Quality Measure Development: Dual Enrollees, Managed Long-Term Services and Supports, and Medicaid Innovation Accelerator Programs

Prepared for
U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services, Center for Clinical Standards and Quality

More Americans now receive health coverage through Medicaid or the Children’s Health Insurance Program (CHIP) than any other source of insurance; in 2018, more than 70 million Americans were enrolled in these programs according to the Centers for Medicare & Medicaid Services (CMS). To better understand the quality of care provided through these programs, CMS has contracted with Mathematica to develop reliable and valid quality measures.

Specifically, this work addresses critical gaps in quality measures for:

  • People eligible for both Medicare and Medicaid, often referred to as “dual eligible beneficiaries”
  • Beneficiaries with disabilities and older adults receiving long-term services and supports (LTSS) in institutions or home- and community-based settings through managed care organizations
  • Beneficiaries with substance use disorders, conditions that require the integration of behavioral and physical health services, conditions that require long-term services or supports, or complex conditions that lead to high use of emergency room visits and hospital care

Although some quality measures already exist for specific services that Medicaid provides to these groups, few measures assess outcomes of care. CMS is aiming to develop better measures related to care coordination, transitions across care settings, quality of life and community integration for people with disabilities, use of preventive services, management of behavioral health problems, and avoidance of unnecessary emergency room visits and hospital and nursing home admissions.   

Mathematica is joined in this effort by the National Committee for Quality Assurance and Brandeis University. The measure development process builds on work of the National Quality Forum, follows guidelines established in the Blueprint for the CMS Measures Management System, and includes multiple opportunities for stakeholder engagement and feedback. This project is one of the first national efforts to systematically develop a set of quality measures focused on Medicaid beneficiaries.

Please contact MedicaidQualMeasures@mathematica-mpr.com with any questions.