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Medicaid Quality Measures Announcement Mirrors Efforts in Other Programs

While some states initiated strong quality enhancement programs (complete with quality bonuses and extra member assignments) years back in their Medicaid programs, most states have been ignoring their abysmal quality track record. Now, more states are doing something about it and waking up to the appallingly low results whether in their fee-for-service (FFS) or managed care programs.

The recent positive movement was in part due to pressure from the federal Centers for Medicare and Medicaid Services (CMS) over the past few years. More recently, the Patient Protection and Affordable Care Act (PPACA) required the Department of Health and Human Services (HHS) to issue core reporting measures to be used in Medicaid. HHS did so by its January 1, 2012 requirement and issued an initial set of 26 quality measures for adults enrolled in Medicaid. A standard format to be used by states is due to be issued by Jan. 1, 2013. Additional measures will be announced in the future.

The measures proposed are not new. They draw from the requirements of a myriad of other programs, such as NCQA HEDIS® measures, Accountable Care Organization (ACO) measures, physician quality reporting measures, EMR/EHR incentive program and CAHPS surveys.

While there will be voluntary reporting initially beginning in late 2013, it is bound to spur Medicaid quality reforms in the laggard states. It also signals a growing role for the federal government in the area of quality in health care. HHS and CMS are driving consistency on the types and rigor of quality measures. There are strong similarities in the quality measures and approach between Medicare Advantage, Medicaid, the ACO pilots, the Medicare physician quality program and Medicare hospital quality program. This Medicaid and Medicare approach is bound to be the basis for quality assurance when the state Exchanges come on line in 2014. PPACA requires Exchange plans to have strong quality programs and Exchanges to collect quality measures from plans.

Whether it is Medicare, Medicaid or commercial lines of business, the federal government will make quality performance and reporting foremost on their agenda moving forward.

Marc Ryan

Marc S. Ryan serves as MedHOK’s Chief Strategy and Compliance Officer. During his career, Marc has served a number of health plans in executive-level regulatory, compliance, business development, and operations roles. He has launched and operated plans with Medicare, Medicaid, Commercial and Exchange lines of business. Marc was the Secretary of Policy and Management and State Budget Director of Connecticut, where he oversaw all aspects of state budgeting and management. In this role, Marc created the state’s Medicaid and SCHIP managed care programs and oversaw its state employee and retiree health plans. He also created the state’s long-term care continuum program. Marc was nominated by then HHS Secretary Tommy Thompson to serve on a panel of state program experts to advise CMS on aspects of Medicare Part D implementation. He also was nominated by Florida’s Medicaid Secretary to serve on the state’s Medicaid Reform advisory panel.

Marc graduated cum laude from the Edmund A. Walsh School of Foreign Service at Georgetown University with a Bachelor of Science in Foreign Service. He received a Master of Public Administration, specializing in local government management and managed healthcare, from the University of New Haven. He was inducted into Sigma Beta Delta, a national honor society for business, management, and administration.

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