The states also are not adequately tracking patient experience-of-care measures based on individuals' goals and preferences. In addition, there are few metrics for assessing whether states are making progress on keeping people out of long-term care facilities and allowing them to remain in home- and community-based settings.
Among the many challenges that states, managed care plans, and the CMS face in designing and implementing these demonstration projects is how to choose and apply measures that accurately track changes in quality and performance over time. The authors examined quality measures chosen by eight states with federally approved memorandums of understanding for their demonstrations as of December 2013: California, Illinois, Massachusetts, New York, Ohio, South Carolina, Virginia and Washington.
It's largely not the states' fault that they are not tracking quality issues adequately, said Sabiha Zainulbhai, a co-author of the policy brief and a health policy analyst at the National Academy of Social Insurance. On the core list of metrics the CMS has required states to monitor, these types of quality-of-life measures are not mandatory. That's because there are not adequate federal measurements for such issues, explained Lee Goldberg, study co-author and vice president for health policy at the National Academy of Social Insurance.
As a result, some states are voluntarily tracking particular issues, Zainulbhai said. For instance, Illinois is the only state studied that is tracking long-term care and hospital utilization related to urinary tract infection or bacterial pneumonia.
Goldberg said she hopes organizations like the National Committee for Quality Assurance will develop performance measures on quality-of-life issues for programs serving dual eligibles.
NCQA has begun working with several managed care plans that serve dual eligibles to identify best practices for treating this population. That research could lead to the creation of new Healthcare Effectiveness Data and Information Set (HEDIS) quality measures, said Jessica Briefer French, a senior consultant for research at NCQA.
The demonstration projects are taking place under the CMS' Financial Alignment Initiative, a program established by the Patient Protection and Affordable Care Act. The goal of the program is to better coordinate care for the 9.1 million beneficiaries who receive coverage from both Medicare and Medicaid. These individuals cost the federal government around $350 billion a year. A total of 26 states applied to participate in the program, with only 10 states thus far getting the formal go-ahead to begin building programs.
Most of the state demonstrations have yet to launch, with the exception of Massachusetts, which began enrollment Oct. 1, 2013. The rest have begun or are just about to begin taking in patients.