National Quality Forum
The National Quality Forum (NQF) builds consensus on national priorities and goals for performance improvement. Under contract with the Department of Health and Human Services (HHS), the NQF Measure Applications Partnership (MAP) establishes a portfolio of quality measures to report and improve healthcare quality in all HHS funded programs.
On July 1, 2015, Clarke Ross of AAHD was re-appointed to a second three year termed member of the NQF workgroup on persons dually eligible for Medicare and Medicaid (www.qualityforum.org) representing the Consortium for Citizens with Disabilities (CCD) Task Force on Long Term Services and Supports (www.c-c-d.org). Dr. Ross has also served on the NQF population health, post-acute care/long term care committee, clinician workgroup, and 2017 member of the Medicaid Adult Measures Task Force. Dr. Ross carefully follows the work of the following NQF committees: home-and-community-based services; socio-demographic status factors and risk-adjustment, health-and-well-being, Medicaid children, patient- reported outcomes, person- and- family centered- care, behavioral health, and disparities.
Nearly 9 million people, including 5.5 million low-income seniors and 3.4 million people with disabilities under the age of 65, are dually eligible for and enrolled in both Medicare and Medicaid. 66% of the beneficiaries have 3 or more chronic conditions; 61% have a cognitive or mental impairment; and 86% of these persons have incomes below 150% of poverty. These persons have complex but highly varied needs.
The disability movement endorses an “independent living” paradigm and philosophy, rather than a “medical model” paradigm and philosophy. CCD has identified six gaps in existing quality standards as they directly relate to persons with disabilities. These are consumer and family centered measure areas. They are not intended to reflect all important measures to disability. The six consumer and family measure areas are:
- Consumer Choice and Participant-Directed Services
- Satisfaction: Individual Experience with Services and Supports
- % in employment or meaningful day activity
- % in independent housing – Consumer choice, housing appropriateness, stability
- Integrated primary and specialty care
- Access to timely and appropriate care
In addition to existing measures, there are successful models of third-party, independent, consumer and family operated monitoring teams to assist in determining individual experience with services and supports.
NQF MAP (Measure Applications Partnership) Identification of Gaps
As of June 2016, 9 High Priority Measure Gaps
- Goal-directed, person-centered care planning and implementation
- Shared decision-making
- Systems to coordinate healthcare with non-medical community resources and service providers
- Beneficiary sense of control/autonomy/self-determination
- Psychosocial needs
- Community integration/inclusion and participation
- Optimal functioning (e.g., improving when possible, maintaining, managing decline)
- Home and community-based services
- Affordable and effective care