While most states have well-developed performance measurement approaches for managed care, many are still determining how to best assess the quality of care provided to adults in fee-for-service (FFS) programs. These beneficiaries — who typically have multiple chronic conditions and intense health needs — represent under 30 percent of the nation’s Medicaid population, yet account for approximately 80 percent of total Medicaid spending. Developing performance measurement strategies that address the quality and cost effectiveness of health care for the FFS population is imperative.

This CHCS report synthesizes best practices from nine states for designing successful performance measurement approaches for Medicaid FFS beneficiaries, particularly those with complex needs. Made possible through support from the California HealthCare Foundation, the report outlines recommendations for using quality measurement to drive program accountability and improvement in FFS programs. The hands-on lessons for selecting, implementing, and reporting on measures for FFS populations can guide other states in advancing more effective measurement strategies. This best practice synthesis can also inform national activities to standardize performance measures for adult Medicaid beneficiaries.

Through health reform, Medicaid will soon provide vital health services for up to one quarter of all Americans. By building on lessons from existing states in designing performance measurement approaches for FFS programs, states can advance opportunities to better serve current Medicaid beneficiaries as well as those who are newly eligible.