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State Health System Performance
The State Health System Performance measures show how states serve Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries in six areas:
- Promoting communication & care coordination
- Reducing harm in care delivery
- Promoting prevention & treatment of chronic diseases
- Strengthening engagement in care
- Making care affordable
- Working with communities to promote healthy living
In some cases, states are just beginning to report these voluntary measures. Over time, more states may choose to report these measures and work to incorporate them into quality improvement programs.
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Promote Effective Communication & Coordination of Care |
Follow-up care after hospitalization for mental illness or intentional self-harm helps improve health outcomes and prevent readmissions. Recommended post-discharge treatment includes a visit with a mental health provider within 30 days after discharge. Ideally, patients should see a mental health provider within 7 days after discharge. Explore the percentage of discharges for children and adolescents ages 6 to 17 in each state who were hospitalized for treatment of selected mental illness diagnoses or intentional self-harm and had a follow-up visit with a mental health provider within 7 days after discharge and within 30 days after discharge. Higher rates are better on this measure. The purple dashed line represents the median, or middle, of all values reported. |
This measure reports state performance on the percentage of discharges among children ages 6 to 17 who were hospitalized for treatment of selected mental illness diagnoses or intentional self-harm and who had a follow-up visit with a mental health provider within (1) 7 days and (2) 30 days after discharge. Follow-up visits include:
States voluntarily report on Follow-Up After Hospitalization for Mental Illness: Ages 6 to 17 (FUH-CH) as part of the Core Set of Children's Health Care Quality Measures. These data show performance rates for states that voluntarily reported the measure using Child Core Set measure specifications. The included populations for Child Core Set measures can vary by state. For example, some states report a single combined rate for both the Medicaid and CHIP populations, but other states report separate rates for these populations. In addition, states may include beneficiaries in some delivery systems, but exclude other delivery systems. For example, a state may include beneficiaries who are enrolled in managed care, but exclude beneficiaries who are covered on a fee-for-service (FFS) basis. This variation in populations can affect measure performance and comparisons between states. Specifications for this measure changed substantially for Federal Fiscal Year (FFY) 2019. Rates are not comparable with rates reported for previous years. |
| State Health System Performance |
Source: Mathematica analysis of Medicaid and CHIP Program System (MACPro) reports for the Child Core Set FFY 2019 reporting cycle as of May 31, 2020; see 2019 Child and Adult Health Care Quality Measures. For more information on the Follow-Up After Hospitalization for Mental Illness: Ages 6 to 17 (FUH-CH) measure, visit Child Health Care Quality Measures. Notes: The following states did not report data to the Centers for Medicare & Medicaid Services (CMS) for either the 7-day Follow-Up or 30-day Follow-Up rate for this measure: CO, DE, GA, ID, and MT. The following states reported the measure to CMS, but did not use Child Core Set specifications to calculate the measure: NY and OR. CMS did not include the rates for these states. # = Rate not reported because denominator is less than 30. The Child Core Set specifications include guidance for calculating this measure using the administrative method. Unless otherwise specified, the administrative data source is the state’s Medicaid Management Information System (MMIS) and/or data submitted by managed care plans, including behavioral health plans. Unless otherwise specified:
ACO = Accountable Care Organization; ADHD = Attention-Deficit/Hyperactivity Disorder; CCO = Coordinated Care Organization; CHIP = Children’s Health Insurance Program; CMS = Centers for Medicare & Medicaid Services; CPT = Current Procedural Terminology; CY = Calendar Year; ED = Emergency Department; EPSDT = Early and Periodic Screening, Diagnostic, and Treatment; EQRO = External Quality Review Organization; FFS = Fee for Service; FFY = Federal Fiscal Year; HEDIS = Healthcare Effectiveness Data and Information Set; HMO = Health Maintenance Organization; ICD = International Classification of Diseases; LOINC = Logical Observation Identifiers Names and Codes; MACPro = Medicaid and CHIP Program System; MCO = Managed Care Organization; MMIS = Medicaid Management Information System; NCQA = National Committee for Quality Assurance; NR = Not Reported; PCCM = Primary Care Case Management; PCP = Primary Care Practitioner. | ||
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Promote Effective Communication & Coordination of Care |
Follow-up care after hospitalization for mental illness or intentional self-harm helps improve health outcomes and prevent readmissions. Recommended post-discharge treatment includes a visit with a mental health provider within 30 days after discharge. Ideally, patients should see a mental health provider within 7 days after discharge. Explore the percentage of discharges for adults in each state who were hospitalized for treatment of selected mental illness diagnoses or intentional self-harm and had a follow-up visit with a mental health provider within 7 days after discharge and within 30 days after discharge. Higher rates are better on this measure. The purple dashed line represents the median, or middle, of all values reported. |
This measure reports state performance on the percentage of discharges among adults age 18 and older who were hospitalized for treatment of selected mental illness diagnoses or intentional self-harm and who had a follow-up visit with a mental health provider within (1) 7 days and (2) 30 days after discharge. Follow-up visits include:
States voluntarily report on Follow-Up After Hospitalization for Mental Illness: Age 18 and Older (FUH-AD) as part of the Core Set of Adult Health Care Quality Measures. These data show performance rates for states that voluntarily reported the measure using Adult Core Set measure specifications. The included populations for Adult Core Set measures can vary by state. For example, some states include populations in certain programs, such as beneficiaries covered by Medicaid, but exclude beneficiaries in other programs, such as those dually eligible for Medicare and Medicaid. In addition, states may include beneficiaries in some delivery systems, but exclude other delivery systems. For example, a state may include beneficiaries who are enrolled in managed care, but exclude beneficiaries who are covered on a fee-for-service (FFS) basis. This variation in populations can affect measure performance and comparisons between states. Specifications for this measure changed substantially for Federal Fiscal Year (FFY) 2019. Rates are not comparable with rates reported for previous years. |
| State Health System Performance |
Source: Mathematica analysis of Medicaid and CHIP Program System (MACPro) reports for the Adult Core Set FFY 2019 reporting cycle as of May 31, 2020; see 2019 Child and Adult Health Care Quality Measures. For more information on the Follow-Up After Hospitalization for Mental Illness: Age 18 and Older (FUH-AD) measure, visit Adult Health Care Quality Measures. Notes: The following states did not report data to the Centers for Medicare & Medicaid Services (CMS) for either the 7-day Follow-Up or 30-day Follow-Up rate for this measure: AK, CO, GA, ID, ME, MT, and ND. The following states reported the measure to CMS, but did not use Adult Core Set specifications to calculate the measure: NY and OR. CMS did not include the rates for these states. The Adult Core Set specifications include guidance for calculating this measure using the administrative method. Unless otherwise specified, the administrative data source is the state’s Medicaid Management Information System (MMIS) and/or data submitted by managed care plans, including behavioral health plans. Unless otherwise specified:
ACO = Accountable Care Organization; AHRQ = Agency for Healthcare Research and Quality; CCO = Coordinated Care Organization; CHIP = Children’s Health Insurance Program; CMS = Centers for Medicare & Medicaid Services; CMO = Care Management Organization; CY = Calendar Year; ED = Emergency Department; EHR = Electronic Health Record; EQRO = External Quality Review Organization; FFS = Fee for Service; FFY = Federal Fiscal Year; HEDIS = Healthcare Effectiveness Data and Information Set; HMO = Health Maintenance Organization; ICD = International Classification of Diseases; LOINC = Logical Observation Identifiers Names and Codes; MACPro = Medicaid and CHIP Program System; MCO = Managed Care Organization; MMIS = Medicaid Management Information System; NCQA = National Committee for Quality Assurance; NR = Not Reported; PCCM = Primary Care Case Management; PCP = Primary Care Practitioner.
