Medicaid and CHIP children's healthcare quality measures: what states use and what they want

Abstract

Objective: The objective of this research was to explore state Medicaid and Children's Health Insurance Program (CHIP) use of children's healthcare quality measures and the need for additional support as the Children's Health Insurance Program Reauthorization Act (CHIPRA) legislation is being implemented.

Methods: This summary analysis draws from a December 2008 survey of state CHIP programs fielded by the National Academy for State Health Policy (NASHP) and a February 2009 survey of Medicaid and CHIP programs conducted by Health Management Associates (HMA).

Results: Nearly all (90%) Medicaid and CHIP directors rate children's health care quality as a high priority (7 or above on a 10-point scale). Almost all state Medicaid programs collect performance measures from plans or providers and almost all CHIP programs collect pediatric performance measures from managed care organizations, although significantly fewer collect such data from fee-for-service providers. Most state programs also collect encounter data, perform enrollee surveys, and utilize medical record reviews. Fewer track duration of enrollment in coverage or analyze measures for disparities by race and ethnicity. Almost all state programs feel that their quality improvement efforts have led to positive changes. Less than one third believe current measures are adequate, almost two thirds seek better measures of care coordination, and roughly half agreed better outcome measures are needed. Many state programs supplement existing standard measures with their own state-developed measures.

Conclusion: The surveys' findings of high levels of state children's health care quality measurement and improvement activity and interest suggest that new federal CHIPRA provisions are coming at an opportune time. To achieve significant state participation in measuring and reporting on children's access to quality care, national programs need to be guided not only by national priorities but by state goals, capacity, and practice.