CMS Scorecard for Medicaid, CHIP Measures Draws Scrutiny From State Directors

Allison Inserro

CMS Monday released a scorecard that reports quality metrics voluntarily reported by states for Medicaid and the Children’s Health Insurance Program (CHIP), as well as federally reported measures, but the association that represents state Medicaid directors expressed some concerns with the scorecard’s data and what sorts of conclusions may be drawn from them, given the huge variability of state programs, essentially giving it a score of “needs improvement.”

CMS said that it is the “first time” it is publishing state and federal administrative performance metrics; the first 3 areas to be included are state health system performance, state administrative accountability, and federal administrative accountability. Health metrics include things like well-child visits, mental health conditions, children’s preventive dental services, and other chronic health conditions.

In its own release, the National Association of Medicaid Directors (NAMD) said that it has been reporting Medicaid performance data to different agencies and organizations for years, including CMS, and called the first-time inclusion of federal data “commendable.”

Matt Salo, the head of the NAMD, which represents state Medicaid directors, said that they have concerns about “the comparability, accuracy, and timeliness of the data” and “conclusions that may be drawn when making comparisons across states with significantly different structures and care delivery approaches.”

The scorecard needs improvement, like using an “accurate and comparable data set,” Salo said.

It also needs “meaningful context for using the data,” adding that “differences in eligible patient populations, covered benefits, delivery models, and types of measures used impact availability of data and calculation of results.”

CMS said that the scorecard is “a central component of the Administration’s commitment to modernize the Medicaid and CHIP program through greater transparency and accountability for the program’s outcomes.” The information “begins to offer taxpayers insights into how their dollars are being spent and the impact those dollars have on health outcomes.”

“Despite providing health coverage to more than 75 million Americans at a taxpayer cost of more than $558 billion a year, we have lacked transparency in the performance and outcomes of this critical program,” CMS Administrator Seema Verma said in a statement. She said the scorecard will be used “to track and display progress being made throughout and across the Medicaid and CHIP programs, so others can learn from the successes of high performing states. By using meaningful data and fostering transparency, we will see the development of best practices that lead to positive health outcomes for our most vulnerable populations.”

In a follow-up email to The American Journal of Managed Care®, Salo said that NAMD wanted to point out that the scorecard is “a beta version” and is important as a first step.

“I think the primary thing we’re saying is that individual states have been focused on quality metrics and system improvement for a long time, for example through HEDIS [Health Plan Employer Data and Information Set] measurements, or CAHPS [Consumer Assessment of Healthcare Providers and Systems]. Those efforts were all about helping that state measure and improve its own performance,” he said.
“But given that 50+ states are in fact quite different from one another, efforts to measure national outcomes or cross-state comparisons have been few and far between. There isn’t much point in bench-marking across states if the data just doesn’t support doing so in a responsible way.”
He said the benchmarking goal “is aspirational” and said NAMD is “happy to work with CMS to make progress on this” but wants the data to be meaningful.

“Otherwise you’re not comparing apples to apples, or even apples to oranges,” he said, “it can be like apples to fruit salad.”
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