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Promote Effective Communication & Coordination of Care |
Timely follow-up care after an emergency department (ED) visit for mental illness or intentional self-harm may reduce repeat ED visits, prevent hospital admissions, and improve health outcomes. The period immediately after the ED visit is important for engaging individuals in treatment and establishing continuity of care. Explore the percentage of ED visits for adults in each state with a principal diagnosis of mental illness or intentional self-harm with a follow-up for mental illness within 7 days of the ED visit and within 30 days of the ED visit. Higher rates are better on this measure. The purple dashed line represents the median, or middle, of all values reported. |
This measure reports state performance on the percentage of emergency departments (ED) visits for adults age 18 or older with a principal diagnosis of mental illness or intentional self-harm and who had a follow-up visit for mental illness within (1) 7 days and (2) 30 days of the ED visit. Follow-up visits include:
States voluntarily report on Follow-up After Emergency Department Visit for Mental Illness (FUM-AD) as part of the Core Set of Adult Health Care Quality Measures. These data show performance rates for states that voluntarily reported the measure using Adult Core Set measure specifications. The included populations for Adult Core Set measures can vary by state. For example, some states include populations in certain programs, such as beneficiaries covered by Medicaid, but exclude beneficiaries in other programs, such as those dually eligible for Medicare and Medicaid. In addition, states may include beneficiaries in some delivery systems, but exclude other delivery systems. For example, a state may include beneficiaries who are enrolled in managed care, but exclude beneficiaries who are covered on a fee-for-service (FFS) basis. This variation in populations can affect measure performance and comparisons between states. Specifications for this measure changed substantially for Federal Fiscal Year (FFY) 2019. Rates are not comparable with rates reported for previous years. |
| State Health System Performance |
Source: Mathematica analysis of Medicaid and CHIP Program System (MACPro) reports for the Adult Core Set FFY 2019 reporting cycle as of May 31, 2020; see 2019 Child and Adult Health Care Quality Measures. For more information on the Follow-Up After Emergency Department Visit for Mental Illness (FUM-AD) measure, visit Adult Health Care Quality Measures. Notes: The following states did not report data to the Centers for Medicare & Medicaid Services (CMS) for either the 7-day Follow-Up or 30-day Follow-Up rate: AK, DE, GA, ID, IL, IN, LA, ME, MD, MI, MT, ND, SD, UT, and WY. The Adult Core Set specifications include guidance for calculating this measure using the administrative method. Unless otherwise specified, the administrative data source is the state’s Medicaid Management Information System (MMIS) and/or data submitted by managed care plans, including behavioral health plans. Unless otherwise specified:
ACO = Accountable Care Organization; AHRQ = Agency for Healthcare Research and Quality; CCO = Coordinated Care Organization; CHIP = Children’s Health Insurance Program; CMS = Centers for Medicare & Medicaid Services; CMO = Care Management Organization; CY = Calendar Year; ED = Emergency Department; EHR = Electronic Health Record; EQRO = External Quality Review Organization; FFS = Fee for Service; FFY = Federal Fiscal Year; HEDIS = Healthcare Effectiveness Data and Information Set; HMO = Health Maintenance Organization; ICD = International Classification of Diseases; LOINC = Logical Observation Identifiers Names and Codes; MACPro = Medicaid and CHIP Program System; MCO = Managed Care Organization; MMIS = Medicaid Management Information System; NCQA = National Committee for Quality Assurance; NR = Not Reported; PCCM = Primary Care Case Management; PCP = Primary Care Practitioner. | ||
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Promote Effective Communication & Coordination of Care |
Without access to high quality outpatient diabetes care, certain diabetes conditions can become life-threatening. These complications may result in costly and avoidable inpatient hospital admissions. Inpatient hospital admissions for these complications can be an indicator that diabetes is not being properly prevented or managed. Explore inpatient hospital admission rates per 100,000 beneficiary months for short-term complications of diabetes in each state. Lower rates are better on this measure. The purple dashed line represents the median, or middle, of all values reported. |
This measure reports state performance on inpatient hospital admission rates for diabetes short-term complications, including:
The measure is the rate of inpatient admissions per 100,000 beneficiary months for adults age 18 and older. This measure aligns with the Centers for Disease Control and Prevention’s 6|18 Initiative focus on providing appropriate diabetes care. The 6|18 Initiative focuses on six common and costly health conditions or health behaviors and highlights evidence-based interventions that can prevent or control those conditions. For information on how to drive improvement on this measure, visit: www.cdc.gov/sixeighteen. States voluntarily report on PQI 01: Diabetes Short-Term Complications Admissions Rate (PQI01-AD) as part of the Core Set of Adult Health Care Quality Measures. These data show performance rates for states that voluntarily reported the measure using Adult Core Set measure specifications. The included populations for Adult Core Set measures can vary by state. For example, some states include populations in certain programs, such as beneficiaries covered by Medicaid, but exclude beneficiaries in other programs, such as those dually eligible for Medicare and Medicaid. In addition, states may include beneficiaries in some delivery systems, but exclude other delivery systems. For example, a state may include beneficiaries who are enrolled in managed care, but exclude beneficiaries who are covered on a fee-for-service (FFS) basis. This variation in populations can affect measure performance and comparisons. |
| State Health System Performance |
Source: Mathematica analysis of Medicaid and CHIP Program System (MACPro) reports for the Adult Core Set Federal Fiscal Year (FFY) 2019 reporting cycle as of May 31, 2020; see 2019 Child and Adult Health Care Quality Measures. PQI stands for prevention quality indicators, a set of measures maintained by the Agency for Healthcare Research and Quality (AHRQ). For more information on the PQI 01: Diabetes Short-Term Complications Admissions Rate (PQI01-AD) measure, visit Adult Health Care Quality Measures. Notes: The following states did not report data to the Centers for Medicare & Medicaid Services (CMS) for this measure: AK, CO, DC, FL, HI, ID, IN, KS, KY, ME, MS, MT, ND, NE, NV, OH, RI, SD, UT, VA, and WI. The Adult Core Set specifications include guidance for calculating this measure using the administrative method. Unless otherwise specified, the administrative data source is the state’s Medicaid Management Information System (MMIS) and/or data submitted by managed care plans, including behavioral health plans. Unless otherwise specified:
ACO = Accountable Care Organization; AHRQ = Agency for Healthcare Research and Quality; CCO = Coordinated Care Organization; CHIP = Children’s Health Insurance Program; CMS = Centers for Medicare & Medicaid Services; CMO = Care Management Organization; CY = Calendar Year; ED = Emergency Department; EHR = Electronic Health Record; EQRO = External Quality Review Organization; FFS = Fee for Service; FFY = Federal Fiscal Year; HEDIS = Healthcare Effectiveness Data and Information Set; HMO = Health Maintenance Organization; ICD = International Classification of Diseases; LOINC = Logical Observation Identifiers Names and Codes; MACPro = Medicaid and CHIP Program System; MCO = Managed Care Organization; MMIS = Medicaid Management Information System; NCQA = National Committee for Quality Assurance; NR = Not Reported; PCCM = Primary Care Case Management; PCP = Primary Care Practitioner. | ||
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Promote Effective Communication & Coordination of Care |
If a nursing home sends many residents to the hospital, it may indicate that the nursing home is not properly assessing or taking care of its residents. This measure reports the number of unplanned hospitalizations, including observation stays, per 1,000 long-stay nursing home resident days in calendar year 2019. Long-stay resident days are all days after the 100th cumulative day in a nursing home. Lower rates are better on this measure. The purple dashed line represents the median, or middle, of all values reported. |
CMS calculates this measure using Medicare claims data. Not all of a state’s residents reflected in the data for this measure are enrolled in Medicaid, but Medicaid is the primary payer across the country for long-term care services. |
| State Health System Performance |
Source: Provider Data Catalog Note: Data for American Samoa, Guam, Northern Mariana Islands, Puerto Rico, and U.S. Virgin Islands are not available. | ||
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Make Care Safer by Reducing Harm |
Antipsychotic drugs are an important treatment for patients with certain mental health conditions, but they are associated with an increased risk of death when used in elderly patients with dementia. The medications also have side effects. If possible, nursing homes should try to address a resident’s expressions of distress by first implementing person-centered approaches that do not involve medications. Addressing each resident’s needs through approaches other than medications—like higher staffing ratios, non-pharmacological interventions, and regular assignment of nursing staff—may lower the use of medications in many cases. This measure reports the percentage of long-stay nursing home residents who received antipsychotic drugs in calendar year 2019. Lower rates are better on this measure. The purple dashed line represents the median, or middle, of all values reported. |
CMS calculates this measure using data from the Minimum Data Set (MDS). The MDS is part of the federally mandated process for clinical assessment of all residents in Medicare and Medicaid certified nursing homes. Not all of a state’s residents reflected in the data for this measure are enrolled in Medicaid, but Medicaid is the primary payer across the nation for long-term care services. |
