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What's New in Quality summarizes recent activities, publications, and findings that contribute to the advancement of Medicaid quality. The following developments are discussed in greater detail below: CMS Conducts Oral Health Quality Teleconference AHRQ Selects Recipients of Clinical Decision Support Grants CMS Issues First Quality Assessment Report CMS Joins Surgeon General in Promoting Childhood Overweight and Obesity Prevention Initiative Materials for Fall Quality Conference, November 1, 2007 HHS Inspector General Completes National Review of States' Use of EQRO Reports to Improve Care for Medicaid Beneficiaries ------------------------------------------------------------------------------------------------------------------------- Medicaid Has Working Relationships with Many Recently Selected Charter Value Exchanges
On February 1, 2008 Department of Health and Human Services (HHS) Secretary Mike Leavitt recognized 14 communities as the country's first Chartered Value Exchanges (CVE). Conveying this special designation represents one of a number of initiatives undertaken by HHS through its Value Driven Health Care initiative. (More information about VDHC is available via the link at the bottom of this page.) These partnerships of providers, employers, insurers, consumers, and pubic payers (including State Medicaid and other health agencies) were recognized for their strong commitment to improving quality and value in health care and for their efforts to implement innovative, collaborative approaches to transform health care at the local level. This focus on the community underscores the importance the Department attaches to advancing quality through solutions tailored to different local characteristics and circumstances. The communities selected are located in 12 different States: Louisiana, Maine, Massachusetts, Michigan, Minnesota, New York, Oregon, Pennsylvania, Tennessee, Utah, Washington, and Wisconsin. As Chartered Value Exchanges, these communities will have access to certain Medicare data on the quality of care physicians provide to patients. Combined with similar private-sector data, this information can be used to produce a comprehensive consumer guide on physician performance. In addition, CVE communities are participating in a nationwide Learning Network sponsored by HHS' Agency for Healthcare Research and Quality to facilitate peer-to-peer learning experiences through meetings and on-line resources.
State Medicaid programs and health plans have working relationships with at least 10 CVEs. This relationship can take a variety of forms – sometimes multiple forms in the same State. The State Medicaid agency may be formally represented as a purchaser stakeholder, as in Louisiana, Michigan, Minnesota, Oregon, and Utah. In Massachusetts, Michigan, Minnesota, and New York, health plans participating in State Medicaid programs are formal stakeholders in Exchanges and learning networks. Medicaid may be represented through the participation of other State government representatives in a CVE or CVE learning network, as in Louisiana, New York, and Washington. In Maine and Massachusetts, the State Medicaid program has an indirect relationship with a CVE by serving on the board of a stakeholder. (Specific information describing the involvement of Medicaid in various CVEs is available via the link at the bottom of this page.)
CMS Conducts Oral Health Quality Teleconference On April 3, 2008 CMS' Division of Quality, Evaluation, and Health Outcomes convened a teleconference to provide information on current Federal and State efforts to improve the access to high quality pediatric oral health services under the Medicaid and SCHIP programs. More than 500 individuals, representing State Medicaid agencies, foundations, professional associations, health care providers, academic institutions, consultants, and other Federal agencies, were estimated to have participated in the call. CMS Chief Dental Officer Conan Davis, DMD, MPH indicated that the Office of the Surgeon General Department of Health and Human Services reported in 2000 that tooth decay and untreated caries were more prevalent in low-income populations. According to Dr. Davis, the U.S. General Accountability Office has also noted disparities in access by these populations to oral health services. Dr. Davis noted that many State Medicaid dental programs, including those featured on this teleconference, had devised innovative responses to such concerns. CMS Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Program Coordinator Cindy Ruff reviewed statutory requirements for State reporting of dental services on the CMS-416, the annual EPSDT reporting form. Ms. Ruff also indicated that CMS staff expected to conclude a series of oral health program reviews of State Medicaid programs in the Spring of 2008, with release of a national report summarizing the results of these reviews anticipated by December 2008. Several State Medicaid representatives described their oral health initiatives. North Carolina Dental Director Mark W. Casey, DDS, MPH discussed "Into the Mouth of Babes", a State Medicaid effort to deliver preventive oral health services, including topical fluoride varnish, to pre-school Medicaid recipients at EPSDT/Health Check well child visits. Tennessee Medicaid Dental Director Dr. Jim Gillcrist, DDS, MPH indicated that using a single dental benefit manager to provide oral health services to Medicaid beneficiaries as a carveout to the State's TennCare section 1115 demonstration program has lessened the administrative burden on dental providers, enhanced reimbursement rates for dental services, and thereby increased utilization. Michigan Medicaid Policy Specialist Christine Farrell, MPA, RDH, BSDH described the State's Health Kids Dental program, which provides dental services on a fee-for-service basis to Medicaid-eligible children in 37 counties. Program data demonstrate improvements in utilization rates and number of children treated per participating dentist since 2001. Robert Isman, DDS, MPH discussed the efforts of California's State Children's Health Insurance Program Dental Quality Advisory Committee to identify performance measures of access to, and utilization of, dental services. To obtain copies of the handouts used in this teleconference, submit your request to the Medicaid Quality Mailbox - MedicaidQuality@cms.hhs.gov.
