance programs simultaneously. The report was produced with support from The SCAN Foundation.
œCare for people with Medicare and Medicaid—including seniors and people with disabilities and mental illnessis a n important frontier in quality measurement,said NCQA President Margaret E. O’Kane. People enrolled in both programs tend to have multiple chronic conditions and too often receive spotty, poorly coordinated care. This report will help build measurement strategies that foster integrated, high-quality care for this vulnerable population.
CMS, state Medicaid departments and health plans are engaged in the difficult work of integrating care across the two very different financing systems, making NCQA's white paper timely and relevant.
By helping federal, state and private insurers design and measure the effectiveness of integrated care programs, NCQA's recommendations can support integration and improve the quality of care that people with Medicare and Medicaid receive.
The white paper articulates a goal of a national measurement system that evaluates health outcomes. As a bridge or transitional strategy for creating that environment, an implementation plan presented by the paper starts with measuring structures and processes that are known to improve quality and that are necessary to capture data needed for outcome measurement.
Effective integration of care for people in Medicare and Medicaid is an important factor in the financial soundness of both programs. Dual-eligible enrollees account for a disproportionate share of the program spending ”39 percent of costs from just 15 percent of enrollees, in the case of Medicaid.
To advance a measurement agenda that improves care of people with Medicare-Medicaid eligibility, NCQA seeks to collaborate with a few leading integrated care plans over the next three years to develop meaningful, person-centered measures. Interested organizations should contact
NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. NCQA is committed to providing health care quality information for consumers, purchasers, health care providers and researchers.