| State Health System Performance |
Source: Provider Data Catalog Note: Data for American Samoa, Northern Mariana Islands, and U.S. Virgin Islands are not available. | ||
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Promote Effective Prevention & Treatment of Chronic Diseases |
Medicaid is the largest payer for maternity care in the United States. The program has an important role to play in improving maternal and perinatal health outcomes. Timely postpartum visits provide an opportunity to assess a woman’s physical recovery from pregnancy and childbirth. Postpartum visits provide an opportunity to address:
Explore the percentage of women delivering a live birth who had a timely postpartum care visit in each state. Higher rates are better on this measure. The purple dashed line represents the median, or middle, of all values reported. |
This measure reports state performance on the percentage of deliveries of live births during the measurement year with a postpartum care visit on or between 21 and 56 days after delivery. States voluntarily report on Prenatal & Postpartum Care: Postpartum Care (PPC-AD) as part of the Core Set of Adult Health Care Quality Measures. These data show performance rates for states that voluntarily reported the measure using Adult Core Set measure specifications. The included populations and calculation methods for Adult Core Set measures can vary by state. For example, some states include populations in certain programs, such as beneficiaries covered by Medicaid, but exclude beneficiaries in other programs, such as those dually eligible for Medicare and Medicaid. In addition, states may include beneficiaries in some delivery systems, but exclude other delivery systems. For example, a state may include beneficiaries who are enrolled in managed care, but exclude beneficiaries who are covered on a fee-for-service (FFS) basis. States can also choose to calculate this measure using the administrative or hybrid method. This variation in populations and calculation methods can affect measure performance and comparisons between states. |
| State Health System Performance |
Source: Mathematica analysis of Medicaid and CHIP Program System (MACPro) reports for the Adult Core Set Federal Fiscal Year (FFY) 2019 reporting cycle as of May 31, 2020; see 2019 Child and Adult Health Care Quality Measures. For more information on the Postpartum Care (PPC-AD) measure, visit Adult Health Care Quality Measures. Notes: The following states did not report data to the Centers for Medicare & Medicaid Services (CMS) for this measure: AK, AR, AZ, GA, IA, ID, ME, MT, ND, NE, SD, and VT. The Adult Core Set specifications include guidance for calculating this measure using the administrative method or the hybrid method. The hybrid method uses a combination of administrative and medical records data to identify services included in the numerator or to determine exclusions from the denominator based on diagnoses or other criteria. Unless otherwise specified, administrative data sources are the state’s Medicaid Management Information System (MMIS) and/or data submitted by managed care plans; medical record data sources are paper and/or electronic health records. Unless otherwise specified:
ACO = Accountable Care Organization; AHRQ = Agency for Healthcare Research and Quality; CCO = Coordinated Care Organization; CHIP = Children’s Health Insurance Program; CMS = Centers for Medicare & Medicaid Services; CMO = Care Management Organization; CY = Calendar Year; ED = Emergency Department; EHR = Electronic Health Record; EQRO = External Quality Review Organization; FFS = Fee for Service; FFY = Federal Fiscal Year; HEDIS = Healthcare Effectiveness Data and Information Set; HMO = Health Maintenance Organization; ICD = International Classification of Diseases; LOINC = Logical Observation Identifiers Names and Codes; MACPro = Medicaid and CHIP Program System; MCO = Managed Care Organization; MMIS = Medicaid Management Information System; NCQA = National Committee for Quality Assurance; NR = Not Reported; PCCM = Primary Care Case Management; PCP = Primary Care Practitioner. | ||
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Promote Effective Prevention & Treatment of Chronic Diseases |
Medicaid is the largest payer for maternity care in the United States. Infant birth weight is a common measure of infant and maternal health and well-being. Infants weighing less than 2,500 grams at birth may experience serious and costly health problems and developmental delays. Explore the percentage of live births that weighed less than 2,500 grams in each state. Lower rates are better on this measure. The purple dashed line represents the median, or middle, of all values reported. |
This measure reports state performance on the percentage of live births weighing less than 2,500 grams in the state during the measurement year. Pregnant women are at higher risk of a low birth weight baby if they have:
States voluntarily report on Live Births Weighing Less Than 2,500 Grams (LBW-CH) as part of the Core Set of Children's Health Care Quality Measures. CMS calculated this measure using data from the Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research (CDC WONDER) Database for states that did not report the measure for Federal Fiscal Year (FFY) 2019 or reported the measure but did not use Child Core Set specifications. The CDC WONDER Database includes state-submitted natality data that is compiled by the National Center for Health Statistics (NCHS). States that reported the measure using Core Set specifications also had the option to use the rate calculated by CMS using CDC WONDER data. The included populations for Child Core Set measures can vary by state. For example, some states report a single combined rate for both the Medicaid and CHIP populations, but other states report separate rates for these populations. In addition, states may include beneficiaries in some delivery systems, but exclude other delivery systems. For example, a state may include beneficiaries who are enrolled in managed care, but exclude beneficiaries who are covered on a fee-for-service (FFS) basis. This variation in populations can affect measure performance and comparisons between states. As a result of the change in data sources used for this measure for some states, rates for FFY 2019 are not comparable to rates reported for previous years. |
| State Health System Performance |
Source: CMS used two data sources for reporting this measure for the 2019 Child Core Set. The two sources are Mathematica analysis of Medicaid and CHIP Program System (MACPro) reports for the Child Core Set FFY 2019 reporting cycle as of May 31, 2020 and the Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research (CDC WONDER) data; see 2019 Child and Adult Health Care Quality Measures. The notes below identify the data source for each state’s rate for FFY 2019. For more information on Live Births Weighing Less Than 2,500 Grams (LBW-CH) visit Child Health Care Quality Measures. Notes: For FFY 2019, some states calculated and reported a rate in MACPro for LBW-CH using Child Core Set specifications, based on CDC 2019 specifications. The Child Core Set specifications include guidance for calculating this measure using state vital records. States may link vital records data to administrative claims data to determine payer source. Denominators are assumed to be the measure-eligible population for states that reported using Child Core Set specifications. Some states reported exclusions from the denominator, as noted in the state-specific comments. The following states calculated and reported the measure in MACPro using Core Set specifications: AL (CHIP), IN, KY, ME, MN, NY, NC, OH, OK, PA, SC, TX, and WV. Additional context for these states is included in the state-specific comments. For states that did not report the measure in MACPro using Child Core Set specifications, CMS calculated LBW-CH using natality data submitted by states and compiled by the NCHS in CDC WONDER. In addition, some states that reported the measure in MACPro using Child Core Set specifications opted to have CMS report the rate based on CDC WONDER data. The rates calculated using CDC WONDER data include resident live births in the state that met the measure eligibility requirements and had a Source of Payment for Delivery of "Medicaid" on the birth certificate. In some states, this group may include deliveries that were paid for by CHIP. Rates for the following states were calculated using CDC WONDER data: AL (Medicaid), AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, HI, ID, IL, IA, KS, LA, MD, MA, MI, MS, MO, MT, NE, NV, NH, NJ, NM, ND, OR, RI, SD, TN, UT, VT, VA, WA, WI, and WY. The population for all state rates calculated using CDC WONDER data are reported as “Medicaid only” because these rates include births that had a Source of Payment for Delivery of “Medicaid” on the birth certificate. In some states, this group may include deliveries that were paid for by CHIP. ACO = Accountable Care Organization; ADHD = Attention-Deficit/Hyperactivity Disorder; CCO = Coordinated Care Organization; CHIP = Children’s Health Insurance Program; CMS = Centers for Medicare & Medicaid Services; CPT = Current Procedural Terminology; CY = Calendar Year; ED = Emergency Department; EPSDT = Early and Periodic Screening, Diagnostic, and Treatment; EQRO = External Quality Review Organization; FFS = Fee for Service; FFY = Federal Fiscal Year; HEDIS = Healthcare Effectiveness Data and Information Set; HMO = Health Maintenance Organization; ICD = International Classification of Diseases; LOINC = Logical Observation Identifiers Names and Codes; MACPro = Medicaid and CHIP Program System; MCO = Managed Care Organization; MMIS = Medicaid Management Information System; NCHS = National Center for Health Statistics; NCQA = National Committee for Quality Assurance; NR = Not Reported; PCCM = Primary Care Case Management; PCP = Primary Care Practitioner. | ||
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Promote Effective Prevention & Treatment of Chronic Diseases |
The American Academy of Pediatrics and Bright Futures recommend nine well-care visits by the time a child turns 15 months of age. Early intervention increases overall wellness and reduces medical costs. Explore the percentage of children who had 6 or more well-child visits in their first 15 months in each state. Higher rates are better on this measure. The purple dashed line represents the median, or middle, of all values reported. |
