Health care reform promises to make insurance benefits newly available to many, eliminate inequitable treatment limits and financial requirements, and promote integrated primary and behavioral health care. Quality measures can help achieve the full promise of these reforms by providing feedback to payers and providers, and enabling greater transparency and accountability. This project identified and tested measures that addressed pharmacological treatment, psychosocial treatment, and physical health needs for individuals with schizophrenia that can be calculated solely from Medicaid claims data. The psychosocial treatment measure was eventually dropped because procedure codes used in claims data are ambiguous, lacking sufficient detail to reflect the actual service provided and these codes are not used consistently in different states and programs. Ten measures in the other domains were pilot tested using Medicaid Analytic eXtract (MAX) data. They addressed the following concepts: use of antipsychotic medications, antipsychotic medication possession ratio, diabetes screening, diabetes monitoring, cardiovascular health screening, cardiovascular health monitoring, cervical cancer screening, emergency department utilization for mental health conditions, and follow-up after mental health hospitalization within seven days and within thirty days.
Five of the ten proposed measures demonstrated significant variability in state-level performance, indicating general utility of the measures. Seven of the ten proposed measures demonstrated evidence of either construct or convergent validity.
Report Title: Developing Quality Measures for Medicaid Beneficiaries with Schizophrenia: Final Report http://aspe.hhs.gov/daltcp/reports/2012/schqm.shtml
Agency Sponsor: OASPE, Office of the Assistant Secretary for Planning and Evaluation
Federal Contact: Kirsten Beronio, 202-690-6443
Contract Performer: Mathematica Policy Research, Inc.
Record ID: 10218 (June 26, 2013)