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), a core set of health home quality measures (Health Home Core Set), and a range of other activities.
The goals of this project are to accomplish the following: (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 is helping CMCS with other high-priority initiatives, such as implementing mandatory reporting of the Child Core Set, Health Home Core Set, and behavioral health measures in the Adult Core Set; designing and implementing the Medicaid and CHIP Quality Reporting System; building state capacity for digital quality measures; using alternate data sources to calculate Core Sets measures; modernizing Core Sets 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 various 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 three 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 chart packs showing state performance on the Core Set measures, a Medicaid and CHIP beneficiary profile and infographic, and topic-specific infographics (such as oral health, sickle cell disease, child and adolescent behavioral health, and adult behavioral health). In addition, the Mathematica Core Set TA team helps CMCS produce data for the State Health System Performance pillar 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 track of the annual CMS Quality Conference, including selecting and preparing presenters, producing slide decks, and providing other logistical and content support. In addition, Mathematica has produced toolkits for states to help drive improvement in children’s oral health care and postpartum care in Medicaid and CHIP.
Medicaid and CHIP managed care quality. The Mathematica TA team analyzes states’ external quality review (EQR)-related activities annually, including performance measures and performance improvement projects (PIPs) used to measure and improve quality, timeliness, and access. We also assess regulatory compliance of states’ EQR technical reports and quality strategies and analyze alignment of the performance measures reported in the Core Sets against those included in state EQR technical reports and quality strategies. Mathematica also supports CMCS’s state directed payment review process. We also are helping CMCS develop and test prototypes for a quality rating system 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. 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 will provide 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.
