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Figure 1. Medicaid and CHIP Leaders’ Views of Their State’s Top Children’s Health Priorities. Number of states. (N=53). Source: Health Management Associates/Commonwealth Fund Child Health Quality Survey, 2009. Figure 2. Performance Measures Currently in Use. - PowerPoint PPT Presentation
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Figure 1. Medicaid and CHIP Leaders’ Views ofTheir State’s Top Children’s Health Priorities
47
27
47
29
10
36
0
10
20
30
40
50
Quality Healthy Living Access
Number rating the topic 7–10 out of 10
Number rating the topic 9–10 out of 10
Source: Health Management Associates/Commonwealth Fund Child Health Quality Survey, 2009.
Number of states(N=53)
Figure 2. Performance Measures Currently in Use
91 89
70 66
15
88 86 8371
17
100 100
18
45
9
0
20
40
60
80
100
HEDIS accessmeasures
HEDISeffectiveness ofcare measures
State-developedmeasures
CAHPS patientexperience with
care surveys
Other measures included in
NQF-endorsednational measure
sets
% Total (N=53) % Medicaid (N=42) % CHIP (N=11)
Source: Health Management Associates/Commonwealth Fund Child Health Quality Survey, 2009.
Percent of programs using each measure
Figure 3. Other State-Developed Measures
Source: Health Management Associates/Commonwealth Fund Child Health Quality Survey, 2009.
• Early and Periodic Screening, Diagnosis and Treatment Rates, reported to the Centers for Medicare & Medicaid Services in the CMS–416 Report; or specific measures related to EPSDT such as developmental testing, lead screening, and immunization rates
• Modifications of standard HEDIS questions (e.g., well-child visits in the first 15 months; lead screening)• Dental CAHPS Survey; other dental measures (e.g., access to dental care for children with
special needs)• Some AHRQ measures (e.g., taken from the National Quality Measures Clearinghouse)• Process of care measures (e.g., use of beta agonists for asthma; diabetic care; vision)• Youth Behavioral Risk Factor Surveillance Survey• Increased health services utilization (general)• Preventable hospitalizations (also known as ambulatory care–sensitive conditions)• Post-hospital discharge follow-up care• Mental health measures, e.g., attempted suicide rate or depression screening• Member satisfaction survey developed and used by multipayer group• Readmission rates• Disease management reports• Child Health Assessment and Monitoring Program (CHAMP) and Pregnancy Risk Assessment
Monitoring (PRAMS)• Adolescent preventive care measures (e.g., sexual activity, depression, tobacco, and substance abuse
screening and counseling rates)• Childhood obesity measures• Birth outcomes• Bright Futures
Figure 4. Beliefs of State OfficialsAbout the Adequacy of Current Measures
Source: Health Management Associates/Commonwealth Fund Child Health Quality Survey, 2009.
% Total(N=53)
% Medicaid(N=42)
% CHIP(N=11)
Currently available measures are adequate right now for Medicaid and/or CHIP 28 24 45
Currently available measures are not adequate right now for Medicaid and/or CHIP 26 31 9
Medicaid and CHIP could do a better job to improve care for children and adolescents if there were:
Additional measures 75 79 64
Improvements in existing measures 74 76 64
Figure 5. States Reporting an Interest in New Measures
61
4943 41
21 19
6757
5042
2719
37
18 18
37
0
18
0
20
40
60
80
100
Coordinationof care
Mental healthscreening
Mental healthtreatment
Dental careaccess
Adolescentaccess to
familyplanning
counseling
Patient safety
% Total (N=53) % Medicaid (N=42) % CHIP (N=11)
Source: Health Management Associates/Commonwealth Fund Child Health Quality Survey, 2009.
Percent of programs indicating each area
Figure 6. Improved Measurement Strategies or MethodologiesThat States Report Would Be Beneficial
52
38
29
62
40
29
18
28 28
0
20
40
60
80
100
Measures that focus onoutcomes rather than
process of care
Fewer, less burdensomemeasures
Standardization of measurement definitions
and specifications
% Total (N=53) % Medicaid (N=42) % CHIP (N=11)
Source: Health Management Associates/Commonwealth Fund Child Health Quality Survey, 2009.
Percent of programs reporting each improvement
Figure 7. States’ Use of Incentives to Promote Quality Improvement
4
67
5243
21 17 1750
90 0 0
131319
3447
58
2727
0
20
40
60
80
100
Reportinghealth plan
performance
Publicreporting,e.g., web-
basedreports, onhealth planor individual
providerperformance
Financialbonus for
performanceon specificmeasures
Financialpenalty forfailing to
reach target
Reportingperformanceof individual
providers
Auto- enrollment
to healthplans basedon quality
performance
Denial ofpayment forpoor care,
such asmedicalerrors
% Total (N=53) % Medicaid (N=42) % CHIP (N=11)
Source: Health Management Associates/Commonwealth Fund Child Health Quality Survey, 2009.
Percent of programs using each incentive
Figure 8. Programs’ Priorities for Technical Assistance
75
62
5147 47
43
73
61
5045
57
40
82
6354 55
9
54
0
20
40
60
80
100
Nationalbenchmarkingdatabase for
qualityimprovement
Information onwhat other
states are doing
Disparitiesbenchmarking
database
Training inapplying andpresenting
qualitymeasures
Support of HITcapacity andtraining forproviders
Information ortraining on howto use existing
measures
% Total (N=53) % Medicaid (N=42) % CHIP (N=11)
Source: Health Management Associates/Commonwealth Fund Child Health Quality Survey, 2009.
Percent of programs indicating each initiative
