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Measuring the Quality of Medicaid Services for People Who Are Aging or Disabled 

Measuring the Quality of Medicaid Services for People Who Are Aging or Disabled 


For some Medicaid members, quality of care also is about “quality of life.” People with intellectual and/or developmental disabilities (ID/DD) and those in need of long-term services and supports (LTSS) often require supprt for daily living and social activities, employment and transportation.

Assessing the quality and impact of services delivered to these individuals has been difficult due to the highly specialized and unique services they require. In fact, there is no consensus among the federal government and state Medicaid agencies about which quality measures are most appropriate for these groups. This makes it challenging to identify opportunities to improve programs that serve these individuals.

A Growing Demand 

The demand for Medicaid LTSS and ID/DD services is anticipated to rise, particularly as the nation’s population ages. Increased investment in specialized care will be required in the near future, heightening the need for a sound approach to quality measurement.  

The Case for Consistent, Meaningful Measurement

What is needed is the development of quality measures that capture what’s uniquely important to the well-being and lives of Medicaid members who have disabilities or who are of advanced age. That means assessing not only the quality of clinical services, but also examining: 

·  Social and behavioral supports. 
·  How individual goals are being met.
·  Satisfaction with living arrangements.
·  Access to employment and services such as transportation.

·  Extent of self-care and independence.
·  Feeling secure and respected.
·  Overall well-being and quality of life.

 

Widespread adoption of a common set of measures will give state Medicaid agencies much-needed information to shape program design and structure, to direct Medicaid resources effectively, and to benchmark performance against other states and over time.

Looking to Experts for Solutions

To help bring consistency to quality measurement for these Medicaid groups, UnitedHealthcare convened an independent National Advisory Board (NAB) of aging and disability experts, advocates and consumer representatives. The NAB developed the first comprehensive quality measurement frameworks uniquely suited to ID/DD and LTSS Medicaid members. These frameworks go beyond quantifying the use and quality of clinical, social and behavioral services to assess health outcomes and quality of life. Moreover, the frameworks may be instituted by states and managed care organizations with the data systems and tools already in place.

UnitedHealthcare is moving forward to implement these frameworks in its managed Medicaid programs across the nation. The measurement frameworks are available for use by any Medicaid managed care plan and by any state that has or is contemplating a managed Medicaid program.

Learn More

For more information about this topic or the frameworks developed by NAB, please contact: MedicaidQuality@uhc.com


References 

1      University of Minnesota Families Information Systems Project, Supporting Individuals with Intellectual or Developmental Disabilities and Their Families: Status and Trends Through 2013.  
2      The Arc, Still in the Shadows with Their Future Uncertain: A Report on Family and Individual Needs for Disability Supports2011. 
3      Ervin, Hennen, Merrick and Morad, Healthcare for Persons with Intellectual and Developmental Disability in the Community
4      Medicaid and CHIP Payment Access CommissionBehavioral Health in the Medicaid Program—People, Use, and Expenditures. June 2015. 
5      Tricia Burke, Dual Diagnosis: Overview of Therapeutic Approaches for Individuals with Co-Occurring Intellectual/ Developmental Disabilities and Mental Illness for Direct Support Staff & Professionals Working in the Developmental Disability System. 2013. 
6      Kaiser Family Foundation, Medicaid and Long-Term Services and Supports: A Primer
7      Reinhard, Feinberg, Choula and Houser, Valuing the Invaluable 2015 Update: Undeniable Progress, but Big Gaps Remain
8      Kaiser Family Foundation, Medicaid and Long-Term Services and Supports: A Primer.

Measuring the Quality of Medicaid Services for People Who Are Aging or Disabled 


For some Medicaid members, quality of care also is about “quality of life.” People with intellectual and/or developmental disabilities (ID/DD) and those in need of long-term services and supports (LTSS) often require supprt for daily living and social activities, employment and transportation.

Assessing the quality and impact of services delivered to these individuals has been difficult due to the highly specialized and unique services they require. In fact, there is no consensus among the federal government and state Medicaid agencies about which quality measures are most appropriate for these groups. This makes it challenging to identify opportunities to improve programs that serve these individuals.

A Growing Demand 

The demand for Medicaid LTSS and ID/DD services is anticipated to rise, particularly as the nation’s population ages. Increased investment in specialized care will be required in the near future, heightening the need for a sound approach to quality measurement.  

The Case for Consistent, Meaningful Measurement

What is needed is the development of quality measures that capture what’s uniquely important to the well-being and lives of Medicaid members who have disabilities or who are of advanced age. That means assessing not only the quality of clinical services, but also examining: 

·  Social and behavioral supports. 
·  How individual goals are being met.
·  Satisfaction with living arrangements.
·  Access to employment and services such as transportation.

