Developing Quality Measures for Medicaid Beneficiaries with Schizophrenia: Final Report

Despite enormous expenditures and innovations in treatment, the United States health care system
does not consistently deliver effective treatment to individuals with serious mental illnesses. 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
payors and providers and enabling greater transparency and accountability. The purpose of this project
was to identify, specify, and test at least three measures that address 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 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 were pilot tested using MAX data. They address 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 30 days. [149 PDF pages]