NQF Releases Interim Report to CMS on Quality Measures for Dual Eligibles

By Clarke Ross, D.P.A.

The National Quality Forum, a nonprofit membership organization created to develop and implement a national strategy for healthcare quality measurement and reporting, builds consensus on national priorities and goals for performance improvement. The NQF released its interim report to the Centers for Medicare and Medicaid Services (CMS) on quality measures for people dually eligible for Medicare Medicaid. Roughly 3.4 million — almost 40% — of the 9 million people dually eligible are people with disabilities under age 65.

According to the NQF report, “Further Exploration of Healthcare Quality Measurement for the Dual Eligible Beneficiary Population,” the NQF workgroup on persons dually eligible for Medicare and Medicaid is “population-centered,” compared with other federal measurement programs focused on “single settings of care or types of services.” Other highlights of the interim report include the following:

  1. The NQF workgroup recognizes the importance of quality measurement in long-term services and supports rather than long-term care.
  2. The workgroup uses stratification, which is a method used to examine the results associated with distinct groups within a broader population.
  3. The workgroup is developing an “Evolving Core Measure Set,” which focuses on families of measures (related measures and measure gaps that span programs, care settings, levels of analysis, and populations).
  4. The NQF workgroup has identified four high-need populations: people with physical and sensory disabilities; people with medically complex conditions, age 65 and older; people with serious mental illness and/or substance abuse disorders; and people with cognitive disabilities, including those with intellectual and other developmental disabilities. The workgroup also recognizes the co-occurrence and connection between people with these labels. These are areas to be developed, not areas with solid existing standardized measures.
  5. The NQF workgroup recognizes the importance of self-direction.
  6. The NQF workgroup recognized the importance of the following measure gaps because they generally lack a strong empirical evidence base and are not currently administered in a standardized way):
    • Home and community-based settings
    • Sensitive to healthcare disparities
    • Independent living skills
    • Stable housing
    • Self-determination
    • Goal-directed person-centered planning and implementation
    • Connect health system to long-term services and supports
  7. The NQF workgroup is working with another NQF workgroup to use “patient/consumer/person” terminology in reference to patient reported outcome measures. However, its efforts so far have been largely unsuccessful.
  8. The NQF workgroup believes the most important measure gaps are coordination of clinical care and factors outside the health system.
  9. Role of proxy responses.
  10. National Core Indicators.
  11. Personal Outcome Measures/Council on Quality and Leadership.
  12. Consumer and Family Independent Monitoring Teams.
  13. Continuing area of exploration – CAHPS (Consumer Assessment of Healthcare Providers and Systems).
  14. Parsimony. Ideally, a set should include the smallest possible number of measures to achieve a program’s objectives. The NQF recognizes a point made by the Consortium for Citizens with Disabilities (CCD): “Using too few measures will leave stakeholders with only an unclear picture of results and insufficient information.”

In June 2012, the CCD established six advocacy objectives with the NQF. (They are not intended to reflect all important measures related to disability.)

  1. Consumer choice and participant-directed services
  2. Satisfaction: individual experience with services and supports
  3. Percentage in employment or meaningful day activity
  4. Percentage in independent housing — consumer choice, housing appropriateness, stability
  5. Integrated primary and specialty care
  6. Access to timely and appropriate care

With the exception of employment, the NQF interim report addresses the CCD objectives.

Clarke Ross, D.P.A.,  is a member of the National Quality Forum workgroup on persons dually eligible for Medicare and Medicaid (www.qualityforum.org); an NQF representative of the Consortium for Citizens with Disabilities (CCD) Task Force on Long-Term Services and Supports (www.c-c-d.org); policy associate for the American Association on Health and Disability (www.aahd.us) and member of the SAMHSA Wellness Campaign National Steering Committee (http://promoteacceptance.samhsa.gov/10by10/).