Quality Measurement

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

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.

NCQA Equity Measurement in Medicaid: AAHD and Lakeshore Foundation Observations

AAHD and the Lakeshore Foundation have responded to the National Committee on Quality Assurance (NCQA) equity measurement in Medicaid white paper. AAHD and Lakeshore were reactors to the October 11 NCQA webinar. Available here are the white paper and webinar slides.

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.”

CMS Meaningful Measures – Value Based Care

The Centers for Medicare and Medicaid Services (CMS) implements a “Meaningful Measures” program. The August 9, 2021 CMS meaningful measures goals and domains are here: PDF.

AAHD seeks to apply these CMS goals, domains, and measures to improve the health and life situation of persons with disabilities. We particularly focus on the CMS areas of outcome and patient reported measures, measures that reflect social determinants of health (SDOH), patient-centeredness, chronic conditions, equity, seamless care coordination, behavioral health, and wellness and prevention.

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 projects to operationally 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
  3. The CMS “meaningful measures” (see above) as important reference points in AAHD’s work.

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) Measure Applications Partnership (MAP) Coordinating Committee (July 2021-present; a 3-year assignment). MAP is the CMS authorized and funded partnership with the NQF.
  2. NQF Medicare Hospital Star Ratings Technical Expert Panel (June-November 2019 and September-October 2020)
  3. NQF workgroup on Medicaid adult measures (appointed in 2016 and 2017),
  4. NQF Medicaid-CHIP Scorecard Committee (October 2018-2019)
  5. NQF Measure Sets and Measurement Systems TEP (June 2019-August 2020).
  6. NQF Workgroup on persons dually eligible for Medicare and Medicaid (July 2012-July 2017)
  7. 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 Dually Eligible Persons Workgroup, 2012-2017)
  8. NQF Population health task force (2013-2014)
  9. NQF 2016-2017 NQF duals workgroup liaison to the NQF clinician workgroup.
  10. NQF 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 (AAHD representative; (2019-present). Dr. Ross serves on the CQMC behavioral health; ACO-PCMH-Primary Care; and Cross-Cutting workgroups.
  2. Special Needs Plans (SNP) Coalition on Medicare Health Outcomes Survey (HOS)
  3. Integrated behavioral health-primary care-and general health efforts including the No Health without Mental Health dialogue with the National Committee on Quality Assurance (NCQA)

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

  1. ACL funded, NQF project on HCBS (home and community-based services)
  2. ACL funded, NQF project – Person-Centered Planning and Practices
  3. Patient Experience and Function Committee
  4. Primary Care and Chronic Illness Committee
  5. Behavioral Health Committee
  6. New NQF MAP workgroup on equity
  7. Former Population and Community Health committee
  8. Former Health and Well-Being committee
  9. CMS-Mathematica Medicaid and CHIP 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.

Quality Measurement Entities

Document is available here: PDF.

Quality Measurement – 10 Issues

AAHD is a member of the NCQA (National Committee on Quality Assurance) Consumer Advisory Council. Available here are the November 22  AAHD & Lakeshore Foundation presentation of 10 quality measurement issues to the NCQA CAC: PDF.

Health Care Quality Metrics and Measures – Resource Guide for Aging and Disability

Available here is the December 20 ACL Aging and Disability Business Institute “Health Care Quality Metri cs and Measures” resource guide: PDF.

Behavioral Health Quality Measures

In response to an invitation to be interviewed by the National Committee on Quality Assurance (NCQA), AAHD provided the attached behavioral health quality measures submission prior to the April 24 interview: PDF.

Quality Measures – AAHD and Lakeshore Foundation to NCQA

AAHD and the Lakeshore Foundation submitted an outline of quality measures priorities and interests to the May 2 spring meeting of the National Committee on Quality Assurance (NCQA); the outline is here: PDF.

Quality Measures and Persons with Disabilities – Connections

AAHD and the Lakeshore Foundation presented an overview of three federal policy issues and their connection to quality measures at the National Committee for Quality Assurance (NCQA) Consumer Advisory Council. AAHD is a CAC member. The October 10 presentation outline is here: PDF.