Developing Quality Measures for Medicaid Beneficiaries with Schizophrenia: Final Report. I. Overview of the Project

01/30/2012

Despite enormous expenditures and remarkable breakthroughs in medical treatment, the United States behavioral health care system does not consistently deliver safe and effective treatment to those with serious and persistent mental illness (SPMI), many of whom go untreated or inadequately treated. Now, as the nation stands at the doorstep of fundamental reforms that offer insurance benefits for those without them, remove inequitable treatment limits and financial barriers to mental health treatments, and promote integrated primary and behavioral health care, we have an enormous opportunity to close the gap between the availability of effective treatments and providing them in a manner that promotes recovery. By enhancing transparency, new quality measures that promote feedback to providers and enable value-based purchasing represent an essential tool to achieve the full promise of these reforms.

In August 2010, the U.S. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation (ASPE) contracted with Mathematica Policy Research and its subcontractor--the National Committee for Quality Assurance (NCQA)--to develop evidence-based quality measures to assess the quality of care provided to Medicaid enrollees diagnosed with schizophrenia. The goal of the project was to create a set of claims-based ambulatory care measures that meet National Quality Forum (NQF) criteria for importance, scientific acceptability, usability, and feasibility and would thus be suitable for submission to the NQF for endorsement consideration.

The project began with a review of existing literature and other evidence describing evidence-based practices for people with schizophrenia. Assisted by expert consultants, this effort emphasized the findings of the Schizophrenia Patient Outcomes Research Team (PORT) and allowed the team to create concepts for new measures that assess the quality of medication management, underuse of evidence-based psychosocial treatments, and access to primary care and preventive health services. Once the measure concepts were vetted by a Technical Advisory Group (TAG), we developed draft specifications and sought comment from measure stakeholders, including representatives from managed behavioral healthcare organizations (MBHOs), Medicaid medical directors, and state mental health directors to assess their perspectives on the importance, scientific acceptability, usability, and feasibility of the proposed measures. After these key stakeholders gave their input, measure specifications were posted for public comment, and they were pilot-tested using Medicaid Analytic eXtract (MAX) data from 2007 and 2008 to further assess their feasibility, reliability, and validity. Throughout the project, the project team received valuable advice and guidance from ASPE, members of the TAG, and our project consultants.

This report presents a chronology of the process, key findings, and lessons learned during our project to develop claims-based measures of services provided to Medicaid enrollees with schizophrenia that meet key NQF criteria. Chapter II reviews that process and describes how several findings in our data collection changed the course of measure development. Chapter III summarizes key findings from our field and pilot-testing efforts, and Chapter IV discusses lessons learned that we hope will improve the process of measure development and the quality of the resulting measures. The appendices contain all key documents produced throughout the project, including material presented at each TAG meeting, pilot-testing results, and the candidate measure summary information.

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