The more than 3 million people receiving home and community-based services are not protected by national quality measures. As the nation's elderly population grows, the National Quality Forum is pushing to create standards that use data and measure outcomes.
A new report released this week by the NQF recommends HHS develop a set of performance measures for home and community-based services funded by Medicaid.
"That really does not exist in this, what I call, new world where there are lots of changes in reimbursement and lots of money going to states to refigure and to develop programs,” said Margaret Terry, a senior director at NQF.
States are required to measure the quality of participating providers. but the report found that few assessed performance or developed metrics to measure outcomes.
Home and community-based health programs long have been the biggest drivers of long-term Medicaid spending. In 2014, the services represented 53% of Medicaid spending, or more than $80 billion.
The CMS attempted to address lax oversight of the sector when it issued a final rule that would require states to report standard measures for care provided within Medicaid Managed Care plans. The measures addressed quality of life and community integration.
The report identifies 11 areas that could be assessed, including measuring the ability of patients to make their own choices regarding the support they receive, the level of support made available to caregivers, and the degree to which a provider's workforce is adequately paid and trained.
“You have to see home and community-based services as really different than healthcare as we know it today,” Terry said. “It's sort of a combination of what do you need in order to try to keep people where they want to be, which is in the community.”
The growth in demand for home and community-based services in recent years is driven partly by the shift from fee-for-service reimbursement to a value-based payment model. Another reason is the growing elderly population, which will likely double to more than 83 million by 2050.