·  Extent of self-care and independence.
·  Feeling secure and respected.
·  Overall well-being and quality of life.

 

Widespread adoption of a common set of measures will give state Medicaid agencies much-needed information to shape program design and structure, to direct Medicaid resources effectively, and to benchmark performance against other states and over time.

Looking to Experts for Solutions

To help bring consistency to quality measurement for these Medicaid groups, UnitedHealthcare convened an independent National Advisory Board (NAB) of aging and disability experts, advocates and consumer representatives. The NAB developed the first comprehensive quality measurement frameworks uniquely suited to ID/DD and LTSS Medicaid members. These frameworks go beyond quantifying the use and quality of clinical, social and behavioral services to assess health outcomes and quality of life. Moreover, the frameworks may be instituted by states and managed care organizations with the data systems and tools already in place.

UnitedHealthcare is moving forward to implement these frameworks in its managed Medicaid programs across the nation. The measurement frameworks are available for use by any Medicaid managed care plan and by any state that has or is contemplating a managed Medicaid program.

Learn More

For more information about this topic or the frameworks developed by NAB, please contact: MedicaidQuality@uhc.com


References 

1      University of Minnesota Families Information Systems Project, Supporting Individuals with Intellectual or Developmental Disabilities and Their Families: Status and Trends Through 2013.  
2      The Arc, Still in the Shadows with Their Future Uncertain: A Report on Family and Individual Needs for Disability Supports2011. 
3      Ervin, Hennen, Merrick and Morad, Healthcare for Persons with Intellectual and Developmental Disability in the Community
4      Medicaid and CHIP Payment Access CommissionBehavioral Health in the Medicaid Program—People, Use, and Expenditures. June 2015. 
5      Tricia Burke, Dual Diagnosis: Overview of Therapeutic Approaches for Individuals with Co-Occurring Intellectual/ Developmental Disabilities and Mental Illness for Direct Support Staff & Professionals Working in the Developmental Disability System. 2013. 
6      Kaiser Family Foundation, Medicaid and Long-Term Services and Supports: A Primer
7      Reinhard, Feinberg, Choula and Houser, Valuing the Invaluable 2015 Update: Undeniable Progress, but Big Gaps Remain
8      Kaiser Family Foundation, Medicaid and Long-Term Services and Supports: A Primer.

For some Medicaid members, quality of care also is about “quality of life.” People with intellectual and/or developmental disabilities (ID/DD) and those in need of long-term services and supports (LTSS) often require supprt for daily living and social activities, employment and transportation.

Assessing the quality and impact of services delivered to these individuals has been difficult due to the highly specialized and unique services they require. In fact, there is no consensus among the federal government and state Medicaid agencies about which quality measures are most appropriate for these groups. This makes it challenging to identify opportunities to improve programs that serve these individuals.

A Growing Demand

The demand for Medicaid LTSS and ID/DD services is anticipated to rise, particularly as the nation’s population ages. Increased investment in specialized care will be required in the near future, heightening the need for a sound approach to quality measurement.  

The Case for Consistent, Meaningful Measurement

What is needed is the development of quality measures that capture what’s uniquely important to the well-being and lives of Medicaid members who have disabilities or who are of advanced age. That means assessing not only the quality of clinical services, but also examining: 

· Social and behavioral supports.
· How individual goals are being met.
· Satisfaction with living arrangements.
· Access to employment and services such as transportation.
· Extent of self-care and independence.
· Feeling secure and respected.
· Overall well-being and quality of life.

Widespread adoption of a common set of measures will give state Medicaid agencies much-needed information to shape program design and structure, to direct Medicaid resources effectively, and to benchmark performance against other states and over time.

Looking to Experts for Solutions

To help bring consistency to quality measurement for these Medicaid groups, UnitedHealthcare convened an independent National Advisory Board (NAB) of aging and disability experts, advocates and consumer representatives. The NAB developed the first comprehensive quality measurement frameworks uniquely suited to ID/DD and LTSS Medicaid members. These frameworks go beyond quantifying the use and quality of clinical, social and behavioral services to assess health outcomes and quality of life. Moreover, the frameworks may be instituted by states and managed care organizations with the data systems and tools already in place.

UnitedHealthcare is moving forward to implement these frameworks in its managed Medicaid programs across the nation. The measurement frameworks are available for use by any Medicaid managed care plan and by any state that has or is contemplating a managed Medicaid program.

Learn More

For more information about this topic or the frameworks developed by NAB, please contact: MedicaidQuality@uhc.com



References