This measure reports state performance on the percentage of children who turned 15 months old during the measurement year and who had 6 or more well-child visits with a primary care practitioner during that time. Well-child visits should include:
States voluntarily report on Well-Child Visits in the First 15 Months of Life (W15-CH) as part of the Core Set of Children's Health Care Quality Measures. These data show performance rates for states that voluntarily reported the measure using Child Core Set measure specifications. The included populations and calculation methods for Child Core Set measures can vary by state. For example, some states report a single combined rate for both the Medicaid and CHIP populations, but other states report separate rates for these populations. In addition, states may include beneficiaries in some delivery systems, but exclude other delivery systems. For example, a state may include beneficiaries who are enrolled in managed care, but exclude beneficiaries who are covered on a fee-for-service (FFS) basis. States can also choose to calculate this measure using the administrative or hybrid method. This variation in populations and calculation methods can affect measure performance and comparisons between states. |
| State Health System Performance |
Source: Mathematica analysis of Medicaid and CHIP Program System (MACPro) reports for the Child Core Set Federal Fiscal Year (FFY) 2019 reporting cycle as of May 31, 2020; see 2019 Child and Adult Health Care Quality Measures. For more information on the Well-Child Visits in the First 15 Months of Life (W15-CH) measure, visit Child Health Care Quality Measures. Notes: The following states did not report data to the Centers for Medicare & Medicaid Services (CMS) for this measure: CA, ID, and MT. The Child Core Set specifications include guidance for calculating this measure using the administrative method or the hybrid method. The hybrid method uses a combination of administrative and medical records data to identify services included in the numerator or to determine exclusions from the denominator based on diagnoses or other criteria. Unless otherwise specified, administrative data sources are the state’s Medicaid Management Information System (MMIS) and/or data submitted by managed care plans; medical record data sources are paper and/or electronic health records. Unless otherwise specified:
ACO = Accountable Care Organization; ADHD = Attention-Deficit/Hyperactivity Disorder; CCO = Coordinated Care Organization; CHIP = Children’s Health Insurance Program; CMS = Centers for Medicare & Medicaid Services; CPT = Current Procedural Terminology; CY = Calendar Year; ED = Emergency Department; EPSDT = Early and Periodic Screening, Diagnostic, and Treatment; EQRO = External Quality Review Organization; FFS = Fee for Service; FFY = Federal Fiscal Year; HEDIS = Healthcare Effectiveness Data and Information Set; HMO = Health Maintenance Organization; ICD = International Classification of Diseases; LOINC = Logical Observation Identifiers Names and Codes; MACPro = Medicaid and CHIP Program System; MCO = Managed Care Organization; MMIS = Medicaid Management Information System; NCQA = National Committee for Quality Assurance; NR = Not Reported; PCCM = Primary Care Case Management; PCP = Primary Care Practitioner. | ||
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Promote Effective Prevention & Treatment of Chronic Diseases |
The American Academy of Pediatrics and Bright Futures recommend children have at least one well-child visit with a primary care practitioner (PCP) each year. Early intervention increases overall wellness and reduces medical costs. Explore the percentage of children ages 3 to 6 who had at least one well-child visit with a PCP in each state. Higher rates are better on this measure. The purple dashed line represents the median, or middle, of all values reported. |
This measure reports state performance on the percentage of children ages 3 to 6 who had one or more well-child visits with a PCP during the measurement year. Well-child visits should include:
States voluntarily report on Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life (W34-CH) as part of the Core Set of Children's Health Care Quality Measures. These data show performance rates for states that voluntarily reported the measure using Child Core Set measure specifications. The included populations and calculation methods for Child Core Set measures can vary by state. For example, some states report a single combined rate for both the Medicaid and CHIP populations, but other states report separate rates for these populations. In addition, states may include beneficiaries in some delivery systems, but exclude other delivery systems. For example, a state may include beneficiaries who are enrolled in managed care, but exclude beneficiaries who are covered on a fee-for-service (FFS) basis. States can also choose to calculate this measure using the administrative or hybrid method. This variation in populations and calculation methods can affect measure performance and comparisons between states. |
| State Health System Performance |
Source: Mathematica analysis of Medicaid and CHIP Program System (MACPro) reports for the Child Core Set Federal Fiscal Year (FFY) 2019 reporting cycle as of May 31, 2020; see 2019 Child and Adult Health Care Quality Measures. For more information on the Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life (W34-CH) measure, visit Child Health Care Quality Measures. Notes: The following states did not report data to the Centers for Medicare & Medicaid Services (CMS) for this measure: ID and MT. The Child Core Set specifications include guidance for calculating this measure using the administrative method or the hybrid method. The hybrid method uses a combination of administrative and medical records data to identify services included in the numerator or to determine exclusions from the denominator based on diagnoses or other criteria. Unless otherwise specified, administrative data sources are the state’s Medicaid Management Information System (MMIS) and/or data submitted by managed care plans; medical record data sources are paper and/or electronic health records. Unless otherwise specified:
ACO = Accountable Care Organization; ADHD = Attention-Deficit/Hyperactivity Disorder; CCO = Coordinated Care Organization; CHIP = Children’s Health Insurance Program; CMS = Centers for Medicare & Medicaid Services; CPT = Current Procedural Terminology; CY = Calendar Year; ED = Emergency Department; EPSDT = Early and Periodic Screening, Diagnostic, and Treatment; EQRO = External Quality Review Organization; FFS = Fee for Service; FFY = Federal Fiscal Year; HEDIS = Healthcare Effectiveness Data and Information Set; HMO = Health Maintenance Organization; ICD = International Classification of Diseases; LOINC = Logical Observation Identifiers Names and Codes; MACPro = Medicaid and CHIP Program System; MCO = Managed Care Organization; MMIS = Medicaid Management Information System; NCQA = National Committee for Quality Assurance; NR = Not Reported; PCCM = Primary Care Case Management; PCP = Primary Care Practitioner. | ||
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Promote Effective Prevention & Treatment of Chronic Diseases |
The American Academy of Pediatrics and Bright Futures recommend annual well-care visits during adolescence. Annual well-care visits during adolescence promote healthy behaviors, prevent risky ones, and detect conditions that can interfere with physical, social, and emotional development. Explore the percentage of adolescents who had an annual well-care visit in each state. Higher rates are better on this measure. The purple dashed line represents the median, or middle of all values reported. |
This measure reports state performance on the percentage of adolescents ages 12 to 21 who had at least one comprehensive well-care visit with a primary care provider (PCP) or an obstetrical/gynecological (OB/GYN) provider during the measurement year. Comprehensive well-care includes:
States voluntarily report on Adolescent Well-Care Visits (AWC-CH) as part of the Core Set of Children's Health Care Quality Measures. These data show performance rates for states that voluntarily reported the measure using Child Core Set measure specifications. The included populations and calculation methods for Child Core Set measures can vary by state. For example, some states report a single combined rate for both the Medicaid and CHIP populations, but other states report separate rates for these populations. In addition, states may include beneficiaries in some delivery systems, but exclude other delivery systems. For example, a state may include beneficiaries who are enrolled in managed care, but exclude beneficiaries who are covered on a fee-for-service (FFS) basis. States can also choose to calculate this measure using the administrative or hybrid method. This variation in populations and calculation methods can affect measure performance and comparisons between states. |
| State Health System Performance |
Source: Mathematica analysis of Medicaid and CHIP Program System (MACPro) reports for the Child Core Set Federal Fiscal Year (FFY) 2019 reporting cycle as of May 31, 2020; see 2019 Child and Adult Health Care Quality Measures. For more information on the Adolescent Well-Care Visits (AWC-CH) measure, visit Child Health Care Quality Measures. Notes: The following states did not report data to the Centers for Medicare & Medicaid Services (CMS) for this measure: ID and MT. The Child Core Set specifications include guidance for calculating this measure using the administrative method or the hybrid method. The hybrid method uses a combination of administrative and medical records data to identify services included in the numerator or to determine exclusions from the denominator based on diagnoses or other criteria. Unless otherwise specified, administrative data sources are the state’s Medicaid Management Information System (MMIS) and/or data submitted by managed care plans; medical record data sources are paper and/or electronic health records. Unless otherwise specified:
ACO = Accountable Care Organization; ADHD = Attention-Deficit/Hyperactivity Disorder; CCO = Coordinated Care Organization; CHIP = Children’s Health Insurance Program; CMS = Centers for Medicare & Medicaid Services; CPT = Current Procedural Terminology; CY = Calendar Year; ED = Emergency Department; EPSDT = Early and Periodic Screening, Diagnostic, and Treatment; EQRO = External Quality Review Organization; FFS = Fee for Service; FFY = Federal Fiscal Year; HEDIS = Healthcare Effectiveness Data and Information Set; HMO = Health Maintenance Organization; ICD = International Classification of Diseases; LOINC = Logical Observation Identifiers Names and Codes; MACPro = Medicaid and CHIP Program System; MCO = Managed Care Organization; MMIS = Medicaid Management Information System; NCQA = National Committee for Quality Assurance; NR = Not Reported; PCCM = Primary Care Case Management; PCP = Primary Care Practitioner. | ||
