Measuring and improving the quality of care for children and adults in Medicaid and the Children’s Health Insurance Program (CHIP) is a high priority for the Centers for Medicare & Medicaid Services (CMS) and its Center for Medicaid and CHIP Services (CMCS).
Mathematica leads the Technical Assistance (TA) and Analytic Support Program for the Medicaid and CHIP Quality Measurement and Improvement Program. This program includes support for a core set of children’s health care quality measures (Child Core Set), a core set of adult health care quality measures (Adult Core Set), core sets of health home quality measures (Health Home Core Sets), and a range of other activities.
The goals of this project are to: (1) provide the support states need to reliably collect, calculate, and report the Core Set measures; (2) help states use the Core Set measures to inform decisions about policies, programs, and practices to improve the quality of care they provide to Medicaid and CHIP beneficiaries; and (3) disseminate and translate findings so that CMCS, states, and other quality partners can share emerging best practices and lessons learned related to collecting, reporting, and using the Core Sets of quality measures to drive improvement.
Mathematica also helps CMCS with other high-priority initiatives, such as monitoring and supporting mandatory reporting of the Child Core Set, Health Home Core Sets, and behavioral health measures in the Adult Core Set; designing and implementing the Medicaid and CHIP Quality Rating System; building state capacity for digital quality measurement; using alternate data sources to calculate Core Sets measures; modernizing Core Set and other analytics products; helping states use managed care quality tools more effectively; and creating the next generation of quality improvement offerings.
Project highlights
TA and training. Mathematica provides states with one-on-one TA through a TA mailbox, group TA through webinars and affinity groups, and large-scale TA through the CMS Quality Conference. We also prepare TA resources that are posted on Medicaid.gov. Issues raised by states inform annual updates to the technical specifications and resource manuals that guide the measure calculation, and suggest topics for cross-cutting TA resources. Priority TA topics include (1) helping states with measure stratification to advance the use of Core Set measures; and (2) addressing challenges with measure calculation to improve the quality and completeness of Core Set reporting.
Annual Core Set review. As specified in the Children’s Health Insurance Program Reauthorization Act (CHIPRA) and the Affordable Care Act, the Child and Adult Core Sets must be reviewed by an external work group annually. These work groups are charged with identifying gaps in the existing Core Sets and recommending updates to strengthen the Core Sets. Mathematica convenes the work groups and produces annual reports with the work group recommendations.
Annual Core Set updates. Each year, Mathematica updates the technical specifications and resource manuals (including value sets) and other reporting resources (such as a data quality checklist) for the Core Sets. All materials are posted by CMS on Medicaid.gov, and we share updates through an annual training with states when the new reporting cycle opens.
Analytics and reporting. Mathematica conducts statistical analyses of the Core Set measures for annual public reporting by the secretary of the U.S. Department of Health and Human Services (as specified in CHIPRA and the Affordable Care Act). This includes reviewing data quality, developing tables and graphics, and preparing reports to Congress. Signature data products include the Core Set Data Dashboard, which shows state performance on the Core Set measures, a Medicaid and CHIP beneficiary profile and infographic, and topical infographics (such as oral health, sickle cell disease, maternal health, attention-deficit/hyperactivity disorder, autism, child and adolescent behavioral health, and adult behavioral health). In addition, the Mathematica Core Set TA team helps CMCS produce data for the Health Care Quality Performance section of the Medicaid & CHIP Scorecard.
Learning and diffusion. In collaboration with CMCS, we develop and conduct webinars to help states calculate, report, and use the Core Set measures, such as the dental sealant, developmental screening, or antipsychotic medication measures in the Child Core Set or the substance use disorder measures in the Adult Core Set. We also help CMCS plan and implement the Medicaid and CHIP sessions of the annual CMS Quality Conference, including selecting and preparing presenters, producing slide decks, and providing other logistical and content support. In addition, we plan and facilitate Quality Technical Advisory Group (QTAG), Oral Health Technical Advisory Group (OTAG), and Medicaid and CHIP Quality eXChange (MAC QX) meetings, providing CMCS and state participants with structured opportunities to share lessons learned, discuss implementation challenges, and highlight best practices in quality measurement and improvement.
Medicaid and CHIP managed care quality. Mathematica leads efforts to strengthen managed care quality oversight by assessing state compliance with federal quality requirements, analyzing managed care quality findings and performance trends, and providing targeted TA to help states enhance the effectiveness and consistency of their managed care programs. We review states’ external quality review (EQR), quality assessment and performance improvement (QAPI), and quality strategy (QS) activities to ensure alignment with federal requirements and conduct analyses to better understand the performance measures and performance improvement projects (PIPs) used to assess and improve quality, timeliness, and access. We also provide TA to help states better leverage managed care quality activities more strategically to drive quality improvement. In addition, we support CMCS by reviewing state directed payment proposals and developing and testing prototypes for a Medicaid and CHIP quality rating system (MAC QRS) using human-centered design.
Quality Improvement TA initiatives. Mathematica partners with CMCS to provide quality improvement (QI) TA to states and their quality partners using three primary strategies: (1) self-directed skill-building resources that states could acquire and apply to any QI project; (2) topic-specific, on-demand resources to help states confidently launch QI projects; and (3) opportunities to work with and learn from QI coaches and other states to develop and implement a QI project as part of an affinity group. Resources include how-to videos on conducting QI projects and toolkits that support improvement in children’s oral health care and postpartum care in Medicaid and CHIP. Current affinity groups focus on improving hypertension control and behavioral health screenings among pregnant and postpartum women, enhancing early childhood preventive care, and increasing dental screenings for children. Previous affinity groups have focused on improving asthma control, postpartum care, oral health care, behavioral health care follow-up, care for children and youth in foster care, and infant well-child care.
TA to support Transforming Maternal Health (TMaH) Model. Mathematica is working with CMS to prepare for and provide TA to a cohort of Center for Medicare and Medicaid Innovation (CMMI) state Medicaid agency awardees and their partners, for a new maternal health-focused model called TMaH. TMaH is a ten-year payment and care-delivery model, testing whether targeted TA to state Medicaid agencies that includes payment reforms, expanded workforce, and implementation of evidence-based approaches and risk-appropriate care can reduce rates of low-risk c-section, severe maternal morbidity and low-birth-weight infants, and improve the experience of care for pregnant and postpartum Medicaid beneficiaries and their newborns. During the three-year pre-implementation period, we are providing state Medicaid agencies, managed care entities and providers intensive TA to build capacity to implement the TMaH care delivery elements and payment model.
Other tasks. Mathematica frequently assists CMCS with other tasks, such as convening expert work groups, conducting ad hoc analyses of Medicaid and CHIP data, and providing expert input on new and emerging quality measurement and improvement initiatives.