AHRQ Selects Recipients of Clinical Decision Support Grants On March 13, 2008 the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services, announced total awards of $5 million in contracts to make clinical decision support tools related to preventive health care and treatment of patients with multiple chronic illnesses more readily available to health professionals. As recipients of these contract awards, the Brigham and Women's Hospital in Boston and Yale University School of Medicine in New Haven, Connecticut will incorporate clinical decision support into popular health information technology (HIT) products, share lessons learned with HIT vendors, and evaluate clinicians' use of clinical decision support.
"These projects build on AHRQ's investment in health IT and the lessons that we have already learned from our grantees and contractors," said AHRQ Director Carolyn M. Clancy, M.D. "We hope that important lessons from this body of work will further enhance the nation's efforts to make evidence-based clinical knowledge more readily available to health care providers."
Researchers at the selected institutions will seek to define effective clinical decision support tools and identify preferred methods and processes for incorporating these tools into electronic medical records and in busy practice settings. The projects will implement clinical decision support tools in products certified by the Certification Commission for Healthcare Information Technology and will apply guidelines set by the American National Standards Institute's Healthcare Information Technology Standards Panel. The researchers will also assess clinical decision support services in terms of effects on patient satisfaction, measures of efficiency, cost, risk, and replicability. For more information on AHRQ's health information technology program, visit the link below.
CMS Issues First Quality Assessment Report On January 8, 2008 CMS sent the first Quality Assessment Report to the North Carolina Department of Health and Human Services, the State's single State Medicaid agency.
Issuing such reports supports States in their efforts to enhance the ability of Medicaid beneficiaries and State Children's Health Insurance Program (SCHIP) enrollees to obtain the highest quality healthcare services. It also helps the Centers for Medicare & Medicaid Services demonstrate the effectiveness of the Medicaid and SCHIP programs. Under the terms of a long-term Government Performance and Results Act (GPRA)/ Program Assessment Rating Tool (PART) subgoal, CMS is required to "increase the number of States that have the ability to assess improvements in access and quality of health care through implementation of the Medicaid quality strategy". To achieve this subgoal, CMS is providing individual States with Quality Assessment Reports (QAR), comprehensive information about the status of access and quality and activities already underway to improve them under both managed care and fee-for-service delivery systems. The process of developing and issuing QARs has been shared with the National Association of State Medicaid Directors. Each Report draws on a broad array of sources and a draft is vetted through the appropriate CMS regional office. Each QAR includes information describing the State's quality initiatives; data on access and quality for the general Medicaid population and children in particular; facility- and State-specific hospital and nursing home performance measures; analyses of the State's most recent annual External Quality Review Report and State Quality Strategy; recommendations for incorporating beneficiary-centered elements into the State's Medicaid information system; descriptions of issues addressed through CMS-sponsored technical assistance provided to the State by CMS staff and contractors; quality assessments of home and community based service programs; and data on State Children's Health Insurance Program (SCHIP) performance. Each State is asked to provide feedback on the usefulness of information furnished in its QAR, as well as any additional technical assistance needed. CMS plans to request annual updates on the progress each State has made in utilizing this information. All States can expect to receive individual QARs in the coming months. While the exact order of States has not been determined, QARs will be issued in a sequence that distributes them among various geographic areas and among States with both managed care and fee-for-service delivery systems. CMS Joins Surgeon General in Promoting Childhood Overweight and Obesity Prevention Initiative On November 27, 2007 First Lady Laura Bush launched "Healthy Youth for a Healthy Future", the U.S. Department of Health and Human Services' new childhood overweight and obesity prevention initiative, with a keynote address at the annual National Prevention Summit. As the First Lady indicated in her remarks, "our government is working to address one of the greatest dangers to America's young people: childhood overweight and obesity. Nearly one in five school-age children in the United States is overweight and the problem seems to be getting worse. Today, the Department of Health and Human Services is launching a new effort -- led by the Acting Surgeon General -- to coordinate and expand our government's existing childhood-overweight and -obesity prevention programs."
