Measuring health plan and provider performance allows states to determine the quality of care that Medicaid beneficiaries are receiving and to pinpoint areas for improvement. As more states develop accountable care models for aged, blind, and disabled beneficiaries, the need to reexamine and augment traditional performance measures to reflect the population’s complex and varied needs is critical.

From 2006 to 2008, the Center for Health Care Strategies worked closely with six states — California, Indiana, Pennsylvania, New York, Nevada, and Washington — within the Managed Care for People with Disabilities Purchasing Institute to identify and test alternative measurement strategies for Medicaid beneficiaries with complex needs.

Based on the experiences of these states and others, this technical assistance brief describes how state purchasers can use the Agency for Healthcare Research and Quality’s Prevention Quality Indicators to enhance measurement approaches for aged, blind, and disabled beneficiaries. It also looks at which HEDIS measures may be best suited for evaluating the care of beneficiaries with complex needs.

Prevention Quality Indicators or PQIs

PQIs are a set of measures developed by the Agency for Healthcare Research and Quality (AHRQ) that are used with hospital inpatient discharge data to identify beneficiaries with “ambulatory care sensitive conditions.” For more information and/or to download the measures, visit Prevention Quality Indicators Overview on AHRQ’s website.