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How new CMS quality measure rules in 2024 will impact states

Dustin Haisler, host of GovTech.com’s ICYMI, and Optum leaders discuss the new mandatory reporting requirements for Medicaid and CHIP.

April 6, 2023 | 3-minute read

Mylynn Tufte, MBA, MSIM, RN
Practice Lead, Population Health for Optum Advisory Services

With more than 25 years of experience in health care, Mylynn Tufte helps organizations develop and implement solutions that improve health equity and social determinants of health. A former ICU nurse, she now leads the Optum Center for Health Equity. She is also a national speaker and instructor on population health policy and leadership. As the state health officer for North Dakota, she led the state Department of Health during the initial phase of the COVID-19 pandemic.

Meta Kreiner
Population Health Specialist, Optum State Government Solutions

Meta Kreiner has over 15 years of experience ‌working with Optum and at the state of Michigan in the Medicaid Bureau. She works with state partners to understand how to improve outcomes with health equity and social determinants of health.

Will you be ready? New CMS Medicaid and CHIP quality measures rules for 2024 will rely on 2023 reporting.

Data and technology will be key to identify gaps and health disparities within Medicaid and CHIP Services.

How do you evaluate health equity for those enrolled in Medicaid and the Children’s Health Insurance Program (CHIP)? With nationally standardized quality measures established by CMS. Reporting is currently voluntary. But for 2024 it will be mandatory – based on reporting data from 2023 – for the following data sets:

  • Core Set of Children’s Health Care Quality Measures for Medicaid and CHIP
  • Behavioral health measures on the Core Set of Adult Health Care Quality Measures for Medicaid
  • Core Sets of Health Home Quality Measure for Medicaid

As leaders within Optum State Government Solutions we focus on supporting states’ population health and health equity efforts. We sat down with Government Technology’s In Case You Missed It (ICYMI) hosts to take a closer look at the new mandatory reporting requirements and how states will comply.

Why are the new reporting requirements important?

  • The updates to the Core Sets represent a focus on national consistency in reporting.
  • States will have Medicaid-centric metrics for monitoring and quality improvement within their own programs. They’ll partner with providers and managed care organizations to gather the data.
  • Health equity is being further prioritized. In the past, efforts have focused on stratifying age, sex, race, ethnicity, geography and urban and rural data. Now, stratifications are expanding beyond this traditional data set so states can further identify sub-populations and disparities to promote greater health equity.

Challenges states will face

For states, there are many challenges when it comes to reporting requirements. To start, Core Sets metrics are complex — as is gathering the data — and increasingly there’s a focus on health outcomes and metrics that go to the next level with data integration. This can include public health data sets like vital records, childhood immunization registries and more.

Bringing all this information together requires data sharing agreements, data security, person-matching and other complex tasks. It also means acquiring the technology to integrate with electronic health records and health information exchange. Finally, this new reporting requirement is made all the more challenging because Medicaid may have incomplete demographics. Various systems may be collecting and storing data in different ways, sometimes requiring more data sets.

5 ways to support these new requirements

To support these new requirements, states should consider focusing on 5 key areas:

  1. Overall strategy — Assess your technology and understand where the gaps may be.
  2. Data governance — Ensure beneficiaries can trust that the data they are sharing is gathered, stored and processed within regulatory constraints.
  3. Automation and artificial intelligence/machine learning — Invest in analytics and look for technologies that can efficiently advance your identification and stratification work.
  4. Day-to-day operations — Evaluate your processes and technologies for collecting, storing and analyzing data, and how to support those who are collecting the data. These may include providers, hospitals, clinics and managed care organizations.
  5. Sharing results — Develop a process for sharing results with your partners to reveal disparities. This will help them address the gaps and advance quality improvement.

As states consider these factors, partnering with a strong analytics vendor is key. Together we can support these new requirements and work toward health improvements for all citizens.

Ready to learn more?
For more insights, check out our interview as part of Government Technology’s In Case You Missed It series here.

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