This measure is important because the CMS Core Sets of healthcare quality measures for adult and children are often used to provide a snapshot of quality within Medicaid. They are not comprehensive, but prior to their creation and implementation, performance measurement varied greatly by state, and it was not possible to glean an overall picture of quality. Statute requires CMS to release annual reports on behalf of the Secretary on the reporting of state-specific adult Medicaid quality information. 

The trendline above demonstrates DVHA’s commitment to increasing our CMS Core Set measure production. Doing so is key to the state’s ability to keep pace with other state Medicaid plans and to evaluate the effectiveness of our payment reform models.  Additionally, states’ ability to report on all Child and Behavioral Health Core Measures becomes mandatory starting with the Federal Fiscal Year (FFY) 2024 reporting period 

One of the biggest challenges that DVHA faces related to performance measure production has to do with measures that require gathering clinical elements from medical records. The Quality Unit has worked diligently over the past five years to develop and grow an in-house Medical Records Review (MRR) team consisting of both administrative coordinators (Quality Unit) and clinical supervisors and record reviewers (Clinical Services Team). It is this complex effort that created the growth in the trend line shown above.

Narrative last updated:  12/21/2022

• DVHA Data Unit
• DVHA Clinical Services Team
• Quality measure production vendor

As we strive to report on all performance measures within the CMS core quality measure sets by FFY 2024, the Quality Improvement team: 

• Partners with the Data Unit to maintain an already high level of accurate and complete reporting;
• Actively engages in annual budgetary and health IT conversations related to performance measure set reporting;
• Continually improves our process for medical record collection from providers’ offices.