CMS is working with 37 states on quality measurement in Medicaid and the Children’s Health Insurance Program, the agency shared Sept. 25.
The initiative, called “Investing in Health Outcomes,” allows states to sign onto a voluntary pledge centered on prioritizing health outcomes over processes, streamlining quality measure inventories, adopting digital quality measurement with near-real-time data when possible and aligning financial accountability with outcomes measures.
In May, CMS analyzed Medicaid managed care programs in 42 states, identifying roughly 450 reporting requirements linked to about 260 unique quality measures. Many focused on utilization and processes. Differences between state requirements can contribute to reporting burden and challenges drawing comparisons, CMS said. For example, the news release said diabetes control could be considered using different A1C cutoffs.
The pledge has earned bipartisan support from governors. The initial state participants have about 56 million Medicaid and CHIP beneficiaries and account for roughly $701 billion in fiscal 2024 Medicaid spending, according to Medicaid.gov.
“Taxpayers deserve to know their dollars are making a genuine, lasting difference. Through this pledge, Utah is doubling down on accountability in Medicaid — aligning and modernizing quality data reporting enables us to better focus resources toward proactive chronic disease care, prevention and behavioral health,” Utah Republican Gov. Spencer Cox said. “When we measure success by actual health outcomes rather than dollars spent, both our state’s budget and our communities win.”
CMS said it will host workshops on value-based arrangements, lowered reporting burden and digital quality measurement.
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