- Quality measures should be well-tested, evidence-based, peer-reviewed, and focused on measuring the health outcomes of individuals. Particular attention should be given to ensuring metrics are representative of the growing diversity of managed care enrollees and their health care needs, such as behavioral health and long-term services and supports.
- As CMS considers a nationwide quality rating framework, it should build on the successful models already underway in many states. States should continue to serve as testing grounds for innovative quality measurement and reporting approaches.
- It will be critical to assess on an ongoing basis whether and to what extent quality rating systems are able to effectively drive changes in consumer, health plan and provider behavior. Additional work should focus on ensuring that consumer-facing quality ratings are clear, relevant, and align with consumers' other priorities related to health plan selection.
- The "Nuts and Bolts" Behind Quality Measurement in Medicaid Managed Care . This first paper explores the state of quality measurement in state Medicaid programs and makes several recommendations to improve quality measures.
- Balancing Standardization and State Flexibility in Medicaid Quality Measurement and Reporting . This paper analyzes the variation in current state approaches to quality measurement for Medicaid MCOs and discusses the trade-offs between standardization of measures and state flexibility to innovate and use state-specific measures.
- The Impact of Medicaid Quality Rating Systems on Consumer, Health Plan and Provider Behavior . The final paper examines state-developed quality rating systems that help consumers compare quality among health plans, with the goal of encouraging them to consider health plan quality when selecting a plan.
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