Using the Core Set of Quality Measures

The National Evaluation reports provide useful insights into their strategies and lessons learned:

• Evaluation Highlight No. 1: How are CHIPRA demonstration States approaching practice-level quality measurement and what are they learning?
• Evaluation Highlight No. 4: How the CHIPRA quality demonstration elevated children on State health policy agendas
• Evaluation Highlight No. 5: How are the CHIPRA Quality Demonstration States encouraging health care providers to put quality measures to work?
• Evaluation Highlight 11: How are CHIPRA quality demonstration States using quality reports to drive health care improvements for children?

Learn more about quality measurement for children on this page:

• Increased Attention to Quality Measures for Children
• Demonstration Project Activities
• Evaluating these Projects

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Increased Attention to Quality Measures for Children

Accurate measures of quality provide the foundation for better and more efficient health care. In particular, nationally recognized and well-tested quality measures can drive quality improvement activities for children enrolled in Medicaid and CHIP. Moreover, Federal and State agencies can use a comprehensive set of such measures to track the performance of the health system for children and identify areas needing improvement.

When it was enacted in 2009, CHIPRA set in motion a series of initiatives that have led to a vigorous and multifaceted national effort to (a) develop valid and reliable measures of quality of care for children, (b) encourage State Medicaid and CHIP agencies to report these measures to CMS, and (c) promote the use of these measures to improve quality of care for children enrolled in Medicaid and CHIP. The CHIPRA quality demonstration projects highlighted in Table 1 are important examples of the many efforts currently underway nationwide to achieve these goals. Other important efforts include:

• The Secretary of Health and Human Services releases an annual report on the Quality of Care for Children in Medicaid and CHIP (PDF).
• Through the CHIPRA Technical Assistance and Analytic Support Program, CMS offers technical assistance to States to help them develop, report, and use the core set of quality measures.
• As part of the Pediatric Quality Measures Program (PQMP), the Agency for Healthcare Research and Quality (AHRQ) has funded seven centers of excellence to develop new quality measures for children.
• CHIPRA Webinar on Care Coordination Measures for Children with Medical Complexity (May 12, 2015)

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Demonstration Project Activities

As Table 1 shows, 10 States are implementing projects using the initial set of 24 core quality measures for children that was released by the U.S. Secretary of Health and Human Services in January 2010. This measure set addresses a wide range of high-priority topics including: preventive services, treatments for acute conditions, availability of care in a range of ambulatory and inpatient settings, and duration of insurance coverage. The State projects involve several different kinds of activities. Some States are using grant funds to support the collection and reporting of the entire core set; some are focusing on selected measures; and some are developing and testing additional State-specific measures. In addition to collecting and reporting these quality measures to CMS, some States are using the measures to produce performance reports for providers, families, managed care plans, and policymakers (Table 2).

 Table 1. Demonstration States' Producing and Reporting Core Measures

 Table 2. Using Core Measures to Improve Quality

Source: Information gathered from the demonstration States in 2011 through telephone calls and project documents.
Note: * denotes Grantee. Oregon is partnering with Alaska and West Virginia. Florida is partnering with Illinois.

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Evaluating these Projects

In the context of multiple efforts to improve measures of the quality of health care for children, the national evaluation team will assess the demonstration projects by integrating quantitative and qualitative information from CMS reports, a multi-State physician survey, key informant interviews, focus groups with parents, and review of project documents to address a wide range of questions, such as:

• What resources helped grantees collect and report the core measures?
• What methods did grantees use to report core measures back to consumers and practices?
• How did stakeholders (health plans, providers, and consumers) use these measures?
• Compared with States that did not have CHIPRA grants, what was the impact of these demonstrations on the capacity of State systems to improve health care to children?

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Learn More About the CHIPRA Quality Demonstration

This page summarizes projects that States are implementing under the first category (Category A), using a set of core quality measures to enhance the quality of children's health care. To learn about the other grant categories, please use the left navigational bar, organized by 5 areas of focus.

Please note: This Web site uses the term "national evaluation" to distinguish this evaluation of the entire demonstration program from evaluations commissioned or undertaken by grantees. The word "national" should not be interpreted to mean that findings are representative of the United States as a whole.