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Promote Effective Prevention & Treatment of Chronic Diseases |
A key indicator of the continuity of primary care is whether adolescents are up to date on their immunizations. Continuity of primary care is essential for high-quality, cost effective patient care. Explore the percentage of adolescents who received the recommended immunizations by their 13th birthday in each state:
Higher rates are better on this measure. The purple dashed line represents the median, or middle, of all values reported. |
This measure reports state performance on the percentage of adolescents who turned 13 years old during the measurement year and had up to date vaccinations on three types of vaccines:
States calculate a rate for each vaccine as well as two combination rates for this measure. These data show state reporting for (1) the Combination 1 rate—the percentage receiving both meningococcal and Tdap vaccines—and (2) the HPV vaccine rate. States voluntarily report on Immunizations for Adolescents (IMA-CH) as part of the Core Set of Children's Health Care Quality Measures. These data show performance rates for states that voluntarily reported the measure using Child Core Set measure specifications. The included populations and calculation methods for Child Core Set measures can vary by state. For example, some states report a single combined rate for both the Medicaid and CHIP populations, but other states report separate rates for these populations. In addition, states may include beneficiaries in some delivery systems, but exclude other delivery systems. For example, a state may include beneficiaries who are enrolled in managed care, but exclude beneficiaries who are covered on a fee-for-service (FFS) basis. States can also choose to calculate this measure using the administrative or hybrid method. This variation in populations and calculation methods can affect measure performance and comparisons between states. Specifications for the HPV Vaccine rate changed substantially for Federal Fiscal Year (FFY) 2018. Rates for this measure cannot be trended from FFY 2017 to 2019. |
| State Health System Performance |
Source: Mathematica analysis of Medicaid and CHIP Program System (MACPro) reports for the Child Core Set FFY 2019 reporting cycle as of May 31, 2020; see 2019 Child and Adult Health Care Quality Measures. For more information on the Immunizations for Adolescents (IMA-CH) measure, visit Child Health Care Quality Measures. Notes: The following state did not report data for the Combination 1 rate: CA. The following states did not report either the HPV or Combination 1 rate: AR, AZ, ID, IA, ME, and MT. The Child Core Set specifications include guidance for calculating this measure using the administrative method or the hybrid method. The hybrid method uses a combination of administrative and medical records data to identify services included in the numerator or to determine exclusions from the denominator based on diagnoses or other criteria. Unless otherwise specified, administrative data sources are the state’s Medicaid Management Information System (MMIS) and/or data submitted by managed care plans; medical record data sources are paper and/or electronic health records. Unless otherwise specified:
ACO = Accountable Care Organization; ADHD = Attention-Deficit/Hyperactivity Disorder; CCO = Coordinated Care Organization; CHIP = Children’s Health Insurance Program; CMS = Centers for Medicare & Medicaid Services; CPT = Current Procedural Terminology; CY = Calendar Year; ED = Emergency Department; EPSDT = Early and Periodic Screening, Diagnostic, and Treatment; EQRO = External Quality Review Organization; FFS = Fee for Service; FFY = Federal Fiscal Year; HEDIS = Healthcare Effectiveness Data and Information Set; HMO = Health Maintenance Organization; ICD = International Classification of Diseases; LOINC = Logical Observation Identifiers Names and Codes; MACPro = Medicaid and CHIP Program System; MCO = Managed Care Organization; MMIS = Medicaid Management Information System; NCQA = National Committee for Quality Assurance; NR = Not Reported; PCCM = Primary Care Case Management; PCP = Primary Care Practitioner. | ||
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Promote Effective Prevention & Treatment of Chronic Diseases |
Tooth decay, or dental caries, is one of the most common chronic diseases in children. It is almost entirely preventable through a combination of:
Explore the rate of preventive dental service use by children and adolescents in each state. Higher rates are better on this measure. The purple dashed line represents the median, or middle, of all values reported. |
This measure reports state performance on the percentage of children and adolescents ages 1 to 20 who were enrolled in Medicaid or Children’s Health Insurance Program (CHIP) Medicaid Expansion programs for at least 90 days, are eligible for Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services, and who had at least one preventive dental service during the reporting period. States report data for this measure on Form CMS-416, which is used by CMS to collect information about the EPSDT benefit. Data for the Percentage of Eligibles Who Received Preventive Dental Services (PDENT-CH) measure are included in the Core Set of Children's Health Care Quality Measures. |
| State Health System Performance |
Source: Mathematica analysis of Federal Fiscal Year (FFY) 2019 Form CMS-416 reports (annual EPSDT report), Lines 1b and 12b as of July 1, 2020, for the Child Core Set FFY 2019 reporting cycle; see 2019 Child and Adult Health Care Quality Measures. For more information on the Percentage of Eligibles Who Received Preventive Dental Services (PDENT-CH) measure, visit Child Health Care Quality Measures. | ||
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Promote Effective Prevention & Treatment of Chronic Diseases |
Asthma affects more than six million children under age 18 in the United States. Long-term asthma control medications are recommended for children with persistent asthma. Uncontrolled asthma among children can result in:
Explore the percentage of children and adolescents with persistent asthma who were dispensed appropriate asthma controller medications in each state. Higher rates are better on this measure. The purple dashed line represents the median, or middle, of all values reported. |
This measure reports state performance on the percentage of children and adolescents ages 5 to 18 who were identified as having persistent asthma and had a ratio of controller medications to total asthma medications of 0.50 or greater during the measurement year. The Centers for Medicare & Medicaid Services has launched the Improving Asthma Control Learning Collaborative to support state Medicaid and CHIP agencies’ efforts to improve health outcomes among beneficiaries with asthma. This measure also aligns with the Centers for Disease Control and Prevention’s 6|18 Initiative focus on controlling asthma. The 6|18 Initiative focuses on six common and costly health conditions or health behaviors and highlights evidence-based interventions that can prevent or control those conditions. For information on how to drive improvement on this measure, visit: www.cdc.gov/sixeighteen. States voluntarily report on Asthma Medication Ratio: Ages 5 to 18 (AMR-CH) as part of the Core Set of Children's Health Care Quality Measures. These data show performance rates for states that voluntarily reported the measure using Child Core Set measure specifications. The included populations for Child Core Set measures can vary by state. For example, some states report a single combined rate for both the Medicaid and CHIP populations, but other states report separate rates for these populations. In addition, states may include beneficiaries in some delivery systems, but exclude other delivery systems. For example, a state may include beneficiaries who are enrolled in managed care, but exclude beneficiaries who are covered on a fee-for-service (FFS) basis. This variation in populations can affect measure performance and comparisons between states. This measure has only been publicly reported for two years. CMS does not recommend trending based on two years of reporting. |
| State Health System Performance |
Source: Mathematica analysis of Medicaid and CHIP Program System (MACPro) reports for the Child Core Set Federal Fiscal Year (FFY) 2019 reporting cycle as of May 31, 2020; see 2019 Child and Adult Health Care Quality Measures. For more information on the Asthma Medication Ratio: Ages 5 to 18 (AMR-CH) measure, visit Child Health Care Quality Measures. Notes: The following state did not report data to the Centers for Medicare & Medicaid Services (CMS) for ages 5 to 18: VA. The following states did not report data for ages 5 to 11 or 12 to 18: GA and ME. The following states did not report for any age group: HI, ID, IL, MT, NE, NV, OR, SD, and WV. # = Rate not reported because denominator is less than 30. The Child Core Set specifications include guidance for calculating this measure using the administrative method. Unless otherwise specified, the administrative data source is the state’s Medicaid Management Information System (MMIS) and/or data submitted by managed care plans, including behavioral health plans. Unless otherwise specified:
ACO = Accountable Care Organization; ADHD = Attention-Deficit/Hyperactivity Disorder; CCO = Coordinated Care Organization; CHIP = Children’s Health Insurance Program; CMS = Centers for Medicare & Medicaid Services; CPT = Current Procedural Terminology; CY = Calendar Year; ED = Emergency Department; EPSDT = Early and Periodic Screening, Diagnostic, and Treatment; EQRO = External Quality Review Organization; FFS = Fee for Service; FFY = Federal Fiscal Year; HEDIS = Healthcare Effectiveness Data and Information Set; HMO = Health Maintenance Organization; ICD = International Classification of Diseases; LOINC = Logical Observation Identifiers Names and Codes; MACPro = Medicaid and CHIP Program System; MCO = Managed Care Organization; MMIS = Medicaid Management Information System; NCQA = National Committee for Quality Assurance; NR = Not Reported; PCCM = Primary Care Case Management; PCP = Primary Care Practitioner. | ||
