What Is the PQMP?

Origin

Together, Medicaid and the Children's Health Insurance Program (CHIP) serve more than 35 million children annually, representing one in two children in the United States. Medicaid and the CHIP play a key role in ensuring that low-income children get healthcare coverage, access to a comprehensive set of benefits, and other medically necessary services. The Department of Health and Human Services (HHS) is working closely with States, health plans, and providers to ensure a high-quality system of care for children in Medicaid/CHIP.

In 2009, Congress passed the Children's Health Insurance Program Reauthorization Act (CHIPRA, Public Law 111-3) (PDF, 403 KB), which presented an unprecedented opportunity to measure and improve health care quality and outcomes for the Nation's children, including those enrolled in Medicaid/CHIP. When CHIPRA was enacted, the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare & Medicaid Services (CMS) began working together to implement selected provisions of the legislation related to children's healthcare quality.

The law called first for identification of an initial set of core measures to be used to voluntarily assess the state of children's health care quality across and within State Medicaid and CHIP programs. It then called for establishment of the CHIPRA Pediatric Quality Measures Program (PQMP) to improve and strengthen the "Initial Core Set" (now called the "Child Core Set") of measures and develop new measures as needed.

The PQMP is a central component of the overall HHS strategy for implementing CHIPRA to support State Medicaid/CHIP agencies in collecting and reporting on the core set of standardized child health quality measures in alignment with other quality measures collected by States, health plans, and providers. The primary goal for the Child Core Set—and, more broadly, the implementation of pediatric quality measures—is to achieve better care, a healthier population, and affordable care as identified in the National Quality Strategy (NQS).

Initial Phase: 2011 to 2015 (Completed)

As identified in CHIPRA, Title IV, Sec. 401, the PQMP was established to increase the portfolio of evidence-based, consensus pediatric quality measures available to public and private purchasers of children's health care services. The initial phase of the PQMP focused on developing new and enhanced pediatric measures to improve children’s quality of care through cooperative agreement grants with PQMP—Centers of Excellence.

In 2011, through the funding announcement "CHIPRA Pediatric Healthcare Quality Measures Program Centers of Excellence (U18)" [RFA HS-11-001], AHRQ and CMS jointly awarded seven cooperative agreement grants totaling $64 million to Centers of Excellence (COEs) composed of multiple entities across the United States. The grants were administered by AHRQ and funded by CMS.

Forming a broad coalition of consumer stakeholders, health services researchers, and State agency partners to inform its work, each COE applied diverse talents and expertise to investigating and finding solutions to some of the most pressing issues in child health quality measurement.

Through the initial phase of the program, the COEs developed pediatric quality measures across diverse areas (including perinatal care, child clinical preventive services, and management of chronic and acute conditions). The COEs tested the performance of these measures against specific criteria identified in the CHIPRA legislation, and then submitted the measures to AHRQ via the Candidate Measure Submission Form (CPCF).

Beginning in 2016, the COEs were provided additional support for the submission of measures to the National Quality Forum (NQF). A number of measures have been endorsed by NQF or are being prepared to be submitted for endorsement.

Phase 2: 2016 to 2021

In 2015, Congress passed the Medicare Access & CHIP Reauthorization Act (MACRA, Public Law 114-10) (PDF, 313 KB), providing funds to extend the PQMP (MACRA, Title III, Sec. 304(b)). A new phase of the PQMP, funded through the funding announcement "Pediatric Quality Measures Program (PQMP): Dissemination and Implementation of Child Health Quality Measures Cooperative Research Grants (U18)" [RFA-HS-16-002], builds on the work previously completed in the initial phase with a shift in focus to disseminating and implementing the PQMP-COE measures.

While the initial phase of the PQMP supported measure development, PQMP 2.0 supports refinement, demonstration, quality improvement (QI), and performance monitoring. More specifically, PQMP 2.0 focuses on assessing the feasibility and usability of the newly developed PQMP-COE measures at the State, health plan, and provider levels.

In October 2016, AHRQ and CMS announced awards totaling $13.4 million (allocated over 4 years) to six PQMP grantees. The table below lists each grantee's principal investigator and institution.