Monitoring Duration of Coverage in Medicaid and CHIP to Assess Program Performance and Quality

Abstract

Prospective and retrospective measures of duration were recommended for inclusion in the core set of quality measures. Although the prospective and retrospective measures were ranked high in terms of validity and importance by the Subcommittee on Quality Measures for Children's Health Care in Medicaid and CHIP, concerns were raised about feasibility given that no state currently uses these measures to monitor program performance. Additional technical and financial resources and enhancements to administrative data systems will be needed to support state efforts in this area of quality assessment, particularly in the areas of linking Medicaid and CHIP data files, improving reason for dis-enrollment codes, and improving race and ethnicity coding. Monitoring how well states are doing at enrolling and retaining children in Medicaid and CHIP is a critical component to assessing overall program performance and quality and for interpreting many of the other proposed quality measures.

Are Pediatric Quality Care Measures Too Stringent?

“…3,5,8 Most of the CHIPRA measures were designed for querying health insurance claims data. Claims data, however, do not include the uninsured, 9,10 and may miss care that is delivered but not submitted for billing to the insurance plan. 11,12 .…”

Medicaid and CHIP Children’s Healthcare Quality Measures: What States Use and What They Want

“…However, this limited state experience may be due more to lack of measures than lack of interest. No existing measures of duration of enrollment have been endorsed by a nationally recognized entity such as the National Committee for Quality Assurance or the National Quality Forum, and although the 2 potential measures recommended by Kenney and Pelletier 15 for inclusion in the initial core set may be suitable for future testing, they did not meet selection criteria for the initial core set. 16,17 From the authors' extensive ongoing interactions with Medicaid and CHIP officials, it seems that many more states would like to measure performance on this dimension, both for its utility in assessing enrollment efforts and because continuous enrollment is a prerequisite for valid measurement of quality of care.…”

Feasibility of Evaluating the CHIPRA Care Quality Measures in Electronic Health Record Data

“…The original specifications of the childhood preventive care measures (Table 1, numbers 6 and 7, [9][10][11][12] are also based on an enrolled population. To calculate these measures for 3-to 6-and 12-to 21-year-olds in EHR data, we suggest defining the denominator as children and youth who have $1 clinic visit in a given measurement year and also had $1 visit in the year prior, to identify "established" clinic patients.…”

“…Claims-based measures cannot be used to evaluate care provided to uninsured or discontinuously insured people, however, limiting the measures' usefulness in assessing care quality in a clinic if patients' payers change, or if patients lose coverage but are still seen at the clinic. 8,[12][13][14] This is unfortunate, as such assessments would be particularly helpful in evaluating how health care reforms initiated through the Patient Protection and Affordable Care Act affect care quality. 15 Further, claims data represent bills issued to insurance plans, potentially missing important care information, as not all care is consistently billed; for example, claims may be entered only if providers believe the services will be reimbursed.…”