Funder: United Hospital Fund

Author: Alice Lind, RN, MPH, Center for Health Care Strategies

December 2011 | Report

The Center for Health Care Strategies was commissioned by the United Hospital Fund’s Medicaid Institute to outline opportunities for establishing a comprehensive measurement approach for New York’s complex Medicaid beneficiaries. The resulting report, Measuring Quality for Complex Medicaid Beneficiaries in New York State addresses the importance of quality measurement for Medicaid beneficiaries with complex needs as a means of improving care as well as a tool to advance New York’s reimbursement reform and service delivery redesign goals for high-need, high-cost populations.

The report specifically focuses on measures for individuals with multiple chronic conditions, behavioral health conditions, and long-term care needs. For these high-need populations, measures can be used for quality improvement, accountability, and evaluation; for stratification to identify those at risk; or, especially relevant to New York, for demonstrating the effectiveness of the health home model.

Having sound quality measurement data is at the heart of improving care, both at the level of individual beneficiaries and at the level of broader system changes, such as moving patients with complex needs from fragmented fee-for-service care to managed care and other care management models. Although developed specifically for New York State, this report offers insights on quality measurement for complex need populations that are useful to all states looking to improve measurement and care management approaches for Medicaid beneficiaries with complex needs.