Simpson View Graph # 1

OUTLINE

What States Are Doing Now

What Is Available Now

Mechanisms to Influence Quality

Choosing a Strategy

What Should Be Available in ‘99 & ‘00

Next Steps

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WHAT STATES ARE DOING NOW

Use of Quality Measures in Medicaid

- Collection of measures

- Use of measures

Proposed Approaches in SCHIP Plans

- Quality in separate programs

- Performance measures

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STATE USE OF PERFORMANCE DATA, 1996-97

Quality Indicator PlanningToCollect

Provide ToHealthPlans

Provide ToEnrollees

Target ForImprovement

SATISFACTION 82 79 38 43

ACCESSTranslatorsSpecialty Care

6277

3235

2918

1013

QUALITYPrenatal CareImmunizations

91100

6880

2118

5367

Landon BE. Et al. Jan. 1998. JAMA 279 (3)

Simpson View Graph # 4

WHAT IS AVAILABLE NOW

HEDIS

- Childhood immunizations

- Adolescent immunizations

- Well child visits in 15 months

- Well child visits in 3rd to 6th year

- Adolescent well care

- CAHPS for 0 - 12 years

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MECHANISMS TO INFLUENCE QUALITY

Value-Based Purchasing

Consumer Information & Choice

Quality Improvement

Public Health Monitoring

Regulation

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CHOOSING A STRATEGY:USE OF MEASURES

Level of Accountability

Short Versus Long Term

Standardization Vs. Innovation

QMAS

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Level of Accountability

Provider Health plan State/Community

Structure % weekend hrs.days wait for WCC

-# pediatricians-health plan stability

-% plans accredited-educationalcampaigns

Process -% immunized-treated w/ respect

-% immunized-asthma care-lead screening-% injury counseling

-% immunized-EPSDT rates-HIV education-care for CSHN-lead screening

Outcome -preventablehospitalizations

-school absenteeism-injury rate-% LBW

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CHOOSING A STRATEGY:STATE CHARACTERISTICS

Target Population

State Goals

Types of Plans Available

Market Share

Data Available

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CHOOSING A STRATEGY:DATA AVAILABLE

Health Plan Data

State Specific

Models From Other States

National Data

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CHOOSING A STRATEGY: CRITERIA FOR MEASURES & MEASURE SETS

Relevance

Scientific Soundness

Feasibility

Comprehensiveness

Balance

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CRITERION: RELEVANCE

Important

Meaningful

Potential for Improvement

Variation

Controllability

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CRITERION: SCIENTIFIC SOUNDNESS

Clinical Evidence

Process-Outcome Link

Reproducible

Valid

Accurate

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CRITERION: FEASIBILITY

Precisely Specified

Reasonable Cost

Logistically Feasible

Auditable

Confidentiality

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WHAT SHOULD BE AVAILABLE IN 1999 AND 2000

Adolescent Survey Instrument

CAHPS Chronic Illness Instrument

RAND Global Quality Assessment Tool

Adolescent Mental Health

Avoidable Hospitalizations

Functional Status Measures