According to the Centers for Disease Control and Prevention, data from two National Health and Nutrition Examination Surveys (NHANES) (1976-1980 and 2003-2004) show that prevalence of childhood overweight is increasing. For children aged 2-5 years, the prevalence increased from 5.0 percent to 13.9 percent; for those aged 6-11 years, prevalence increased from 6.5 percent to 18.8 percent; and for those aged 12-19 years, prevalence increased from 5.0 percent to 17.4 percent.
As chair of HHS' Childhood Overweight and Obesity Coordinating Council, the Acting U.S. Surgeon General, Rear Admiral Steven K. Galson, M.D., MPH, is working with HHS officials and community stakeholders as they develop and foster programs that share the goal of providing options for community-based interventions. On March 10-11, 2008 Rear Admiral Galson began a nationwide tour in Charleston, West Virginia to promote the initiative and recognize some of the communities throughout the nation that are addressing childhood overweight and obesity prevention by helping kids stay active, encouraging healthy eating habits, and promoting healthy choices. In his remarks, Dr. Galson observed that "today more than 12.5 million children and adolescents 2 to 19 years of age are overweight and are therefore at greater risk for numerous health consequences in life such as cardiovascular disease and type 2 diabetes." The Acting Surgeon General continued his nationwide tour with a stop in Miami, Florida on March 18-19, 2008.Additional information about the Surgeon General's Initiative can be found at the link below.
CMS supports the Department's initiative, as well as other activities intended to address childhood obesity by profiling State promising practices on the CMS Medicaid/State Health Insurance Program Quality web section (see the link below) and by working with States seeking to incorporate obesity-related services in their State Medicaid Plans and develop Value Based Purchasing initiatives. CMS also works through the Children's Obesity Action Network (COAN), which addresses issues related to payment policy and health care disparities.
Materials for Fall Quality Conference, November 1, 2007 Materials for this Conference can be downloaded via the link, "Fall Quality Conference 2007," below. HHS Inspector General Completes National Review of States' Use of EQRO Reports to Improve Care for Medicaid Beneficiaries On June 4, 2008, OIG released a report on state use of EQRO reports (see the link below). The Report was a review of State oversight of External Quality Review (EQR) activities in the 37 States that have operational Medicaid managed care programs in existence. The substance of the OIG Report was that, while 29 of the 37 States responding felt that their EQR program was "very important" to their oversight of Medicaid managed care, there was some non-compliance with federal regulations and some State dissatisfaction with EQR Organizations (EQROs). Specifically, eight of the 37 States did not do at least one of the three mandatory EQRO activities and 15 of the 37 States were missing at least one of the five deliverables specified by regulation in their EQRO Reports. More than half of the States expressed some complaint about their EQRO with sixteen States complaining about staffing issues at the EQROs and thirteen States complaining about the quality of the EQRO Reports. There were two OIG Recommendations:
1) CMS should work with States to assure that EQROs are providing complete information.
2) CMS should provide additional technical assistance and written guidance to states. While the Report notes that the EQRO system has areas where improvement is needed, its overall message is that CMS is aware of these issues and is working to bring about the required change. CMS agrees with this conclusion and will continue its efforts to provide assistance to the States in their transition toward a value-based model that promotes the quality of care that Medicaid beneficiaries receive.
Page Last Modified: 07/28/2008 4:15:21 PM
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