Quality Measurement

and Persons with Disabilities: An AAHD Area of Focus

The American Association on Health and Disability is regularly and actively directly involved in health and related “quality” measurement, that impacts and affects persons with disabilities.

Defining Health Care Quality

The National Academy of Medicine defines health care quality as:

“Quality is the degree to which health services for individuals and population increase the likelihood of desired health outcomes and are consistent with current professional knowledge.”

National Quality Strategy

The Department of Health and Human Services (HHS) and its Centers for Medicare an Medicaid Services (CMS) has declared a “National Quality Strategy” which has a “Triple Aim.”  The strategy’s triple aim is:

  1. Improving the patient experience of care (better care)
  2. Improving the health of populations (healthy people and healthy communities)
  3. Reducing the per capita cost of health care (affordable care)

AAHD seeks to apply these aims to persons with disabilities, to improve the health and life situation of persons with disabilities.

National Quality Forum (NQF)

Much of AAHD’s health quality work is done through the National Quality Forum.

Created in 1999 – NQF is a multi-stakeholder non-profit organization to ensure patient protections and health care quality through measurement and public reporting. The NQF public role and relationship to federal government programs was greatly enhanced through expectations and funding through  the Affordable Care Act.

The NQF Vision: every person experiences high-value care and optimal health outcomes

Person-Centered Approach

While still not clearly opeartionally defined, AAHD and most participants support and seek a health and support approach where the individual beneficiary and participant is the center of all efforts. Both the National Quality Forum (NQF) and Administration for Community Living (ACL) have current projects to opeartioanlly define and implement this concept.

AAHD Quality Priorities

American Association on Health and Disability, Consortium for Citizens with Disabilities (CCD) Task Force on LTSS (long-term services and supports), and Disability and Aging Collaborative (DAC) LTSS quality work group priorities are:

  1. Home-and-Community-Based Services and Supports (HCBS)
  2. “Patient” Reported Outcomes (PROs) – Beneficiary-Recipient-Consumer Reported Experiences

American Association on Health and Disability Engagement

Since 2012, AAHD public policy director Dr. Clarke Ross has served on a variety of National Quality Forum committees. These include:

  1. National Quality Forum (NQF) workgroup on Medicaid adult measures (2017; then December 2017-present),
  2. Medicaid-CHIP Scorecard Committee (October 2018-present)
  3. Measure Sets and Measurement Systems TEP (June 2019-present).
  4. Workgroup on persons dually eligible for Medicare and Medicaid (July 2012-July 2017)
  5. NQF representative of the Consortium for Citizens with Disabilities (CCD) Task Force on Long Term Services and Supports ( http://www.c-c-d.org/) (to Dual Eligible Persons Workgroup, 2012-2017)
  6. Population health task force (2013-2014)
  7. 2016-2017 NQF duals workgroup liaison to the NQF clinician workgroup.
  8. 2015-2016 and 2014-2015 NQF duals workgroup liaison to the NQF PAC/LTC (post-acute care/long term care) workgroup.

Other Quality Measurement Projects with Dr. Clarke Ross involvement:

  1. CMS-America’s Health Insurance Plans-NQF “Core Quality Measures Collaborative” project
  2. Special Needs Plans (SNP) Coalition on Medicare Health Outcomes Survey (HOS)

Special NQF Projects/Initiatives that AAHD Closely Monitors and Seek Input

  1. ACL funded, NQF project on HCBS (home and community-based services) Measures
    [Consistent with CMS HCBS Settings Rule and Medicaid evolved Self-Direction Practices]
  1. ACL funded, NQF project – Person-Centered Planning and Practices
  2. Population and Community Health
  3. Health and Well-Being
  4. Behavioral Health
  5. Integrated Behavioral Health-Primary Care-Physical Health
  6. Social Determinants of Health and Disparity Response Mechanisms
  7. Patient Experience and Function
  8. CMS-Mathematica Core Measure Set project

Existing Measure Sets that AAHD Advocates:

  1. National Core Indicators
  2. Personal Outcome Measures
  3. CAHPS-HCBS Experience Survey
    [CAHPS – Consumer Assessment of Healthcare Providers and Systems]

Clinical Quality Measures:

AAHD also monitors and attempts to apply clinical quality measures to persons with disabilities. CMS defines a clinical quality measure as “a tool that quantifies healthcare processes, outcomes, patient perceptions, and organizational structures and/or systems associated with the ability to provide high-quality health care and/or that relate to one of more quality goals for health care; and, is supported by the evidence.