We all want good, quality health care for ourselves and our families. No real debate there. But how many of us really know—fully understand what we’re getting in a health plan? For quite some time now, the Centers for Medicare & Medicaid Services (CMS) have pushed for greater transparency and accountability for health plans. Now, it’s putting its money where its mouth is.
CMS now posts a Medicaid and Children’s Health Insurance Program (CHIP) Scorecard. It includes state Medicaid and CHIP quality metrics along with federally reported measures and puts them in a consumer-friendly scorecard format.
“Despite providing health coverage to more than 75 million Americans at a taxpayer cost of more than $558 billion a year, we have lacked transparency in the performance and outcomes of this critical program.” said CMS Administrator Seema Verma in a statement. “The Scorecard will be used to track and display progress being made throughout and across the Medicaid and CHIP programs, so others can learn from the successes of high performing states. By using meaningful data and fostering transparency, we will see the development of best practices that lead to positive health outcomes for our most vulnerable populations.”
The metrics included in the first Scorecard reflect important health issues such as well child visits, mental health conditions, children’s preventive dental services and other chronic health conditions.
At NCQA, measurement and transparency are staples in our quality cupboard. So NCQA is particularly proud that some of the scorecard’s core measures and metrics utilize many of our own HEDIS measures in the child and adult core sets.
CMS promises to continue to emphasize and elevate quality measurement and outcome metrics. Makes sense, given its important role in covering over 35 million children across the country, paying for approximately 50% of the country’s births, and its role as the single greatest payer for long-term care services for the elderly and people with disabilities.
The Scorecard will be updated year by year with new metrics. And all states will be joining the club. Congress recently required all states to report the Medicaid Child Core Set measures starting in 2024, which will provide for more robust and accurate results.
Congress may also require all states to report the Medicaid Adult Core Set behavioral measures, which would add significant value to the Scorecard.
To Improve health care through measurement, transparency and accountability. That’s the NCQA vision. So, kudos to CMS. It is clearly taking on all three, especially measurement and transparency. Accountability is covered in the sense that consumers (some) can choose a plan based upon this scorecard. BTW, our own health plan ratings can help on that front.
But Is there still room to boost accountability? What do you think?
Alec is a Communication Specialists responsible for Social Media and Internal Communications at NCQA. He is Passionate about Journalism, Media Production, and helping others. He has a background in Public Policy and Administration.