Spotlight on: Medicaid Managed Care Quality Rating System

Accurate, robust, transparent quality measures are a feature of the Centers for Medicare & Medicaid Services (CMS) National Quality Strategy that support the delivery of high quality, equitable, person-centered health care. CMS Quality Reporting Programs (QRPs), which are already in place across multiple programs and care settings, will soon expand standardized quality reporting approaches to include Medicaid and the Children’s Health Insurance Program (CHIP). Following the publication of the Medicaid and CHIP Managed Care Access, Finance, and Quality final rule in April 2024, CMS will require states to publicly report performance on a required measure set for all managed care programs. States will also be required to implement a quality rating system (QRS) for Medicaid and CHIP managed care programs, using quality measures and other program information that allows stakeholders to compare managed care plans based on quality and other factors.

Capabilities

Abt Global has a long history of developing, monitoring, reporting publicly on quality measures for CMS, including the Home Health and Hospice QRPs, and supporting the Five-Star Quality Rating System to support selection of nursing homes. Abt teams expertly manage all phases of the quality measure lifecycle delineated in CMS’s Measures Management System “Blueprint,” from information gathering through measure implementation and public reporting. Abt collaborates with CMS and other contractors to advance health equity, expanding standardized social determinants of health data collection, and stratifying existing quality measures by key organizational and beneficiary characteristics to identify disparities in patient populations. We then help develop rating systems and website improvements that make performance information more understandable, enabling consumers to choose high quality providers.

Technical Areas of Expertise

Abt’s teams include data scientists, economists, policy experts, clinicians, and others from a range of backgrounds with expertise in quality measure development and implementation, measurement science, assessment instrument development, quantitative and qualitative testing and analysis, and public reporting. Our teams are experienced in engaging with key stakeholders and interested parties, so that quality programs and measures are responsive to their perspectives. Abt uses multiple data sources, such as claims, measure results and assessment data, and various methods—including descriptive exploration and policy simulations—to inform quality strategy priorities and policy decisions. We synthesize key findings and translate complicated analyses into clear, concise, and user-friendly content for various audiences in multiple formats. Reports present trends in quality measure performance overall and are stratified by key subgroups such as dual-Medicare and Medicaid enrollment.

Relevant Experience   
 

Home Health (HH) and Hospice Quality Reporting Programs (QRPs) Support and Home Health Value-Based Purchasing (HH VBP) Expanded Model  
Client: Centers for Medicare & Medicaid Services

Abt is providing ongoing support for quality measure development, monitoring, and public reporting in the HH and hospice QRPs, including development, testing, and implementation of new quality measures, and the maintenance of—and updates to—the standardized home health and hospice patient assessment instruments. We also support the implementation, ongoing maintenance, and refinement of the national Home Health Expanded Value-Based Purchasing Model.

Strategic Medicaid & CHIP Managed Care  
Client: CMS

Under this contract, Abt is conducting comprehensive Medicaid and CHIP managed care monitoring and oversight for all managed care programs. The project aim is to improve the organization and standardization of managed care data to help states and CMS assess program performance and quality improvement holistically. The team is creating and disseminating tools and resources to help states develop integrated delivery systems and comply with statutory and regulatory provisions; as well as generating technical and policy resource guides and informational/educational materials. Additionally, as needs arise from state Medicaid managed care programs, the team provides technical assistance on an array of managed care topics, and supports CMS by implementing business process improvements, bolstering a vital program for millions of beneficiaries across the country.

Care Compare: 5-Star Quality Rating System 
Client: CMS

Families throughout the U.S. are benefitting from Abt’s support of CMS’s Care Compare for Nursing Homes website and its Five-Star Quality Rating System. Care Compare includes detailed information on almost all U.S. nursing homes, including numerous measures of regulatory compliance, staffing, and quality of care. Both Care Compare and Five-Star are updated monthly. For the monthly updates, Abt runs the data through a sequence of several dozen programs that perform an extensive series of quality checks, calculate the Five-Star ratings and other information displayed on Care Compare, and create a set of downloadable public use files. Abt also supports CMS in developing new measures, including claims-based hospitalizations and Emergency Department (ED) visit measures and measures of nursing staff turnover.