Technical Assistance and Analytic Support for the Medicaid and CHIP Core Set Measures

Prepared for
U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services, Center for Medicaid and CHIP Services

Measuring and improving the quality of care for children and adults in Medicaid and the Children’s Health Insurance Program (CHIP) is a high priority for the Centers for Medicare & Medicaid Services (CMS) and its Center for Medicaid and CHIP Services (CMCS). Under the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA), CMS developed an initial core set of children’s health care quality measures (Child Core Set). Under the Affordable Care Act, CMS developed an initial core set of adult health care quality measures (Adult Core Set).

Mathematica leads the Technical Assistance and Analytic Support Program for the Medicaid and CHIP Core Set Measures. The Mathematica team provides technical assistance (TA) and analytic support to CMCS, states, and their quality partners related to four core sets of health care quality measures: Child, Adult, Health Homes, and Maternal and Infant Health. The goals of this project are to (1) provide the support states need to reliably collect, calculate, and report the Core Set measures; (2) help states use the Core Set measures to inform decisions about policies, programs, and practices to improve the quality of care they provide to Medicaid and CHIP beneficiaries; and (3) disseminate and translate findings so that CMCS, states, and other quality partners can share emerging best practices and lessons learned related to collecting, reporting, and using the four core sets of quality measures.

Project highlights

TA and training. Mathematica provides states one-on-one TA through a TA mailbox, group TA through webinars and affinity groups, and large-scale TA through the CMS Quality Conference. We also prepare numerous TA resources that are posted on States contact the TA mailbox with specific questions about the quality measures, and we respond by email or via telephone conference calls. We also use the information from state TA contacts to update and enhance our TA resources (including the technical specifications and resource manuals that guide the measure calculations).

Annual Core Set measure updates. As specified in CHIPRA and the Affordable Care Act, the Core Sets are required to be reviewed annually through a multistakeholder review. The TA team assembles information on the status of measure reporting to support the annual review. In addition, we annually update the technical specifications and resource manuals (including value sets) and other reporting resources (such as a data quality checklist) for each of the Core Sets. All of these materials are posted on, and updates are shared through an annual training with states when the new reporting cycle opens.

Analytics and reporting. Mathematica conducts statistical analyses of the Core Set measures for annual public reporting by the secretary of the U.S. Department of Health and Human Services (as specified in CHIPRA and the Affordable Care Act). This includes reviewing data quality, developing tables and graphics, and preparing reports to Congress. Mathematica works closely with CMCS throughout the clearance process. As the quality measures data have matured, Mathematica has begun to use the data for health systems analyses, such as an analysis of which are the higher performing states on the Child Core Set measures, and what strategies do states use to promote reporting and performance. In addition, the Mathematica Core Set TA team helped CMCS develop the data for the State Health System Performance pillar of the Medicaid & CHIP Scorecard.

Learning and diffusion. In collaboration with CMCS, we develop and conduct webinars to help states calculate, report, and use the Core Set measures, such as the dental sealant, developmental screening, or antipsychotic medication measures in the Child Core Set or the substance use disorder readmissions measures in the Adult Core Set. We also convene collaborative learning series on high-priority topics, such as strategies for improving the quality of postpartum care or reducing readmissions. We also help CMCS plan and implement the Medicaid/CHIP track of the annual CMS Quality Conference, including selecting and preparing presenters, producing slide decks, and providing other logistical and content support. In addition, Mathematica has produced toolkits for states to help drive improvement in children’s oral health care and postpartum care in Medicaid and CHIP.

Medicaid managed care quality. The Mathematica TA team analyzes states’ external quality review (EQR)-related activities annually, including the types of performance measures and performance improvement projects (PIPs) used to measure and improve quality, timeliness, and access. We also assess regulatory compliance of states’ EQR technical reports and quality strategies and analyze alignment of the performance measures reported in the Core Sets against those included in state EQR technical reports and quality strategies.

Quality improvement initiatives. The Mathematica TA team has provided trainings to states to build capacity for quality improvement (QI) through a three-part QI 101 webinar series, followed by more in-depth action learning series on maternal and infant health (QI 201) and postpartum care (QI 310). In addition, we are conducting a series of QI coaching pilots using human-centered design and other QI strategies to help states and their partners improve processes and outcomes in their Medicaid and CHIP programs. We also are helping CMS develop and test prototypes for a Quality Rating System using human-centered design.

Other tasks. Mathematica frequently assists CMCS with other tasks, such as determining the feasibility of state reporting of a new quality measure related to patient experience with hospital care, assessing progress toward meeting the Government Performance and Results Act (GPRA) goals for the Child and Adult Core Sets, and testing the accuracy of data systems for reporting the Core Set measures.