Section IV. Quality Metrics
An ACO program must monitor quality metrics to both ensure high quality care as well as confirm that ACOs do not withhold necessary medical care to achieve health care savings. These resources detail approaches used by ACO programs around the country to monitor health care quality.
Quality Measurement Approaches of State Medicaid ACO Programs (May 2017) – This technical assistance tool outlines the quality measurement approaches of eight states to inform states developing ACO programs. This tool presents the quality measures of each state’s Medicaid ACO program and key details, including measure domains, reporting requirements, and contingencies related to payment.
Medicaid Innovation Accelerator Project Final Report (September 2017) – This report, from the the National Quality Forum, includes measure recommendations that address key quality issues in these areas, which include reducing substance use disorders, improving care for Medicaid beneficiaries with complex care needs and high costs, promoting community integration through long-term services and supports, and supporting physical and mental health integration.
Maximizing the Value of Measurement: MAP 2017 Guidance (March 2017) – This report, from the the National Quality Forum’s Measure Applications Partnership (MAP), recommends that the federal government remove 51 quality measures from the 634 measures used across federal health care quality programs. It urges the government to strive for a limited set of high-impact measures to reduce burden on providers while promoting health care quality. Although the recommendations are directed at federal health care programs, some of the measures recommended for removal are used by Medicaid ACO programs.
Medicaid ACO Quality Measurement Strategy Tool (April 2013) – This technical assistance tool is designed to help states select quality measures for Medicaid ACO programs. It can be used to facilitate quality strategy discussions with CMS to achieve regulatory approval. It consists of two parts: (1) key themes and questions to guide states’ quality measurement strategy development; and (2) a grid to help states prioritize quality measures.