The phrase “You can’t improve what you can’t measure” makes sense.
Consider that theme the driving force behind the Centers for Medicare & Medicaid Services (CMS) effort to develop quality measures for programs that serve dual-eligible and Medicaid-only participants.
LTSS: The Next Phase
In 2017, Medicaid managed care plans delivered long-term services and supports (LTSS) to 1.8 million people. Over the last several decades, much of LTSS care moved from institutional facilities to home and community-based services (HCBS). That’s progress!
Still, that shift—and the growth in the number of people using LTSS—happened with very few measures of quality or empirical data to guide us. That’s why NCQA and our partner,
Mathematica Policy Research, under contract with CMS, developed and tested eight new measures. NCQA adopted four of the eight measures into HEDIS®.
The measures evaluate the quality of assessment, care planning and care coordination:
- LTSS Comprehensive Assessment and Update.
- LTSS Comprehensive Care Plan and Update.
- LTSS Shared Care Plan with Primary Care Provider.
- LTSS Reassessment/Care Plan Update After Inpatient Discharge.
And the measures target important issues:
- Previous national measures are clinically oriented and leave gaps in addressing what is often more important to people who need LTSS (HEDIS Medicare Advantage measures and Hospitalization for Ambulatory Care Sensitive Conditions [HCBS users]).
- State-specific measures are imprecise or were not thoroughly tested, and do not allow cross-state comparison.
CMS published the measures last year. NCQA now begins the next phase of measure development: Get feedback from users with hands-on experience.
LTSS: The New Team
With support from The SCAN Foundation, NCQA recruited health plans and community-based organizations that provide or arrange for LTSS. NCQA offers six months of technical support and guidance on reporting our new measures, as well as opportunities for shared learning.
All organizations will submit data on the measures in June. Regular calls will help us understand the measures’ readiness for public reporting based on the participants’ systems strengths and limitations.
We look forward to learning from our participants! These organizations will help shape the development of reporting and audit guidelines—crucial to creating viable, valuable measures.
 HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).