National Advisory Council Subcommittee: Identifying Quality Measures for Medicaid-eligible Adults

The Affordable Care Act requires the Secretary of the Department of Health and Human Services (HHS) to identify and publish a core set of health quality measures for Medicaid-eligible adults. To help facilitate an evidence-based and transparent process for prioritizing measures, the National Advisory Council of the Agency for Healthcare Research and Quality (AHRQ) created a Subcommittee for identifying quality measures for Medicaid-eligible adults. This report documents the process, deliberations, and results of the Subcommittee's efforts. The Subcommittee's advice was reported to the Chair of AHRQ's National Advisory Council and was considered further by officials from the Centers for Medicare & Medicaid Services (CMS) and staff in the Office of the Secretary of the HHS prior to this public posting.

With assistance from the CMS, AHRQ staff identified nearly 1,000 measures for evaluating the quality of care for adults from measures endorsed by the National Quality Forum, used by the Federal Government in various programs, nominated by State Medicaid medical directors, or nominated by the chairs and members of the Subcommittee. In workgroups focusing on four dimensions of health care related to adults in Medicaid—Maternal/Reproductive Health, Overall Adult Health, Complex Health Care Needs, and Mental Health and Substance Use—the Subcommittee reviewed and prioritized measures based on several criteria including relevance to the Medicaid population and existence of a supporting evidence base for the measure.

After deliberations, the workgroups reported back to the full Subcommittee for input and analysis of cross-cutting priorities. The workgroups reconvened on the second day and prepared a revised list of measures. The full Subcommittee voted on the measures through an anonymous electronic voting system. For each measure or measure group, Subcommittee members voted on their agreement to include the measure in the initial core set using a response scale of strongly agree, agree, neutral, disagree, and strongly disagree. The Subcommittee then reviewed a list including all measures where at least 50 percent of the voting Subcommittee members marked "strongly agree" or at least 70 percent of the voting Subcommittee members marked "agree" or "strongly agree."

The full Subcommittee ultimately identified 37 measures as high priority and cross-cutting. The Subcommittee was encouraged to consider whether additional measures were needed to achieve balance in addressing the needs of all adult Medicaid enrollees. Subcommittee members were given an opportunity to nominate measures that had been considered but did not make it onto the list, and another 14 measures were added. The draft list of 51 measures for the initial core set will be posted in the Federal Register for public comment and finalized by January 1, 2012.