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Promote Effective Prevention & Treatment of Chronic Diseases |
Asthma affects nearly 19 million adults in the United States. Long-term asthma control medications are recommended for adults with persistent asthma. Uncontrolled asthma among adults can result in:
Explore the percentage of adults with persistent asthma who were dispensed appropriate asthma controller medications in each state. Higher rates are better on this measure. The purple dashed line represents the median, or middle, of all values reported. |
This measure reports state performance on the percentage of adults ages 19 to 64 who were identified as having persistent asthma and had a ratio of controller medications to total asthma medications of 0.50 or greater during the measurement year. The Centers for Medicare & Medicaid Services has launched the Improving Asthma Control Learning Collaborative to support state Medicaid and CHIP agencies’ efforts to improve health outcomes among beneficiaries with asthma. This measure also aligns with the Centers for Disease Control and Prevention’s 6|18 Initiative focus on controlling asthma. The 6|18 Initiative focuses on six common and costly health conditions or health behaviors and highlights evidence-based interventions that can prevent or control those conditions. For information on how to drive improvement on this measure, visit: www.cdc.gov/sixeighteen. States voluntarily report on Asthma Medication Ratio: Ages 19 to 64 (AMR-AD) as part of the Core Set of Adult Health Care Quality Measures. These data show performance rates for states that voluntarily reported the measure using Adult Core Set measure specifications. The included populations for Adult Core Set measures can vary by state. For example, some states include populations in certain programs, such as beneficiaries covered by Medicaid, but exclude beneficiaries in other programs, such as those dually eligible for Medicare and Medicaid. In addition, states may include beneficiaries in some delivery systems, but exclude other delivery systems. For example, a state may include beneficiaries who are enrolled in managed care, but exclude beneficiaries who are covered on a fee-for-service (FFS) basis. This variation in populations can affect measure performance and comparisons between states. This measure has only been publicly reported for two years. CMS does not recommend trending based on two years of reporting. |
| State Health System Performance |
Source: Mathematica analysis of Medicaid and CHIP Program System (MACPro) reports for the Adult Core Set Federal Fiscal Year (FFY) 2019 reporting cycle as of May 31, 2020; see 2019 Child and Adult Health Care Quality Measures. For more information on the Asthma Medication Ratio: Ages 19 to 64 (AMR-AD) measure, visit Adult Health Care Quality Measures. Notes: The following state did not report data to the Centers for Medicare & Medicaid Services (CMS) for ages 51 to 64: VA. The following states did not report data for any age group: AK, HI, ID, IL, ME, MT, ND, NE, NV, OR, SD, and WY. The Adult Core Set specifications include guidance for calculating this measure using the administrative method. Unless otherwise specified, the administrative data source is the state’s Medicaid Management Information System (MMIS) and/or data submitted by managed care plans, including behavioral health plans. Unless otherwise specified:
ACO = Accountable Care Organization; AHRQ = Agency for Healthcare Research and Quality; CCO = Coordinated Care Organization; CHIP = Children’s Health Insurance Program; CMS = Centers for Medicare & Medicaid Services; CY = Calendar Year; ED = Emergency Department; EHR = Electronic Health Record; EQRO = External Quality Review Organization; FFS = Fee for Service; FFY = Federal Fiscal Year; HEDIS = Healthcare Effectiveness Data and Information Set; HMO = Health Maintenance Organization; ICD = International Classification of Diseases; LOINC = Logical Observation Identifiers Names and Codes; MACPro = Medicaid and CHIP Program System; MCO = Managed Care Organization; MMIS = Medicaid Management Information System; NCQA = National Committee for Quality Assurance; NR = Not Reported; PCCM = Primary Care Case Management; PCP = Primary Care Practitioner. | ||
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Promote Effective Prevention & Treatment of Chronic Diseases |
Opioid use is a growing concern in the United States. The opioid epidemic continues to highlight the need for both preventing inappropriate prescribing and providing access to high quality treatment. High dosage opioid use by people without cancer is an indicator of potential overuse and linked to an increased risk of morbidity and mortality. Explore the percentage of adults without cancer who received prescriptions for opioids at high dosage over a period of 90 days or more in each state. Lower rates are better on this measure. The purple dashed line represents the median, or middle, of all values reported. |
This measure reports state performance on the percentage of adults without cancer age 18 and older who received prescriptions for opioids with a daily dosage greater than or equal to 90 morphine milligram equivalents (MME) for 90 days or more. Adults with a cancer diagnosis or in hospice are excluded from this measure. States voluntarily report on Use of Opioids at High Dosage in Persons Without Cancer (OHD-AD) as part of the Core Set of Adult Health Care Quality Measures. These data show performance rates for states that voluntarily reported the measure using Adult Core Set measure specifications. Adult Core Set performance on this measure is being publicly reported for the first time for Federal Fiscal Year (FFY) 2019. The included populations for Adult Core Set measures can vary by state. For example, some states include populations in certain programs, such as beneficiaries covered by Medicaid, but exclude beneficiaries in other programs, such as those dually eligible for Medicare and Medicaid. In addition, states may include beneficiaries in some delivery systems, but exclude other delivery systems. For example, a state may include beneficiaries who are enrolled in managed care, but exclude beneficiaries who are covered on a fee-for-service (FFS) basis. This variation in populations can affect measure performance and comparisons between states. |
| State Health System Performance |
Source: Mathematica analysis of Medicaid and CHIP Program System (MACPro) reports for the Adult Core Set FFY 2019 reporting cycle as of May 31, 2020; see 2019 Child and Adult Health Care Quality Measures. For more information on the Use of Opioids at High Dosage in Persons Without Cancer (OHD-AD) measure, visit Adult Health Care Quality Measures. Notes: The following states did not report data to the Centers for Medicare & Medicaid Services (CMS) for this measure: AK, FL, GA, HI, ID, IL, IN, KY, ME, MT, ND, NM, NV, OR, RI, TX, UT, VA, and WI. The following states reported the measure to CMS, but did not use Adult Core Set specifications to calculate the measure: CO, KS, NJ, NY, OH, and PA. CMS did not include the rates for these states. The Adult Core Set specifications include guidance for calculating this measure using the administrative method. Unless otherwise specified, the administrative data source is the state’s Medicaid Management Information System (MMIS) and/or data submitted by managed care plans, including behavioral health plans. Unless otherwise specified:
ACO = Accountable Care Organization; AHRQ = Agency for Healthcare Research and Quality; CCO = Coordinated Care Organization; CHIP = Children’s Health Insurance Program; CMS = Centers for Medicare & Medicaid Services; CMO = Care Management Organization; CY = Calendar Year; ED = Emergency Department; EHR = Electronic Health Record; EQRO = External Quality Review Organization; FFS = Fee for Service; FFY = Federal Fiscal Year; HEDIS = Healthcare Effectiveness Data and Information Set; HMO = Health Maintenance Organization; ICD = International Classification of Diseases; LOINC = Logical Observation Identifiers Names and Codes; MACPro = Medicaid and CHIP Program System; MCO = Managed Care Organization; MMIS = Medicaid Management Information System; NCQA = National Committee for Quality Assurance; NR = Not Reported; PCCM = Primary Care Case Management; PCP = Primary Care Practitioner. | ||
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Promote Effective Prevention & Treatment of Chronic Diseases |
Treatment for alcohol and other drug (AOD) abuse or dependence can improve health, productivity, and social outcomes. It can also save millions of dollars on health care and related costs. Recommended care for individuals with a new episode of AOD abuse or dependence includes initiating treatment within 14 days of diagnosis (initiation rate) and then continued treatment with two or more additional AOD services or medication treatment within 34 days of the initiation visit (engagement rate). Explore the percentage of adults with a new episode of AOD abuse or dependence who initiated timely treatment and continued engagement with treatment services in each state. This measure reports the treatment initiation and engagement rates among beneficiaries with the following diagnoses:
Higher rates are better on this measure. The purple dashed line represents the median, or middle, of all values reported. |
This measure reports state performance on the percentage of adults age 18 and older with a new episode of AOD abuse or dependence who (1) initiated timely treatment through an inpatient AOD admission, outpatient visit, intensive outpatient encounter or partial hospitalization, telehealth, or medication treatment within 14 days of the diagnosis (initiation rate) and (2) initiated treatment and had two or more additional AOD services or medication treatment within 34 days of the initial visit (engagement rate). States voluntarily report on Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment (IET-AD) as part of the Core Set of Adult Health Care Quality Measures. These data show performance rates for states that voluntarily reported the measure using Adult Core Set measure specifications. The included populations for Adult Core Set measures can vary by state. For example, some states include populations in certain programs, such as beneficiaries covered by Medicaid, but exclude beneficiaries in other programs, such as those dually eligible for Medicare and Medicaid. In addition, states may include beneficiaries in some delivery systems, but exclude other delivery systems. For example, a state may include beneficiaries who are enrolled in managed care, but exclude beneficiaries who are covered on a fee-for-service (FFS) basis. This variation in populations can affect measure performance and comparisons between states. Specifications for this measure changed substantially for Federal Fiscal Year (FFY) 2018. Rates for this measure cannot be trended from FFY 2017 to 2019. |
