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NQF Measure Applications Partnership (MAP) Dual Eligible Beneficiaries Workgroup

Guidance for the NQF Measure Applications Partnership (MAP) Dual Eligible Beneficiaries Workgroup, which provides recommendations to the Centers for Medicare & Medicaid Services (CMS) on quality and performance measures for Medicare-Medicaid enrollees (also known as dual eligible beneficiaries).

Final

Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: November 17, 2016

The National Quality Forum (NQF) Measure Application Partnership (MAP) Dual Eligible Beneficiaries Workgroup provides recommendations to the Centers for Medicare & Medicaid Services (CMS) on quality and performance measures for Medicare-Medicaid enrollees (also known as dual eligible beneficiaries).  Focusing on the quality improvement opportunities with the largest potential impact, the Workgroup has been working with CMS in developing recommendations for constructing a measurement framework, identifying available measures, identifying gaps in available measures, and proposing modifications and/or new measure concepts to fill those gaps.  The workgroup also advises the NQF MAP Coordinating Committee on a coordination strategy for measuring readmissions and healthcare-acquired conditions and on pre-rulemaking input to the Department of Health and Human Services (HHS) on the selection of measures for various settings.  Specific workgroup tasks include:

  • Assessment of the quality issues specific to the population of dual eligible beneficiaries and identification of high-leverage opportunities for improvement.
  • Construction of a measurement framework appropriate to the unique needs of dual eligible beneficiaries.
  • Identification of current measures that address the identified quality issues and potential for stratification by duals status for reporting of such measures.
  • Identification of critical measure development and endorsement gaps.
  • Proposed modifications to existing measures for dual eligible beneficiaries.
  • Identification of measure concepts for future measure development.
  • Advice to the Coordinating Committee on their pre-rulemaking input to HHS on measures to improve quality across settings, based on the workgroup’s knowledge of the unique needs of the dual eligible population.

The workgroup has recommended to CMS an evolving starter set of specific measures for immediate use that are sensitive to the unique needs of dual eligible beneficiaries, including measures of patient/caregiver experience, hospital readmissions, care transitions, detecting and treating depression, use dependence treatment, and screening older adults for fall risk.  The Federal Coordinated Health Care Office (Medicare-Medicaid Coordination Office [MMCO]) incorporated this starter set into the Financial Alignment Initiative through payment and evaluation quality measures in both models.  This starter set serves also as the foundation for the quality strategy for all Medicare-Medicaid enrollees.

The workgroup further recommended a core set that it felt should be expanded to provide guidance for further measurement development work as well as measure gaps that should be overcome by development of key measures within critical areas important to indicate high quality care for Medicare-Medicaid enrollees. MMCO is working  to move forward in assessing and implementing the suggestions stemming from meeting discussions and the resulting reports.

This partnership is continuing, and the workgroup’s efforts are continuing to inform CMS by providing assessments of efforts relating to measure areas identified as high-opportunity measurement areas (e.g. person-centered care, care coordination, multiple chronic conditions, mental health, community integration, and caregiver/beneficiary experience, etc.); identifying and exploring opportunities for key subpopulations; and recommending ways to address priority gaps for the Medicare-Medicaid enrollee subpopulations.  

Additional information, including reports, meeting materials, and information on panel members, may be found at: http://www.qualityforum.org/MAP/Dual_Eligible_Beneficiaries/?section=2014Events2014-02-052014-02-19#t=1&s=&p=


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