| State Health System Performance |
Source: Mathematica analysis of Medicaid and CHIP Program System (MACPro) reports for the Adult Core Set FFY 2019 reporting cycle as of May 31, 2020; see 2019 Child and Adult Health Care Quality Measures. For more information on the Initiation & Engagement of Alcohol & Other Drug Dependence Treatment (IET-AD) measure, visit Adult Health Care Quality Measures. Notes: CO did not report separate rates for Alcohol Abuse or Dependence, Opioid Abuse or Dependence, or Other Drug Abuse or Dependence. The following states did not report either the Initiation or Engagement rate for any diagnosis cohorts: AK, AR, DC, GA, ID, ME, MT, ND, NE, NJ, SD, UT, and WY. The Adult Core Set specifications include guidance for calculating this measure using the administrative method. Unless otherwise specified, the administrative data source is the state’s Medicaid Management Information System (MMIS) and/or data submitted by managed care plans, including behavioral health plans. This measure is also specified for calculation using electronic health records. Unless otherwise specified:
ACO = Accountable Care Organization; AHRQ = Agency for Healthcare Research and Quality; CCO = Coordinated Care Organization; CHIP = Children’s Health Insurance Program; CMS = Centers for Medicare & Medicaid Services; CMO = Care Management Organization; CY = Calendar Year; ED = Emergency Department; EHR = Electronic Health Record; EQRO = External Quality Review Organization; FFS = Fee for Service; FFY = Federal Fiscal Year; HEDIS = Healthcare Effectiveness Data and Information Set; HMO = Health Maintenance Organization; ICD = International Classification of Diseases; LOINC = Logical Observation Identifiers Names and Codes; MACPro = Medicaid and CHIP Program System; MCO = Managed Care Organization; MMIS = Medicaid Management Information System; NCQA = National Committee for Quality Assurance; NR = Not Reported; PCCM = Primary Care Case Management; PCP = Primary Care Practitioner. | ||
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Promote Effective Prevention & Treatment of Chronic Diseases |
Among diabetic patients, a Hemoglobin A1c (HbA1c) level greater than 9.0% indicates poor control of diabetes. Poor control of diabetes is a risk factor for complications, including renal failure, blindness, and neurologic damage. Explore the percentage of adults with Type 1 or Type 2 diabetes who had their HbA1c in poor control in each state. Lower rates are better on this measure. The purple dashed line represents the median, or middle, of all values reported. |
This measure reports state performance on the percentage of adults ages 18 to 75 with Type 1 or Type 2 diabetes who had HbA1c in poor control (>9.0%) during the measurement year. This measure aligns with the Centers for Disease Control and Prevention’s 6|18 Initiative focus on providing appropriate diabetes care. The 6|18 Initiative focuses on six common and costly health conditions or health behaviors and highlights evidence-based interventions that can prevent or control those conditions. For information on how to drive improvement on this measure, visit: www.cdc.gov/sixeighteen. States voluntarily report on Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Poor Control (>9.0%) (HPC-AD) as part of the Core Set of Adult Health Care Quality Measures. These data show performance rates for states that voluntarily reported the measure using Adult Core Set measure specifications. The included populations and calculation methods for Adult Core Set measures can vary by state. For example, some states include populations in certain programs, such as beneficiaries covered by Medicaid, but exclude beneficiaries in other programs, such as those dually eligible for Medicare and Medicaid. In addition, states may include beneficiaries in some delivery systems, but exclude other delivery systems. For example, a state may include beneficiaries who are enrolled in managed care, but exclude beneficiaries who are covered on a fee-for-service (FFS) basis. States can also choose to calculate this measure using the administrative or hybrid method. This variation in populations and calculation methods can affect measure performance and comparisons between states. Specifications for this measure changed for Federal Fiscal Year (FFY) 2019. Trending between 2019 and prior years should be considered with caution. |
| State Health System Performance |
Source: Mathematica analysis of Medicaid and CHIP Program System (MACPro) reports for the Adult Core Set FFY 2019 reporting cycle as of May 31, 2020; see 2019 Child and Adult Health Care Quality Measures. For more information on the Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Poor Control (HPC-AD) measure, visit Adult Health Care Quality Measures. Notes: The following states did not report data to the Centers for Medicare & Medicaid Services (CMS) for this measure: AK, AL, AZ, GA, IA, ID, IL, ME, MI, MN, MO, MT, NC, ND, NE, OK, SC, SD, TX, and WY. The following states reported the measure to CMS, but did not use Adult Core Set specifications to calculate the measure: AR and CO. CMS did not include the rate for these states. The Adult Core Set specifications include guidance for calculating this measure using the administrative method or the hybrid method. The hybrid method uses a combination of administrative and medical records data to identify services included in the numerator or to determine exclusions from the denominator based on diagnoses or other criteria. Unless otherwise specified, administrative data sources are the state’s Medicaid Management Information System (MMIS) and/or data submitted by managed care plans; medical record data sources are paper and/or electronic health records. This measure is also specified for calculation using electronic health records. Unless otherwise specified:
ACO = Accountable Care Organization; AHRQ = Agency for Healthcare Research and Quality; CCO = Coordinated Care Organization; CHIP = Children’s Health Insurance Program; CMS = Centers for Medicare & Medicaid Services; CMO = Care Management Organization; CY = Calendar Year; ED = Emergency Department; EHR = Electronic Health Record; EQRO = External Quality Review Organization; FFS = Fee for Service; FFY = Federal Fiscal Year; HEDIS = Healthcare Effectiveness Data and Information Set; HMO = Health Maintenance Organization; ICD = International Classification of Diseases; LOINC = Logical Observation Identifiers Names and Codes; MACPro = Medicaid and CHIP Program System; MCO = Managed Care Organization; MMIS = Medicaid Management Information System; NCQA = National Committee for Quality Assurance; NR = Not Reported; PCCM = Primary Care Case Management; PCP = Primary Care Practitioner. | ||
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Promote Effective Prevention & Treatment of Chronic Diseases |
High blood pressure, or hypertension, increases the risk of heart disease and stroke—the leading causes of death in the United States. Controlling high blood pressure is an important step in preventing heart attacks, strokes, and kidney disease. It also reduces the risk of developing other serious conditions. Explore the percentage of adults diagnosed with hypertension whose blood pressure was adequately controlled in each state. Higher rates are better on this measure. The purple dashed line represents the median, or middle, of all values reported. |
This measure reports state performance on the percentage of adults ages 18 to 85 diagnosed with hypertension with adequately controlled blood pressure, defined as less than 140/90 mm Hg, during the measurement year. This measure aligns with the Centers for Disease Control and Prevention’s 6|18 Initiative focus on blood pressure control. The 6|18 Initiative focuses on six common and costly health conditions or health behaviors, including high blood pressure, and highlights evidence-based interventions that can prevent or control those conditions. For information on how to drive improvement on this measure, visit: www.cdc.gov/sixeighteen. States voluntarily report on Controlling High Blood Pressure (CBP-AD) as part of the Core Set of Adult Health Care Quality Measures. These data show performance rates for states that voluntarily reported the measure using Adult Core Set measure specifications. The included populations and calculation methods for Adult Core Set measures can vary by state. For example, some states include populations in certain programs, such as beneficiaries covered by Medicaid, but exclude beneficiaries in other programs, such as those dually eligible for Medicare and Medicaid. In addition, states may include beneficiaries in some delivery systems, but exclude other delivery systems. For example, a state may include beneficiaries who are enrolled in managed care, but exclude beneficiaries who are covered on a fee-for-service (FFS) basis. States can also choose to calculate this measure using the administrative or hybrid method. This variation in populations and calculation methods can affect measure performance and comparisons between states. Specifications for this measure changed substantially for Federal Fiscal Year (FFY) 2019. Rates are not comparable with rates reported for previous years. |
| State Health System Performance |
Source: Mathematica analysis of Medicaid and CHIP Program System (MACPro) reports for the Adult Core Set FFY 2019 reporting cycle as of May 31, 2020; see 2019 Child and Adult Health Care Quality Measures. For more information on the Controlling High Blood Pressure (CBP-AD) measure, visit Adult Health Care Quality Measures. Notes: The following states did not report data to the Centers for Medicare & Medicaid Services (CMS) for this measure: AK, AZ, GA, IA, ID, IL, ME, MI, MO, MT, NC, ND, NE, OK, SC, SD, and WY. The following states reported the measure to CMS, but did not use Adult Core Set specifications to calculate the measure: AR and CO. CMS did not include the rate for these states. The Adult Core Set specifications include guidance for calculating this measure using the administrative method or the hybrid method. The hybrid method uses a combination of administrative and medical records data to identify services included in the numerator or to determine exclusions from the denominator based on diagnoses or other criteria. Unless otherwise specified, administrative data sources are the state’s Medicaid Management Information System (MMIS) and/or data submitted by managed care plans; medical record data sources are paper and/or electronic health records. This measure is also specified for calculation using electronic health records. Unless otherwise specified:
ACO = Accountable Care Organization; AHRQ = Agency for Healthcare Research and Quality; CCO = Coordinated Care Organization; CHIP = Children’s Health Insurance Program; CMS = Centers for Medicare & Medicaid Services; CMO = Care Management Organization; CY = Calendar Year; ED = Emergency Department; EHR = Electronic Health Record; EQRO = External Quality Review Organization; FFS = Fee for Service; FFY = Federal Fiscal Year; HEDIS = Healthcare Effectiveness Data and Information Set; HMO = Health Maintenance Organization; ICD = International Classification of Diseases; LOINC = Logical Observation Identifiers Names and Codes; MACPro = Medicaid and CHIP Program System; MCO = Managed Care Organization; MMIS = Medicaid Management Information System; NCQA = National Committee for Quality Assurance; NR = Not Reported; PCCM = Primary Care Case Management; PCP = Primary Care Practitioner. | ||
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Promote Effective Prevention & Treatment of Chronic Diseases |
Breast cancer causes approximately 40,000 deaths in the United States each year. Early detection via mammography screening and subsequent treatment can reduce breast cancer mortality for women between the ages of 50 and 74. Explore the percentage of women ages 50 to 74 who had a mammogram to screen for breast cancer in each state. Higher rates are better on this measure. The purple dashed line represents the median, or middle, of all values reported. |
This measure reports state performance on the percentage of women ages 50 to 74 who received a mammogram to screen for breast cancer during the measurement year or two years prior to the measurement year. States voluntarily report on Breast Cancer Screening (BCS-AD) as part of the Core Set of Adult Health Care Quality Measures. These data show performance rates for states that voluntarily reported the measure using Adult Core Set measure specifications. The included populations for Adult Core Set measures can vary by state. For example, some states include populations in certain programs, such as beneficiaries covered by Medicaid, but exclude beneficiaries in other programs, such as those dually eligible for Medicare and Medicaid. In addition, states may include beneficiaries in some delivery systems, but exclude other delivery systems. For example, a state may include beneficiaries who are enrolled in managed care, but exclude beneficiaries who are covered on a fee-for-service (FFS) basis. This variation in populations can affect measure performance and comparisons between states. Specifications for this measure changed substantially for Federal Fiscal Year (FFY) 2018. Rates for this measure cannot be trended from FFY 2017 to 2019. |
| State Health System Performance |
Source: Mathematica analysis of Medicaid and CHIP Program System (MACPro) reports for the Adult Core Set FFY 2019 reporting cycle as of May 31, 2020; see 2019 Child and Adult Health Care Quality Measures. For more information on the Breast Cancer Screening (BCS-AD) measure, visit Adult Health Care Quality Measures. Notes: The following states did not report data to the Centers for Medicare & Medicaid Services (CMS) for this measure: AK, AR, ID, ME, MT, ND, OR, and SD. The Adult Core Set specifications include guidance for calculating this measure using the administrative method. Unless otherwise specified, the administrative data source is the state’s Medicaid Management Information System (MMIS) and/or data submitted by managed care plans, including behavioral health plans. This measure is also specified for calculation using electronic health records. Unless otherwise specified:
ACO = Accountable Care Organization; AHRQ = Agency for Healthcare Research and Quality; CCO = Coordinated Care Organization; CHIP = Children’s Health Insurance Program; CMS = Centers for Medicare & Medicaid Services; CMO = Care Management Organization; CY = Calendar Year; ED = Emergency Department; EHR = Electronic Health Record; EQRO = External Quality Review Organization; FFS = Fee for Service; FFY = Federal Fiscal Year; HEDIS = Healthcare Effectiveness Data and Information Set; HMO = Health Maintenance Organization; ICD = International Classification of Diseases; LOINC = Logical Observation Identifiers Names and Codes; MACPro = Medicaid and CHIP Program System; MCO = Managed Care Organization; MMIS = Medicaid Management Information System; NCQA = National Committee for Quality Assurance; NR = Not Reported; PCCM = Primary Care Case Management; PCP = Primary Care Practitioner. | ||
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Strengthen Person & Family Engagement as Partners in their Care |
This measure reports on states’ use of three experience of care surveys administered to long-term services and support (LTSS) beneficiaries. Surveys included in the count are:
Administration of the three surveys is voluntary. States vary in how often they administer surveys and the proportion of the LTSS population covered by surveys. The count below includes surveys administered since 2018. States may also use other surveys to understand the experiences of their LTSS beneficiaries. |
| State Health System Performance |
Source: Data on states’ HCBS CAHPS administration status were verified by the Centers for Medicare & Medicaid Services (CMS). Data reflect administration between 2018 and 2020. Administration status was not available for Illinois, and CMS was not able to verify information for New Jersey or Rhode Island. Data on states’ NCI administration come from NCI administrative records and reflect administration during the 2018-2019 and 2019-2020 reporting cycles. Data on states’ NCI-AD administration come from NCI-AD administrative records and reflect administration during the 2018-2019 and 2019-2020 reporting cycles. | |||
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Make Care Affordable |
Unnecessary visits to a hospital emergency department (ED) may indicate lack of access to more appropriate sources of medical care, such as primary care providers or specialists. Excessive visits to the ED can result in overcrowding and increased ED wait times. Understanding the rate of ED visits among children covered by Medicaid and Children’s Health Insurance Program (CHIP) can help states identify strategies to improve access to and utilization of appropriate sources of care. Explore the rate of ED visits per 1,000 beneficiary months for children and adolescents in each state. Lower rates are better on this measure. The purple dashed line represents the median, or middle, of all values reported. |
This measure reports state performance on the rate of ED visits per 1,000 beneficiary months for children up to age 19. States voluntarily report on Ambulatory Care: Emergency Department Visits (AMB-CH) as part of the Core Set of Children's Health Care Quality Measures. These data show performance rates for states that voluntarily reported the measure using Child Core Set measure specifications. The included populations for Child Core Set measures can vary by state. For example, some states report a single combined rate for both the Medicaid and CHIP populations, but other states report separate rates for these populations. In addition, states may include beneficiaries in some delivery systems, but exclude other delivery systems. For example, a state may include beneficiaries who are enrolled in managed care, but exclude beneficiaries who are covered on a fee-for-service (FFS) basis. This variation in populations can affect measure performance and comparisons between states. |
| State Health System Performance |
Source: Mathematica analysis of Medicaid and CHIP Program System (MACPro) reports for the Child Core Set Federal Fiscal Year (FFY) 2019 reporting cycle as of May 31, 2020; see 2019 Child and Adult Health Care Quality Measures. For more information on the Ambulatory Care: Emergency Department Visits (AMB-CH) measure, visit Child Health Care Quality Measures. Notes: The following states did not report data to the Centers for Medicare & Medicaid Services (CMS) for this measure: ID, MT, ND and SD. The Child Core Set specifications include guidance for calculating this measure using the administrative method. Unless otherwise specified, the administrative data source is the state’s Medicaid Management Information System (MMIS) and/or data submitted by managed care plans, including behavioral health plans. Unless otherwise specified:
ACO = Accountable Care Organization; ADHD = Attention-Deficit/Hyperactivity Disorder; CCO = Coordinated Care Organization; CHIP = Children’s Health Insurance Program; CMS = Centers for Medicare & Medicaid Services; CPT = Current Procedural Terminology; CY = Calendar Year; ED = Emergency Department; EPSDT = Early and Periodic Screening, Diagnostic, and Treatment; EQRO = External Quality Review Organization; FFS = Fee for Service; FFY = Federal Fiscal Year; HEDIS = Healthcare Effectiveness Data and Information Set; HMO = Health Maintenance Organization; ICD = International Classification of Diseases; LOINC = Logical Observation Identifiers Names and Codes; MACPro = Medicaid and CHIP Program System; MCO = Managed Care Organization; MMIS = Medicaid Management Information System; NCQA = National Committee for Quality Assurance; NR = Not Reported; PCCM = Primary Care Case Management; PCP = Primary Care Practitioner. | ||
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Make Care Affordable |
In the future, the Scorecard will include a measure that reports on Emergency Department visits among adult Medicaid beneficiaries. |
Measure to be included in a future Scorecard. | State Health System Performance | ||||
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Work with Communities to Promote Best Practices of Healthy Living |
Medicaid is the primary payer for long-term care services. CMS and states support service delivery through a range of settings—from institutional care to community-based long-term services and supports. These services can provide beneficiaries with disabilities and chronic conditions:
In the future, the Scorecard will include measures that describe the delivery and outcomes of long-term care services for Medicaid beneficiaries as measures and data become available. |
Measure to be included in a future Scorecard. | State Health System Performance |